The Juan F. Luis Hospital between 2014 to 2019 experienced a $114.4 million shortfall for uncompensated care, which is the cost for patients who receive medical attention at the hospital but do not pay. In J.F.L.’s fiscal year 2020 budget, discussed during a Tuesday hearing, the government allocated $22 million for the projected $35 million in uncompensated care. If the projected amount holds, it will bring the total cost for uncompensated care at the hospital to $136.4 million in 7 years.
Each year, the funding appropriated by the Legislature is far less than the projected uncompensated care cost, which has resulted in great financial loss to J.F.L., hospital officials said. The current budget is on the same trajectory and will result in more uncompensated care losses if it is not increased by the $17.9 million J.F.L. is requesting.
Senator Janelle Sarauw asked testifiers if the hospital had a fact sheet to determine where the bulk of the uncompensated care cost is being generated. Dyma Williams, acting chief executive officer of J.F.L., explained that while J.F.L. has a fact sheet that outlines the ten illnesses generating the highest uncompensated care losses, the hospital had not delineated a dollar amount to the specific illnesses.
Ms. Williams told senators that unless there is substantial change in uncompensated care management, to include all future reimbursements from the Medicaid costs audit, J.F.L. will further be driven into insolvency.
Also of great concern is a possible increase to the uncompensated care total from the influx of visitors coming to St. Croix to work at Limetree Bay and continued disaster recovery. Employees affiliated with Limetree Bay were specifically mentioned.
Ms. Sarauw asked for further explanation on how uncompensated care related to the refinery, and Ms. Williams explained that Limetree Bay employees have insurance packages and benefits, but the subcontractors that work in the refinery has either a 90-day gap before health insurance kicks in, or they have no health insurance at all.
This results in additional health care cost to the territory, J.F.L. officials said. There is a higher propensity for these persons to have injuries from opioid-related exposure, according to J.F.L. officials, and when they visit the hospital’s emergency room, J.F.L. becomes encumbered with the cost of their healthcare, Ms. Williams said.
Another matter of grave concern to J.F.L.’s bottom line is the territory’s Medicaid 100 percent federal funding that is set to expire in September. Medicaid has cost J.F.L. a $127.4 million in the last seven years alone. That figure is expected to rise to $142.5 million by the expiration date, according to Ms. Williams. Medicaid is a public health insurance program largely for low-income people, though some middle-class disabled and elderly people also qualify. States and the federal government share the cost, with the federal government footing most of the bill. The U.S. Virgin Islands, however, for years has paid 45 percent of the Medicaid bill — way more than most U.S. states — for its eligible residents, which has led to the high cost to the local government.
In 2015, U.S. Senator Chuck Schumer introduced legislation to provide parity for the Virgin Islands and other U.S. territories in the federal Medicaid program and other U.S. healthcare programs. The Schumer bill sought to lift the annual cap on federal Medicaid payments to the Virgin Islands and other territories and increase the federal matching rate from the 55 percent level to 83 percent. The bill, however, was not successful.
Following the 2017 storms, the Mapp administration successfully lobbied the federal government for a 100 percent match. But the match is expiring in September and the Bryan administration has been asking Washington for an extension. “We urge Congress to extend the disaster-related Medicaid relief in the Bipartisan Budget Act —the local match waiver and the additional Medicaid allotment of 100 percent federal funding—by one year and thereby allow the USVI’s Medicaid program to continue to operate through the end of FY 2020. I would also like to bring to your attention that our citizens have only one hospital that they can access for healthcare on each island,” Mr. Bryan testified in Congress in February.
It remains to be seen if the federal government will extend the 100 percent match.
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