Half of Puerto Rico could lose health coverage if Congress doesn’t act on Medicaid

July 22, 2021

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(WASHINGTON) — Puerto Rico could lose Medicaid funding in less than two months, putting at risk roughly 1.5 million people — nearly half the island’s population — unless Congress acts quickly.

As COVID-19 continues to batter the island — with at least 2,561 deaths among 141,905 confirmed cases, according to World Health Organization data — several U.S. representatives have teamed up to propose the Supporting Medicaid in the U.S. Territories Act.

“Territories get less funding through Medicaid than states do, and it has led to all sorts of adverse health outcomes, debt and a sub-standard of living in those areas,” Rep. Darren Soto, D-Fla., told ABC News in an interview. Puerto Rico was getting “far less than many states, and that led to an erosion of their health care system.”

The territory’s annual Medicaid needs are predicted to reach about $3 billion, but due to restrictions in the Social Security Act Section 11108, Puerto Rico has instead only been given roughly $375 million in Medicaid for the year, Puerto Rican Gov. Pedro Pierluisi told ABC News.

Puerto Rico, by statute, is only set to receive 55% of what is needed to fund Medicaid each year from the federal government, according to the think tank Center on Budget and Policy Priorities. But since the island’s federal block grant is small and often exhausted, CBPP reports that some years the Medicaid program is funded at less than 20%. Whatever the federal government doesn’t pay for, the island is responsible.

“The funding is not the same we would be getting as a state,” Pierluisi said. “You cannot plan or budget reasonably when you are facing this [Medicaid] cliff every couple of years.”

The new bill states that it would extend the federal Medicaid funding to account for 76% of what is needed for five years, offering much relief during the island’s ongoing economic crisis. Mississippi, the poorest U.S. state, also gets 76%.

But with a 43.5% poverty — more than twice that of Mississippi — and higher rates of diabetes, hypertension, asthma and more, Puerto Ricans need reliable health coverage perhaps more than ever.

Roughly 46% of the island’s population relies on Medicaid, according to the Medicaid and CHIP Payment and Access Commission, and almost 44% of Puerto Ricans live in poverty.

“We need that money to provide good medical and hospital services to our population,” said Jorge Galva, executive director of the Puerto Rico Health Insurance Administration. “There is a dire need to provide the full complement of Medicaid services.”

Providing care, Galva added, is made even more difficult as thousands of physicians and other health professionals continue migrating to the U.S. mainland, where they typically receive better pay and enjoy a higher standard of living.

Even with an increased amount of Medicaid funding for Puerto Ricans, Galva said, this wouldn’t be enough to help the island offer some of the federally mandated services, like nursing home care, home health care and nonemergency medical transportation.

“Over the years,” Galva continued, “the gap between the cap on the federal funds for our Medicaid program and the needs of the program grew bigger and bigger and bigger. As a territory, and under the present state of the law, Congress is fully allowed to discriminate and make differences between the treatment to territories and states.”

Local officials are calling on lawmakers to address what’s seen as the U.S. neglecting Puerto Rico because it’s a territory, not a state.

“It’s a matter of fairness and equity that we receive funding in parity with the states and allow Puerto Rico to provide its medically indigent population with all the services they need and deserve,” Galva said.