On Wednesday, Governor Wanda Vazquez of Puerto Rico sent a letter to Congressional leaders calling for continued extended Medicaid funding for Puerto Rico.
The letter was timely as lead Congressional negotiators finalize their decisions on U.S. Medicaid spending in Puerto Rico in end of the year legislative proposals expected to pass this week.
Puerto Rico’s Medicaid funding is different from the U.S. in two very important ways. First, the percentage of Medicaid funding contributed by the federal government is much lower in Puerto Rico than it is in States. Second, there is a cap on the funds in Puerto Rico, but not in States. As a result, Puerto Rico receives billions less in funding and related services than it would if it were a State.
The letter from Vazquez begins by reminding the Congressional leaders – Speaker of the House Nancy Pelosi (D-CA), House Minority Leader Kevin McCarthy (R-CA), Senate Minority Leader Chuck Schumer (D-NY), and Senate Majority Leader Mitch McConnell (R-KY) – that a current Continuing Resolution (CR) funds Medicaid for Puerto Rico (and the other territories) without requiring a state match for federal funding. This CR will end on December 20th. At that point, Puerto Rico will begin using its capped Medicaid funds for next year earlier than expected.
Under this scenario, the next Medicaid cliff could come along, the Governor says, “as soon as the first week of February 2020.” After that time, she continued, “Puerto Rico will then have to fund its Medicaid program entirely with territory funds.”
The next Medicaid cliff?
Medicaid pays States as much as they need to care for their citizens. Even if there are greater needs in a State following a natural disaster or unusual disease outbreak, the federal government additional assistance kicks in automatically and the U.S. continues paying the usual percentage of the Medicaid funds for that State.
Since Puerto Rico has a cap on Medicaid funding, however, the federal government just quits paying when the cap is reached, and Puerto Rico has to come up with all the funds needed thereafter. The result is inevitably a Medicaid cliff — a date on which Puerto Rico will have no more Medicaid funding.
Congress has responded in the past by coming up with a temporary fix which moves the new Medicaid cliff out into the future, when the process begins again. Puerto Rico can’t negotiate with providers or make realistic plans for the future because funding is always uncertain.
Since Hurricane Maria, the situation is even worse. As Governor Vazquez explained in her letter, “The U.S. citizens of Puerto Rico have faced drastic challenges in recent years from the debt crisis to the severe storm damage from Hurricanes Irma and Maria in the fall of 2017. These hardships have caused a serious disruption of services at hospitals and other medical facilities because of an exodus of providers from the Island, and infrastructure damage, which in some circumstances is so dire it has increased the risk of infectious diseases caused by unsanitary conditions.”
Long-term effects
“Medicaid is designed to treat our nation’s most vulnerable populations, including low-income families, the elderly, children, and individuals with disabilities,” the Governor continued. “Without proper federal Medicaid funding, there will be a reduction of health care services, exacerbating the ongoing medical crisis, and making Puerto Rico’s long-term prosperity harder to attain.”
The letter concludes with a request to “include adequate funding for Puerto Rico’s Medicaid program in any possible CR enacted past the December 20th deadline of the current CR.”
