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House Proposal for Puerto Rico Medicaid Funding Introduced

A proposal to increase Medicaid spending for Puerto Rico and delay the upcoming funding “cliff” in September is moving this week in the House of Representatives.

The legislation (H.R. 4406) would provide Puerto Rico with at least $2.809 billion and up to $3.009 billion in Fiscal Year 2022 and, then at least $2.719 billion and up to $2.919 billion through FY 2026. The higher amount for FY22 is due to a COVID-19 enhancement. An additional $106 billion for FY21 is still being sought.

The Medicaid bill was introduced yesterday by Reps. Soto (D-FL) and Bilirakis (R-FL).  It is on track to be approved by the Energy and Commerce Subcommittee Thursday and by the full Committee next Wednesday.

Medicaid in Puerto Rico

Medicaid funding in Puerto Rico is different from that in the States. First, the percentage of coverage provided by the federal government is determined according to a different equation from the one used in the States, so the amount of funding is much smaller. Specifically, Puerto Rico receives a 55% match, while it would have 83% if it were a State.

Second, the total amount is capped, while funding in the States adjusts to the needs of the residents.

The result has been that Puerto Rico must ask for emergency bailouts nearly every other year. This makes planning and negotiating with vendors very difficult for the territory.

In addition, Puerto Rico is unable to provide the same level of medical care offered for Medicaid recipients in the States. The Federal government’s lack of Medicaid spending for Puerto Rico compared with the States has also been a major factor in Puerto Rico’s economic crisis.

The new legislation

The new bill will be introduced this week, and is expected to be considered by the House Energy and Commerce Health subcommittee next week.

The proposal covers Puerto Rico for the next five years and the other territories for eight. Puerto Rico’s percentage would rise from 55% to 76%, while the other territories would increase to the 83% which all the territories would have if they were States. Governor Pierluisi says this will provide stability for  Puerto Rico.

However, Jaime Plá, the executive president of the Hospital Association, says that anything that does not bring Puerto Rico into parity with the states — that is, anything less than 83% and the permanent elimination of the cap — is “a failure.”

As a State, Puerto Rico would automatically have parity under Medicaid and all other federal programs.

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