Governor sends letter to HHS requesting changes to Medicare Advantage rates

By THE STAR STAFF

Gov. Jenniffer González Colón sent a letter this week to U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. in response to the notice of methodological changes for calendar year 2027 to Medicare Advantage capitation rates and payment policies for Parts C and D.

“Puerto Rico cannot continue operating under a formula that does not reflect our reality,” the governor said in a written statement. “We are working directly with federal agencies and our PRFAA [Puerto Rico Federal Affairs Administration] office to achieve specific adjustments that protect our senior citizens and vulnerable populations. This is a priority for our administration, and we are personally leading it.” 

González Colón requested administrative action to address structural inequities in the calculation of Medicare Advantage rates for Puerto Rico, a situation that, she argued, puts the island at a disadvantage compared to the states.

The governor indicated that Medicare Advantage has more than 676,000 beneficiaries in Puerto Rico, including over 305,000 people with dual Medicare and Medicaid eligibility. She added that methodological changes without considering the local context could have disproportionate effects on a system that, she said, operates with the lowest reimbursement levels in the nation.

González Colón maintained that Puerto Rico continues to be ill-affected by a methodology based on the traditional fee-for-service model, which, she said, does not reflect the local market and causes distortions. She also pointed out that the situation generates instability, pressure on providers, and limitations on infrastructure investment and retention of healthcare professionals.

Among her proposals, the governor requested that the Centers for Medicare & Medicaid Services establish a national benchmark floor of at least 0.70 and implement temporary administrative measures to ensure stability and predictability while the structural issues are addressed.