The V.I. Legislature may send a letter asking Congress to permanently bump up federal Medicaid funding to the USVI back up to the level enjoyed after the 2017 hurricanes, if a symbolic measure approved in committee Thursday is enacted.
The petition would ask Congress to permanently raise its default cap on overall Medicaid funding to the territory, which is just shy of $19 million annually. In December, Congress extended funding of more than $126 million per year through 2021. But if it does not vote to extend funding again, the territory will approach another Medicaid cliff and might see funding drop dramatically. If so, as many as 15,000 Virgin Islanders could lose health insurance from the V.I. Medical Assistance Program, and the territory’s hospitals will each lose millions of dollars in revenue. Right now, an additional 15,000 to 20,000 Virgin Islanders are eligible, but they are not currently enrolled. Those people would no longer be eligible.
The petition also asks Congress to permanently raise the federal match to 100 percent, waiving the local match. Under current law, the default rate requires the territory to pay 45 cents for every 55 cents of Medicaid funding. Congress waived the match for two years after the 2017 hurricanes. Following the deal passed in December, the USVI pays 17 local cents for every 83 federal cents – the best rate in the country.
This deal expires in 2021 if Congress does not extend it. Historically, Congress has often extended funding once granted. For example, the territory is heavily dependent on regular congressional extensions of the rate at which the federal government sends back rum taxes. Congress has unfailingly extended them. But there is no guarantee.
The bill states that current funds received from the Federal Medicaid Assistance Program, with a 55 percent limit and the overall cap, “are projected to cover only 26 percent of the federal funding needed during fiscal year ending Sep. 30, 2020.”
The symbolic petition also requests additional funding to offset uncompensated care costs. According to the bill, the territory’s public health care centers, Frederiksted Health Care, Inc. and St. Thomas East End Medical Center Corporation, “serve patients of which 49 percent are covered by the Virgin Islands Medical Assistance Program, over 30 percent are uninsured, and 98 percent of patients have an income below 200 percent of federal poverty guidelines.”
And it asks Congress to provide the territory eligibility to receive Medicaid disproportionate share hospital payments, which is funding for qualifying hospitals that serve a large volume of Medicaid insured persons. These additional payments are needed because the territory’s public healthcare facilities are collectively in more than $50 million in debt, according to the bill.
Schneider Regional Medical Center Chief Executive Officer Luis Amaro said the hospital receives temporary Medicaid funds from the Affordable Care Act and the Bipartisan Budget Act of 2018, which provide health care support to the Virgin Islands and Puerto Rico. But Amaro said the eventual “expiration of these temporary funds without legislation to provide additional funds would result in significant funding shortfalls and have severe consequences for territory budgets, coverage, and health care systems.”
In Nov. 2019, the territory was faced with the potential expiration of the funds from the two acts, which had territory health and hospital officials crying out for a long-term solution. Even with the provided funding, Juan F. Luis Hospital and Medical Center Acting Chief Financial Officer Shenel Moorehead said from 2014 to 2019 “the hospital has experienced a $108.3 million shortfall due to non-reimbursement of uncompensated care by the Virgin Islands Government.” Five months into fiscal year 2020, Moorehead said the shortfall has reached $7.4 million.
As for now, the Medicaid funding totaling $252 million that was negotiated in late 2019 only spans evenly over two fiscal years and only designates 83 percent federal matching funds be carried out to the end of fiscal year 2021, where presumably it would revert back to the original 55 percent of federal matching funds.
The Legislature has approved a number of letters requesting action by Congress over the past two decades, with limited effect. Most direct, face-to-face lobbying of Congress is done through the territory’s congressional representative and the Office of the Governor. Any legislation would have to be proposed by a member of Congress, such as Delegate Stacey Plaskett. The letter would put the wishes of the Legislature on the record.
Committee members voted unanimously to forward the bill to the rules and Judiciary Committee for further discussion. These senators were Oakland Benta, Janelle Sauraw, Athneil Thomas, Donna Frett-Gregory, Marvin Blyden, and Kenneth Gittens. Sen. Kurt Vialet was absent from the vote.