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Members of Congress Concerned Over Lack of Funding for Medicare Advantage in Puerto Rico

A group of ten Senators and Representatives have written to officials at the U.S. Department of Health and Human Services (HHS) to express their “acute disappointment” in a Medicare Advantage  formula announcement released on April 6th that is poised to reduce funding to the U.S. territory by 11 percent while the rest of the country receives a 3% increase.  The letter, dated April 30th,  goes on to say that these cuts will not only threaten the ability of Puerto Rico’s Medicare Advantage program to meet the needs of the 540,000 people it serves, but that there will be further consequences.

“This cut,” the authors wrote, “is likely to have broader ripple effects, placing severe financial pressure on Puerto Rico’s Medicaid program.”

In March, 2015, a similar group of Senators and Congressional Representatives wrote a strongly worded letter to HHS officials expressing  “deep concern regarding the future of the Medicare Advantage program in Puerto Rico” and urging officials to take concrete action in the April 6, 2015 Final Rate Announcement and Call Letter to preserve the stability of the Medicare Advantage program in Puerto Rico.  The letter singled out proposed payment policy changes contained in a February 20th announcement that they feared could result in “the substantial reduction or even elimination of affordable options for MA beneficiaries in Puerto Rico starting next calendar year” if not changed before the April 6th final rule.

Although the April 6th announcement did not directly address the Members’ concerns, HHS’s Center for Medicare & Medicaid Services (CMS) is undertaking an empirical analysis that could change its results.  The April 30th congressional letter noted that if further analysis confirms that an upward adjustment to the payment rates for Medicare Advantage plans is justified, CMS has the administrative authority to make the change and to do so for 2016 payments rather than waiting to 2017.

Puerto Ricans pay taxes that help fund the Medicare program, but they do not receive all of the benefits received by Medicare beneficiaries in the fifty states.

The are also limitations in the U.S. territory’s Medicaid program.  The Federal government provides any funds a State or the District of Columbia needs to operate their Federally approved Medicaid plan as long as local funds match the Federal grants. In Puerto Rico, the amount of Medicaid funding is capped.

Signers of the letters include Puerto Rican Resident Commissioner Pedro Pierluisi (D-PR), Senators Charles Schumer (D-NY), Kirsten Gillibrand (D-NY), Marco Rubio (R-FL), Bill Nelson (R-FL), and Cory Booker (D-NJ); and U.S. Representatives José Serrano (D-NY), Charles Rangel (D-NY), Nydia Velázquez (D-NY), and Luis Gutierrez (D-IL).

Read the April 30th letter.

3 thoughts on “Members of Congress Concerned Over Lack of Funding for Medicare Advantage in Puerto Rico”

  1. Oh yeah… and then they say the US Citizens in Puerto Rico are not 2nd Class Citizens…



  2. Puerto Rico has been struggling for years and now the U.S. Dept.of HHS want to reduce funding for our Medicare recipients. I say this is a trajedy for our Puerto Ricans who have worked hard for this country. I say we fight for our rights and send letters to our U.S Department of Health and Human Services to move towards an increase like the rest of the US is receiving. Equal Right for Puerto Ricans!!!!!!

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