Capitol Correspondence - 06.24.19

Congress Opts for Short-Term Medicaid Fix for Puerto Rico Over Long Term

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ANCOR is sharing this article by Politico Pro because following a recent visit to Puerto Rico, ANCOR members and Board Members expressed concern about the lack of support experienced by Medicaid supports for people with intellectual / developmental disabilities (I/DD) in that U.S. territory.

As written by Politico Pro:

“Lawmakers are negotiating another short-term funding deal for Medicaid in Puerto Rico — just a year after Congress last shored up the health program’s finances. A decade into a series a short-term funding fixes to keep the territory’s program from collapsing, the search for a long-term solution to restructuring its unique Medicaid funding scheme remains elusive.

The House Energy and Commerce Committee on Thursday morning [heard] from health officials in Puerto Rico and other U.S. territories about the coming fiscal cliff and the decades-old structure that has kept their programs chronically underfunded.

Unlike the entitlement program in the 50 states, federal funding is capped for Puerto Rico’s Medicaid program, which covers nearly half the island’s population. Its funding is much lower than it would be if Puerto Rico was a state, and benefits are skimpier.

Because of the cost of overhauling the program as some Democrats and the island’s Republican representative want, as well as President Donald Trump’s hostile stance toward providing aid to Puerto Rico, lawmakers are likelier to strike another temporary fix than negotiate a broader long-term agreement.

Even the territory’s government is asking Congress only for a five-year funding boost, rather than lobbying for Democratic bills that would permanently restructure its Medicaid program. Even that is still a tall order.


Congress has boosted temporary funding for the territory several times over the past decade, including through the Affordable Care Act. The most recent infusion of federal funding — including a short-term 100 percent federal match that is part of a hurricane aid package and an increase in the ACA’s Puerto Rican Medicaid fund — is set to expire later this year, jeopardizing coverage for the island’s 1.5 million Medicaid recipients.

Angela Avila, who oversees the program, will testify Thursday that without an increase in the federal match when the special rate expires at the end of September, the territory will have to deeply cut benefits such as prescription drug coverage, further tighten eligibility and experience a continuing exodus of providers to the mainland — outcomes that she calls “catastrophic.”

Last month, Puerto Rico Gov. Ricardo Rosselló asked Congress to boost the federal match for traditional Medicaid to 83 percent, which is equal to what the territory would receive if the same income-based formula used in other states was applied to the impoverished island. Otherwise it will drop back to 55 percent. That would carry a $15.1 billion price tag over five years.

Facing a tight congressional calendar that includes the month-long August recess, another short-term fix seems more likely.


Puerto Rico’s Medicaid program covers only 10 of the 17 required benefits in Medicaid, according to a report from the Medicaid and CHIP Payment and Access Commission. CMS doesn’t require the territory’s program, for example, to cover long-term nursing care because of underfunding.”