Fiscal board’s preference for ‘fair treatment’ over parity in Medicaid funding is nothing new

By The Star Staff

Several pro-statehood advocates are calling for the resignation of Financial Oversight and Management Board (FOMB) Executive Director Natalie Jaresko over her public remarks about the board seeking fair and equitable treatment in Medicaid funding for Puerto Rico instead of “parity,” but her position is not new and has been the federal entity’s stance since at least 2018.

Pro-statehood lawyer Gregorio Igartúa wrote to President Joe Biden asking for Jaresko’s resignation because she is lobbying against Puerto Rico’s best interests and meddling in political matters. Igartúa also criticized Biden for allowing the U.S. Justice Department to argue in the Supreme Court against extending Supplemental Security Income (SSI) to Puerto Rico because the equal protection clause does not apply to the island, but allowing the department to argue just the opposite against the island Police Department.

Gov. Pedro Pierluisi Urrutia publicly chided the oversight board for lobbying in Congress against Medicaid parity.

“Either they get informed as to how the Medicaid program works for the states or leave the matter to the Resident Commissioner and a coalition created by executive order,” he said via Twitter.

In its 2018 annual report to Congress, however, the oversight board recommended “fair treatment” to Puerto Rico and not parity. The board recommended to Congress at the time “a long-term Medicaid program solution to mitigate the drastic reduction in federal funding for healthcare in Puerto Rico.”

“Although Congress has provided Puerto Rico with additional Medicaid funding to finance Mi Salud (the state-run insurance program) at 100 percent Federal Medical Assistance Percentages (FMAP) for two years, this is not a long-term or sustainable solution for Puerto Rico’s healthcare crisis. It is important to provide fair treatment to the residents of Puerto Rico, to ensure the stability of the island’s healthcare system, and to avoid further outmigration,” the oversight board said. “Amend federal law so that Medicare beneficiaries in Puerto Rico are automatically enrolled in Medicare Part B with the option to opt out of coverage, the same way their counterparts in every state and other territory are treated. Provide fair and equitable treatment to residents of Puerto Rico in all Medicare programs. Residents of Puerto Rico pay the same level of Medicare taxes as mainland residents, but the Island receives substantially lower payments in Medicare programs.”

The oversight board, according to one of its lawyers, who spoke on condition of anonymity, prefers to advocate for fair treatment instead of parity because it is “parity against what?”

“Each state receives different levels of funding,” the lawyer said.

Parity means equality in amount or value and it does not mean treating everyone the same.

In its Twitter account, the oversight board denied it is engaged in lobbying.

“Contrary to reports, the FOMB did not lobby against Medicaid parity, nor has it ever, nor will it, or even ‘lobby’ on any particular topic,” the board tweeted.

The FOMB did stress the need for long-term clarity and equitable treatment in all federal transfers, from Medicaid to SSI and more.

Igartúa did not accept the oversight board’s explanation regarding parity.

“While Puerto Rico has a Medicaid cap of $400 million, it pays more than 15 other states in Medicaid contributions; therefore, it will get a huge amount of funding [without a cap],” he said.

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