Governor unveils final multisector report, urges Congress to fix Medicaid funding for island

By THE STAR STAFF

Gov. Jenniffer González Colón released the Final Report of the Multisector Advisory Board on Puerto Rico’s Medicaid Program on Sunday, outlining the island’s most pressing health‑system needs and warning of severe fiscal consequences if Congress fails to address longstanding disparities in federal Medicaid financing before fiscal year (FY) 2028.

The report, mandated under Executive Order 2026‑006, was produced with input from government agencies, health‑care providers, community health centers, coordinated‑care organizations, beneficiary representatives and other stakeholders across the health system. It documents improvements made in program oversight and service expansion, while underscoring the structural limits that continue to place Puerto Rico at a disadvantage compared with U.S. states.

“This report puts the data on the table and shows why Puerto Rico needs a Medicaid solution,” González Colón said. “We are talking about access to health services for thousands of families, seniors, children and people with disabilities. We have met federal requirements, strengthened oversight and used additional resources to expand services. Now we must work together to secure a financing structure in Congress that gives our health system stability beyond 2027.”

Medicaid currently provides health coverage to roughly 40% of Puerto Rico’s population. Under the Consolidated Appropriations Act of 2023, the federal medical assistance percentage (FMAP) was temporarily increased to 76% through FY 2027, along with higher federal allotments. Those funds allowed the government to expand eligibility, add services and raise provider reimbursements.

The report highlights several improvements, including raising Medicaid’s minimum reimbursement for medical services to 100% of Medicare Part B rates, increasing behavioral‑health payments, revising dental fees and strengthening hospital payment mechanisms. It also details compliance efforts related to federal program integrity, contracting, oversight and transparency requirements.

But the document warns that without congressional action, Puerto Rico’s federal Medicaid funding could drop by an estimated $3.36 billion annually, while the FMAP would revert to the statutory 55%. As resident commissioner, González Colón previously secured temporary funding packages to avert program shortfalls, including $295.9 million in 2017, $4.9 billion in 2018, $4.3 billion in 2019 and a five‑year $19 billion agreement in 2022.

“Waiting until 2028 is not an option,” the governor said. “This is the moment to work with Congress, with both parties, to avoid a funding crisis that would affect not only patients, but also our doctors, hospitals, providers and Puerto Rico’s entire economy. Our administration will continue defending fair treatment for American citizens living in Puerto Rico.”

Among the long‑term solutions outlined in the report is eliminating the federal Medicaid funding cap under Section 1108 of the Social Security Act and applying the same FMAP formula used for states -- a change that could raise Puerto Rico’s FMAP to roughly 83%. The report stresses that any FMAP increase must be paired with an increase or removal of the federal funding ceiling to prevent Puerto Rico from exhausting its allotment more quickly.

The document also recommends expanding Puerto Rico’s participation in federal programs currently unavailable on equal terms, including hospital payments for facilities serving large numbers of uninsured or underinsured patients, access to the Medicare Savings Program to help low‑income beneficiaries with premiums and cost‑sharing, and access to Long‑Term Services and Supports (LTSS). If full LTSS implementation proves financially unfeasible, the report suggests launching a regional pilot program.

The report calls for a bipartisan, multisector strategy in Washington, uniting government officials, providers, coordinated‑care organizations and beneficiary advocates around verified data and measurable program outcomes.

“This cannot be the demand of one party or one administration. It is Puerto Rico’s demand,” González Colón said. “We must arrive in Washington united, with evidence, results and a clear proposal. The report shows how far we’ve come, but also makes clear that temporary fixes cannot replace the stability our health system needs.”

The administration said Puerto Rico will continue strengthening Medicaid governance, technological infrastructure, oversight, transparency and program administration in coordination with federal authorities and health‑system stakeholders.