Nearly 30 percent of the territory’s residents are living without health insurance, but thanks to new federal reforms, there’s now a chance for the government to help make sure thousands more are covered — including 100 percent of children living in poverty, Gov. John deJongh Jr. said Wednesday.
To do that, the government will be focusing on expanding its existing Medicaid program using the up to $280 million expected to come into the territory through the recently passed federal Patient Protection and Affordable Care Act. Some of the territory’s most vulnerable populations are top priorities as the expansion moves forward, deJongh explained during a midday press conference at Government House.
"In particular, we will focus on the connection between access to quality health care and the quality of life in our community," he said, putting the focus on proper pre-natal and birthing care for pregnant women, and preventive care for young children. "This additional federal funding will allow expansion of the program to cover 20,075 individuals — including 100 percent of children living in poverty — in FY 2019, compared to only 8,500 people in FY 2009."
The numbers are still rough and will evolve over the nine-year reform period laid out in the act, but what’s hoped is that the Medicaid program will be covering two and a half times more people in 2019 than it is today, the governor added.
No additional facilities or expansion of workforce is anticipated at this point; the government will be building on its existing infrastructure and initiatives that have been rolled out over the past few months to beef up Medicaid. But there are still a lot of mandates included in the federal act that need to be implemented by specific deadlines, and deJongh announced Wednesday that he had signed an executive order setting up a 14-man task force charged with helping to streamline and guide the implementation process.
Heading the V.I. Health Reform Implementation Task Force is the lieutenant governor, whose team will also consist of the heads of: the Health, Human Services and Justice departments, Office of Management and Budget, Division of Personnel, both of the territory’s hospitals, the Frederiksted Health Care Center, St. Thomas East End Medical Center, the GESC/Health Insurance Board of Trustees, V.I. Equicare and the Legislature’s Committee on Health.
DeJongh also announced the appointment of Barbara Lee-Jackson, former director of V.I. Perinatal Inc., as the task force’s coordinator, tasked with overseeing the efforts of the various agencies.
"I don’t see what we’re doing as being complicated," Lee-Jackson said later. "If we just stay focused on what we’re supposed to do, everything else will fall into place. We’ve been battling out these issues for years, so for me, to be where we are today is extremely exciting."
The task force will also be chiming in on some critical issues still left up in the air by the act, such as the implementation of a local health care exchange, which would give uninsured residents not eligible for Medicaid access to private health care plans.
DeJongh said during that conference that opting to create an Exchange by 2014 will earn the territory up to $30 million in federal funds to help residents pay for their plans, while choosing not to will put more money toward the Medicaid program.
As it stands, the territory is excluded from provisions of the act that require states to establish new exchanges by 2014 — and local residents will also be unable to participate in them or have access to the same level of subsidies and tax credits.
The territory is also not subject to state mandates requiring all residents to obtain minimum levels of insurance coverage by 2014, but local business owners will be encouraged to voluntarily provide coverage to employees through tax credits that will begin to apply during the current tax year. DeJongh said he would be meeting with U.S. Health and Human Services officials later this month to discuss how the credits will be funded locally.
Most of the act’s other provisions do apply, however, including:
-no lifetime or annual limits on coverage; prohibition against rescissions; coverage of preventative health services; and the extension of dependent coverage to age 26 (generally effective Sept. 23, 2010);
-requiring issuers and plan administrations to use standardized definitions and unified documents for clients (effective March 23, 2012); and
-prohibitions against pre-existing condition exclusions or other discrimination based on health status; guaranteed availability of coverage; guaranteed renewability of coverage; prohibition against discriminatory premium rates; and guaranteed minimum coverage benefits (effective by Jan. 1, 2014).
The greatest benefits to the territory, along with hundreds of millions in extra Medicaid dollars, is an increased federal match for Medicaid from 50 percent to 55 percent — meaning that for every dollar spent on local Medicaid enrollees, the local government will receive 55-cents, instead of the current 50-cent match — and an increased federal match rate of 91.5 percent for the Children’s Health Insurance Program during 2014, 2015 and 2016, deJongh said.
Meanwhile, eligible Medicare Part D beneficiaries who have exceeded their coverage limits for drug benefits will also be eligible for a one-time $250 payment, which Delegate Donna Christensen said late Wednesday will soon start going out in the mail.
With high numbers of preterm births, AIDS cases and diabetes patients, the territory has to take every opportunity possible to improve its overall health care status, deJongh said as he wrapped up the conference.
"The largest portion of the increased funding — the additional Medicaid funds — would allow us to increase income thresholds to expand Medicaid eligibility and to increase services," he said. "In particular, we can ensure that all pregnant women receive appropriate and needed prenatal care, and children get all of the immunizations and regularly visit health care providers to ensure they are healthy, developing normally, and able to learn in school."
It is also hoped that with new amendments proposed for the Medicare state plans, that eventually people earning up to 300 or 400 percent of the federal poverty line will be able to qualify for the programs, deJongh added.
