The U.S. Virgin Islands needs more than $100 million from the federal government annually to service Medicaid needs in the territory, Department of Human Services officials said during the department’s budget hearing on Friday. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
But the territory’s annual allotment — which the federal government is matching 100 percent following lobbying by the Mapp administration after the 2017 storms — is temporary and is set to expire at the end of September.
A Medicaid parity bill making its way through Congress, H.R. 3631, dubbed the Territories Health Care Improvement Act, increases the limit on Medicaid payments and the Federal Medical Assistance percentage for the five U.S. territories: Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Mariana Islands. It also sets stipulations to implement integrity and reporting measures for the programs.
But the measure has yet to be heard by the full U.S. House of Representatives and the Senate, though it was voted on favorable in the U.S. House Committee on Energy and Commerce.
Senator Kurt Vialet, chairman of the Committee on Finance, was worried that no action on the measure would be taken before Congress breaks, and he fretted that the bill’s passage could be hindered because it includes funding for Puerto Rico as well, the U.S. commonwealth whose leaders are embroiled in multiple corruption scandals and probes.
Washington — both the White House and lawmakers — have expressed skepticism in Puerto Rico’s leaders managing of federal dollars. On Thursday, FEMA said it would further restrict Puerto Rico’s access to disaster funds.
“I have read the bill and it contains substantial monies for our sister island of Puerto Rico, and I’m really hoping that because of what took place in Puerto Rico over the last two weeks, that they don’t delay that bill and then we have an issue come the end of the fiscal year,” Mr. Vialet said.
The senator asked D.H.S. officials for an emergency plan if the measure were to fail. “It’s going to come down to if we don’t get more money, then we’re going to have to cut people that are currently on the Medicaid program. And when I say cut, we’re not going to be able to receive the funding,” said D.H.S. Commissioner Nominee Kimberley Causey-Gomez.
Who to cut off of Medicaid because of the potential lack of funding will also be a balancing act, according to Ms. Causey-Gomez, who described a scenario where parents may need to be taken off the program while children stay on. “It’s going to be a fine line who receives and who doesn’t,” she said.
D.H.S. official said they have been advocating every week on behalf of the territory. The Bryan administration has been lobbying as well, and some lawmakers — among them Senators Novelle Francis, Myron Jackson, Marvin Blyden, Alicia Barnes and Janelle Sarauw — were in Washington earlier this month doing the same, as part of Delegate to Congress Stacey Plaskett’s Virgin Islands Advocacy Day.
The loss of Medicaid funding would be “detrimental for the Virgin Islands,” the commissioner nominee stated bluntly.
Mr. Vialet agreed, stating, “It seems like if that happens the people of the Virgin Islands need to have a mass protest in reference to the fact that you’re literally crippling the Virgin Islands when it comes to healthcare.”
Mr. Vialet noted that the territory does not qualify under the Affordable Care Act, the beleaguered universal healthcare law championed by former President Barack Obama. “You’re literally locking us out of Medicare and Medicaid; we are American citizens and it’s unfair to treat any jurisdiction this way,” he said.
The legislation provides a path away from capped federal funds for Medicaid program to several years of increased allotments, totaling $12 billion for Puerto Rico, $762 million for Guam, $756 million for USVI, $504 million for American Samoa, and $360 million for Northern Marianas. It also implements important program integrity provisions, including a new asset verification system and payment error rate measurements, both already required for state Medicaid programs. All territories will also need to report annually to Congress on the expenditures of increased Medicaid funds.
The measure also creates a new funding structure increasing the matching rate Federal Medical Assistance Percentage (FMAP): Puerto Rico: 83 percent for the first two years of additional funds, and 76 percent for the final two years. Guam, American Samoa, and CNMI: 100 percent for two years, 83 percent for three years, and 76 percent for one year. And the U.S. Virgin Islands: 100 percent for one year, 83 percent for four years, and 75 percent for one year.
This latest effort is not the first time U.S. lawmakers have attempted to bring Medicaid parity to the U.S. territories. 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.
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