Jenniffer González details congressional agreement to finance Medicaid

December 16, 2019
Press Release

San Juan, Puerto Rico- Congresswoman Jenniffer González Colón, announced that Congressional Leadership reached an agreement to fund the federal government for the remainder of fiscal year 2020. The agreement includes two-year funding for Puerto Rico’s Medicaid Program of up to $ 5.7 billion and Federal Medical Assistance Percentages (FMAP) coverage of 76%. The proposal also eliminates the Health Insurance Tax (HIT).
 
This past weekend Congresswoman Gonzalez-Colon announced that Congressional leadership would meet to discuss the spending package and offered several possible scenarios for how Puerto Rico’s Medicaid could be funded. The Congresswoman remained in communication with leadership throughout the weekend to guarantee that the funds for Puerto Rico’s Medicaid program were included in the federal government appropriations package rather than as part of drug pricing legislation, that will continue to be negotiated after the Christmas break.
 
Under the new agreement, financing for Puerto Rico over the next two fiscal years (FY) would be $2,623,188,000 for FY20, and $2,719,072,000 for FY21.
 
The legislation also requires that not later than 6 months after the date of enactment of the law, the agency responsible for the administration of the Puerto Rico Medicaid program will designate an official to act as the Program Integrity Lead of the program.
 
In addition, not later than 18 months after the date of promulgation, Puerto Rico is required to publish a plan on how it will develop measures to meet the payment error rate measurement (PERM) requirements, including annual benchmarks and audits scheduled for compliance. At the same time, a plan must be prepared to meet the Medicaid eligibility quality control (MEQC) requirements.
 
Under this new agreement, if the established fraud control measures are not complied with, there will be a maximum penalty of 2.5%, which constitutes a reduction of the penalty previously announced in the agreement of the Senate Finance Committee.
 
In turn, this measure provides an opportunity for additional funding of up to $200 million a year if the Medicaid plan covers doctors at least 70% of the Medicare schedule rate is certified and allows payments to health insurers who provide services of the Medicaid plan be audited and investigated. 
 
"What we have accomplished has been through teamwork with the Government of Puerto Rico, my Democratic and Republican colleagues in Congress as well as all of the organizations who have advocated for the sustainability of this program. Thanks to several months of hard work, we have achieved a historic obligation to meet the needs of 1.1 million of my constituents who benefit from the Medicaid program,” said the Congresswoman.
 
On May 2019, Congresswoman Gonzalez filed H.R. 2243 which would make the elimination of the HIT permanent for the territories, which, in turn, would provide relief for subscribers.
 
The Health Insurance Tax (HIT) included in Section 9010 of the Affordable Care Act of 2010, also known as Obamacare, requires that health insurance companies pay a tax when they have a cost in premiums that exceed $25 million.
 
According to a 2009 analysis by the Congressional Budget Office (CBO), the impact of the HIT as well as other taxes established by the Affordable Care Act would be transferred by the insurers to their clients through an increase in the cost of premiums. In the particular case of Puerto Rico, it is estimated that HIT has increased the cost of premiums by 2%.