Congress did not include new $1 billion Medicaid authorization for PR in budget extension

Resident commissioner defends amendment to extend access to Medicaid funds for Puerto Rico

By The Star Staff

Resident Commissioner Jenniffer González Colón on Monday filed an amendment to H.R. 8319, the so-called continuing resolution, which is the legislation that the federal government seeks to finance, so that the Medicaid funds authorized by Congress for this fiscal year ending on Sept. 30 can be rolled over into the next fiscal year.

“Given the denial of the Financial Oversight and Management Board of the $1.1 billion for use in the Medicaid program, today [Monday] I filed an amendment in Congress that allows the government of Puerto Rico to use those funds in the next fiscal year,” González Colón said, “as I am always fighting so that the Democrats who control the House accept my amendment so that it is included in the Continuing Budget Resolution that is under consideration, and to be able to correct the denial by the Financial Oversight and Management Board of these funds.”

The resident commissioner emphasized that she has already obtained the funds for the island health card for the next fiscal year, so that at no time were those funds at risk.

The other programs that will be proposed to the oversight board to use the additional funds raised by the resident commissioner would be: adult vaccines (not only for older adults), expanding coverage of the condition of diabetes (to include plasters, glucometers and others) and non-emergency transport -- in order to take patients to their medical appointments when they do not have transportation.

González Colón introduced her amendment at Monday’s House Rules Committee hearing, which was held virtually. There she recounted how she managed to unite wills to avoid the so-called precipice that Medicaid would fall into in Puerto Rico due to a lack of funds.

The funds raised by González Colón are: $295.9 million in May 2017; $4.8 billion in February 2018, with a 100 percent match by the federal government through the Federal Medical Assistance Percentage (FMAP) formula, to cover two years; a 100 percent extension of the FMAP until Dec. 20, 2019; and $5.7 billion in December 2019 for the next two years, the largest amount in history, with a 76 percent FMAP federal match increase (it was previously 55 percent).

At the time that the negotiations with Congress began in the spring of 2019, the Puerto Rico government made the request based on projections for the entire year. However, the funds were authorized within three months of the fiscal year and Puerto Rico used other federal funds to pay for Medicaid during that period and through February of this year.

Therefore, when Congress authorized Medicaid funding for Puerto Rico in late December, the amounts for fiscal year 2019-2020 included in the bill were not adjusted to the actual time period in which the funds would be spent. Therefore, they included projected expenditures for several months that Puerto Rico could not afford.

Of the funds authorized by Congress in December 2019, about $700 million went for new programs that were to be authorized by the Center for Medicaid and Medicare Services (CMS). The funds allocated to these new programs were also based on an annual budget.

CMS took some time to authorize those funds; one of them in fact is still pending. Therefore, the money budgeted for spending on those programs could not begin to be used until late summer.

Under the Puerto Rico Oversight, Management and Economic Stability Act, those programs also require the approval of the oversight board. It has not yet authorized the programs, so Puerto Rico has not yet disbursed the corresponding funds. Some of the programs will be retroactive, but even those payments are awaiting the oversight board’s approval. Once authorized, a large amount of unused money will be paid out.

The largest of the new programs was a plan to increase Puerto Rico’s poverty level for Medicaid eligibility from 40 percent to 85 percent of the federal poverty level. The oversight board recently informed the commonwealth Health Insurance Administration that the program would not be approved.

There is not enough time left in the current fiscal year to request CMS authorization to spend those funds on other new programs and the money allocated to the expanded Medicaid program cannot be spent this fiscal year.

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