Although Health Secretary Rafael Rodríguez Mercado celebrated yesterday that the federal government has not appointed a monitor to the agency –following fraud schemes that led to the arrest of former Health Insurance Administration (PRHIA) Director Ángela Ávila-, the official acknowledged that the $11,069 billion allocation to Puerto Rico´s Medicaid program over the next four years will depend on the island complying with a series of strict federal requirements.
Requirements include an independent audit on the use of federal funds for the Medicaid program; greater oversight over contracting processes; federal approval to all contracts and eligibility quality control programs.
The governor, Congress, and the federal Health Department Office of the Inspector General will be required to submit periodic reports. Other requirements include, meeting the payment error rate measurement, establishing penalties for noncompliance, and appointing an official to act as Program Integrity Leader.
"If we do good, we're going to get $200,000 more annually. That's why (the figure) reaches $12 million," said Rodríguez Mercado. This includes payments to health-care providers.
A bipartisan agreement reached Friday would increase the federal contribution to Puerto Rico's Medicaid program from 55 percent to 76 percent over the next four years. However, if the local government fails to comply with these requirements, the federal contribution to Medicaid could be reduced up to 5 percent each fiscal quarter.
Yesterday, Resident Commissioner Jenniffer González said this proposal has the endorsement of U.S. President Donald Trump.
González explained that through this agreement, Puerto Rico would receive $2,623,188,000 in fiscal year 2020; $2,719,072,000 in 2021; $2,812,610,000 in 2022 and $2,914,331,000 in 2023, for a total of $11,069,201,000 over those four years.
However, the White House announced Friday that Trump is still reviewing the part of the bill approved by the U.S. Senate Finance Committee leadership, which includes the $11.869 billion in Medicaid funds for the island (including $200,000 annually if they meet certain requirements).
“President Donald J. Trump applauds the work of Chairman Grassley and Ranking Member Wyden to lower prescription drug costs and further improve their bipartisan legislation, such as adding a provision to limit monthly out-of-pocket spending for seniors with chronic high costs,” said Press secretary Stephanie Grisham Friday.
However, when asked if the bill includes language that would allow to allocate up to $11.869 billion in Medicaid funds to Puerto Rico over four years, White House Deputy Press Secretary Judd Deere said they are "still reviewing" language on the extension of health initiatives that include potential allocations to the island.
González, however, insisted that she left a White House meeting on Friday convinced that the funds for the island have the endorsement of the President.
The language that seeks to extend the Medicaid program in Puerto Rico and other territories over the next four years is part of a bill seeking to reduce prescription drug costs or extend funding for health programs.
Since this is a comprehensive bill, which can also be integrated into a big budget bill or a temporary resolution that keeps the federal government operating until the beginning of the year, a single matter does not usually decide the future of the bill.
Trump has opposed allocations to the island in bills he has signed before.
Meanwhile, yesterday Governor Wanda Vázquez Garced highlighted the help of both the Commissioner and the Secretary, as well as private entities that have strengthened lobbying efforts in Washington D.C. seeking the possible approval of this measure.
For González this means that “680,000 people will not lose their health cards and the rest will not see their benefits reduced.”
Rodríguez Mercado anticipated that the local government intends to increase the income level allowed to be eligible for Medicaid so that more people are included in the Reform. They also seek to increase payments to providers to attract those who left the island.