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Charlotte Amalie
Thursday, March 28, 2024
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Feds Lower V.I. Medicaid Match

The V.I. Department of Human Services announced it is preparing to expand Medicaid coverage for childless adults, thanks to recent news the federal government is dramatically lowering the local matching requirement.

On Jan. 13, the Centers for Medicare and Medicaid Services notified Human Services it will pay 78 percent of the cost to U.S. territories to expand the Medical Assistance Program to cover people who are not pregnant or do not have children. MAP is the local program delivering federal Medicaid benefits. The covered population includes many of the homeless, according to a statement from Human Services.

Before the Affordable Care Act, this nonpregnant, childless adult category was not a covered Medicaid group, making the news of the expansion especially welcome, according to the department.

“As Human Services planned Medicaid expansion, we always intended to add this group to the rolls of low income children, parents, seniors and persons with disabilities. With the news of the increased federal match, Human Services will try to more quickly add this group,” Human Services Commissioner Chris Finch said in the department’s statement.

The expansion will not take place right away, unfortunately, because Human Services has to perform a lot of preparatory work required by the ACA. The fiscal assistance awarded to the territory is contingent on the V.I. government’s eligibility to further expand MAP, in accordance with the rules set forth in the Affordable Care Act.

The V.I. government is working toward complying with the federal requirement for eligibility by demonstrating the V.I. government meets the definition of a Medicaid expansion state. According to Human Services, doing that that will require a detailed analysis of the territory’s health coverage for that same childless population since the ACA was enacted in 2010. Human Services’ statement says that "will take considerable time to accomplish."

Under the ACA, states can set up health insurance exchanges that offer a menu of private health insurance policies with federal subsidies for the premiums. States that cannot afford to set one up, or choose not to, can use a federal health insurance exchange. But territories suffer numerous disadvantages compared to states under ACA. Notably, territories cannot use the federal exchange.

In July 2013, Gov. John deJongh Jr.’s administration determined it would be nearly impossible to set up a health insurance exchange in the time allowed and very difficult to pay for and support, so the territory instead opted instead to devote the 24.9 million in federal subsidies to a pool of $275 million in extra Medicaid funding the Affordable Care Act makes the territory eligible for over the next decade.

The federal government requires a 45 percent local match, so the territory would have to come up with more than $100 million in matching funds to access those benefits. This announcement from CMS that the federal government will pay 78 percent and only require a 22 percent match for this particular population makes it much easier for the territory to pay for expanding coverage to more people.

This will be part of a third phase in expanding Medicaid in the territory. In August 2013, Human Services announced the first phase, which raised Medicaid’s allowable income limit for all family sizes by $1,000 and extended Medicaid eligibility to some 3,000 children – up to age 18 – and some 200 pregnant women.

The second phase, which is starting now, will enroll more children, pregnant women and parents of children on Medicaid, senior citizens, those with disabilities and former foster children ages 18 to 26.

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