U.S. Senators and Representatives Express “Deep Concern” Over Medicare Inequalities in Puerto Rico

On March 17, several members of Congress wrote to top Federal health officials expressing “deep concern” regarding the future of the Medicare Advantage (MA) program in Puerto Rico.

In a letter to Department of Health and Human Services Secretary Sylvia Mathews Burwell, Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andrew Slavitt, and CMS Deputy Administrator Sean Cavanaugh, the Senators and Representatives also urged CMS to “take concrete action” in an upcoming April 6, 2015 Final Rate Announcement and Call Letter to preserve the stability of Puerto Rico’s MA program.

Absent this action, the members expressed fear of substantial reduction or even elimination of affordable options for MA beneficiaries in Puerto Rico.  Most at risk, the letter explained, are low-income seniors who are dually eligible for both Medicare and Medicaid.

More than 75% of all Medicare recipients in Puerto Rico use the Medicare Advantage program, in which private companies contract with Medicare to provide coverage for individuals eligible for Medicare.  Puerto Rico has the highest MA penetration rate of any U.S. jurisdiction, and roughly half of all MA beneficiaries are eligible for for both Medicare and Medicaid.

The letter points out that as CMS has recognized, “there are a number of factors unique to Puerto Rico – some of which are rooted in demographics, others of which are rooted in the island’s unequal treatment under federal law – that can and should be considered as the agency proposes payment reforms to the MA program.”  For example, Medicare recipients in the States who earn below 150% of the federal poverty level receive  Medicaid benefits to help pay premiums and out of pocket expenses associated with Medicare. These additional benefits are not available to low-income Medicare recipients in Puerto Rico because of its territory status.

The Government of Puerto Rico does receive some additional funding in lieu of the low-income subsidies, but must provide matching funds. The available funds are only about 10% of the amount that Puerto Ricans would receive in low-income subsidies if Puerto Rico were a State.

It is not surprising, as the letter pointed out, that Medicare recipients in Puerto Rico are less likely to keep up with medications prescribed to them, since they have less access to funding to help pay for these medications. However, MA plans receive star rating based in part on how many individuals leave the plan and how often drugs are prescribed, among other factors. For the Medicare Advantage organizations in Puerto Rico, individuals’ inability to pay for medications may lead to lapses in prescriptions, and that can reduce the star rankings of the MA plans. Failing to take these realities into account when planning for MA programs in Puerto Rico, the letter said, is “illogical and unfair.”

Medicare Advantage funding cuts have more severely affected Puerto Rico than in any State in every year since 2011, with a 19% cut in Puerto Rico and an average of 10% cuts for the States. The latest plan could cut Puerto Rico’s funding by as much as another 14%. The letter concludes with a heartfelt plea that the DHS and the Centers for Medicare and Medicaid Services work with the signers and with “stakeholders in Puerto Rico” to come up with a less drastic plan for Puerto Rico.

The signers of the letter included Puerto Rico’s Resident Commissioner in the U.S. House of Representatives Pedro Pierluisi, who heads the territory’s statehood party, as well as senators and representatives who represent States or districts that have large number of residents with origins in Puerto Rico:

  • Charles E. Schumer,Senator from  New York (D)
  • José E. Serrano, Representative from New York (D)
  • Marco Rubio, Senator from Florida (R)
  • Kirsten Gillibrand, Senator from New York (D)
  • Bill Nelson, Senator from Florida (D)
  • Nydia Velazquez, Representative from New York (D)
  • Charles B. Rangel, Representative from New York (D)
  • Luis V. Gutiérrez, Representative from Illinois (D)

Read the full letter.

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