Resident Commissioner Presents Advances in the Area of Health From the Federal Sphere

Statement

The resident commissioner, Jenniffer González Colón, presented an update of the work she is doing in the federal capital to ensure the continuity of the health coverage of 1.3 million Puerto Ricans who are beneficiaries of Medicaid; this during the Convention of the Association of Hospitals of Puerto Rico.

His presentation focused on advances in Medicaid funds, legislation that works to not penalize late enrollment in Medicare Part B; integrate Puerto Rico into the Medicare Part D low income subsidy (LIS) program; and updating recovery funds in the area of ​​health.

The commissioner managed to insert in HR 2328 an allocation of $ 12 billion in four years to finance the Medicaid program for Puerto Rico; The measure has already been approved by the Committee of Commerce and Energy of the House of Representatives and expects to be approved by the plenary.

Once approved, the Federal Senate Finance Committee will have before it the measure and to ensure its final approval, the commissioner met with the president of said Committee, the Republican Senator for Iowa, Charles Grassley, achieving his commitment not to oppose Medicaid funds for the island.

The commissioner indicated that the senator showed interest in ensuring that the funds reach patients and providers, and Gonzalez Colón concurred, who said the funds measure would be accompanied by proposals to avoid fraud and promote transparency in the hiring of servers .

González Colón also seeks to establish a long-term public policy, even if it depends on annual budget allocations, but that permanently solves the problem of financing Medicaid funds in the territories.

The version of the Chamber is being negotiated with the Senate Finance Committee to finalize an agreement before the measure goes to vote in both bodies.

The Senate version increases the FMAP from the current 55% to 70% for four years and provides for an allocation of $ 9.8 billion for the same period for the Medicaid program in Puerto Rico. It includes additional measures to ensure integrity in the use of the funds and provides for severe penalties in case the integrity requirements are not met.

Other measures

HR 4699 bipartite measure that seeks to eliminate the corresponding matching requirement of Medicare Part D for low-income people.

HR 4195, Expansion of Low-Income Medicare Subsidies for Territories Act of 2019, presented together with representatives Donna Shalala (FL-27), Darren Soto (FL-9) and Stephanie Murphy (FL-7) would allow residents in the territories of the United States be eligible for the Medicare Part D low income subsidy (LIS) program as of the 2021 year plan.

HR 3, the Energy and Commerce Committee included a provision in that measure, Lower Drug Costs Now, to extend the low-income subsidy (LIS) program to the Puerto Rico Medicaid program.

HR 2310 Medicare Part B Enrollment Project; measure that seeks to modify federal law so that, in the future, Medicare beneficiaries in Puerto Rico will be automatically enrolled in Medicare Part B with the option of not participating in the coverage as well as their decision.

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Background of HR 2328

The resident commissioner along with Florida congressman Darren Soto, reached a bipartite agreement in the House of Representatives to allocate $ 12 billion to Puerto Rico for the next four years for the Medicaid program.

The agreement is included in HR 2328, the United States Community Health Reauthorization and Extension Act (the REACH Act). The measure was approved by the Commerce and Energy Committee of the federal House of Representatives and provides the following distribution of funds that would increase annually: Fiscal Year 2020: $ 2,823,188,000; AF21: $ 2,919,072,000; AF22: $ 3,012,610,000 and for AF23: $ 3,012,610,000.

The FMAP for fiscal years 2020 and 2021 will be 83% and for fiscal years 2022 and 2023 will be 76%.

No later than 30 days after the end of each fiscal year, Puerto Rico will have to submit a report to Congress describing how the Medicaid limit increases or increases in the FMAP has been used to access medical care under the Medicaid program.

The measure would now pass the final vote of the House of Representatives and then go to the Senate.

Explaining the Medicaid Cliff

By 2017, there were 1.3 million patients in Puerto Rico under Medicaid coverage, health coverage for indigent doctors, including 250.00 eligible people at the same time under Medicare, a program focused on people 65 years of age or older and those with disabilities

Compared to the states at the percentage level, Puerto Rico has a larger population dependent on these programs that are based on patient income. This occurs because the average income in Puerto Rico ($ 19,775) is lower than the national average ($ 63,179) and lower than that of the poorest state (Mississippi $ 42,009).

The government of Puerto Rico contributes 45% of the costs of the Medicaid program while the federal government contributes the other 55%. This formula is standard for territories, contrary to how it is configured with the states that is based on per capita income. If that same state formula is used for Puerto Rico, the federal contribution would increase from 55% to 83%. This formula is known as the percentage of federal medical assistance (FMAP).

Another difference with financing funds is that the funds for the states have no limits, contrary to the territories that do have limits.

Since 2011, federal spending for Medicaid in Puerto Rico has been exceeded and the state government has had to fund this program in large part, with federal funds allocated to Puerto Rico above the amount received under the Social Security Act.

The current cost for the Medicaid program in Puerto Rico is $ 2.80 billion a year.

Recently, the resident commissioner achieved the approval of 100 percent of federal funding for the Medicaid program in Puerto Rico (FMAP), which was included in the Continuous Budget Resolution.

Thanks to this, Puerto Rico will not have to disburse funds for Medicaid coverage until November 21, 2019, allowing the remaining funds of the Affordable Care Act (ACA) to be spent before its expire on December 31, 2019. This will mean that federal and state funds for the Medicaid program will be depleted in March 2020, resulting in a gap in funds for the 2020 fiscal year of approximately $ 1 billion.

The resident commissioner managed to stop the so-called "Medicaid Cliff" of 2017 by obtaining in May of that year $ 295.9 million to finance the program until April 2018.

Due to the great impact of Hurricane Maria, the commissioner achieved in February 2018 a greater allocation of funds, $ 4,900 million, to cover for the next two years Medicaid with a match of 100% by the federal government (FMAP). | Bipartisan Budget Act of 2018 (PL 115-123).

As the date of exhaustion of these funds approaches, the commissioner continues in the process for a long-term solution of Medicaid funds in Puerto Rico.

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