Health

As expected, the U.S. Senate passed the federal stopgap spending bill and it was duly signed by President Trump before the Sept. 30 deadline.

The measure not only averts a federal government shutdown—for now, at least—but also provides Puerto Rico, the U.S. Virgin Islands and other U.S. territories with much-needed Medicaid resources to avoid the projected funding cliff.

However, the stopgap spending bill only provides funding for the federal government until Nov. 21.

The bill provides temporary funding for the federal government until just before Thanksgiving. U.S. lawmakers must then reach another accord, either another temporary funding patch until Christmas or for the entire fiscal year.

The initiative provides a temporary extension of Federal Medicaid Assistance Percentage (FMAP) benefits to Puerto Rico, the USVI and other “insular territories” ahead of the Sept. 30 expiration of those benefits.

Now signed into law, the Continuing Resolution will extend the temporary 100 percent FMAP to Puerto Rico and USVI to Nov. 21, giving the U.S. Congress an additional eight weeks to work on a long-term solution.

Unlike in the states, where FMAP is not capped and the federal share varies based on the per capita income of residents of that state, federal funding for Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate. As a result, the FMAP to Puerto Rico and the USVI is capped at 55 percent, resulting in a chronic underfunding of the program. Every year, the central government spends more than $1.4 billion in the program, while receiving only $400 million from the federal government due to the cap, according to official figures.

“In Puerto Rico, where median household income stood at $19,775 in 2017, compared to $42,009 in Mississippi, the poorest state, and $57,652 in the United States as a whole, the program has been chronically underfunded. In the poverty-ridden territory, funding limitations further constrain program delivery evidenced in the form of lower eligibility levels, lower federal funding, fewer mandatory benefits, lower provider payments and lower spending per enrollee,” said the Center for a New Economy in a recent report, “Puerto Rico’s Looming 2019 Medicaid Cliff.”

An estimated 1.6 million Puerto Rico residents are Medicaid beneficiaries and without the additional federal funds, the island’s Medicaid funding shortfall for fiscal year 2020 is estimated at over $1 billion—hence, the Medicaid funding cliff.

As in the U.S. House, the U.S. Senate easily passed the bill, H.R. 4378, by a vote of 81 in favor and 16 against—all Republicans, according to Politico. President Trump promptly signed the bill on Sept. 27. Among the U.S. Republican senators who voted against the Continuing Resolution include Ted Cruz of Texas and Rick Scott of Florida, according to Politico.

In terms of avoiding a federal government shutdown, the new law “buys more time for bicameral negotiations on a dozen fiscal 2020 spending bills that would provide updated funding levels for 15 federal departments and dozens of smaller federal agencies,” Politico said.

Along with other Puerto Rico government officials, Resident Commissioner Jennifer González has been lobbying hard for the island to receive 100 percent parity on Medicaid funds. “We know that [applying 100 percent FMAP parity] was done in recognition of the injustice in which American citizens living in the territories are treated by our Medicaid program. This great step is one of those we hope to achieve until we ensure that the millions of American citizens living on the island can safely count on funds for their healthcare,” she said.

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