Capitolio de los Estados Unidos.
Congress must decide soon which will be the next step around Medicaid appropriation for Puerto Rico. (Teresa Canino Rivera)

Washington - Before the Comptroller General’s Office (GAO) report, the Congressional Research Service (CRS) had issued an opinion opposing the Joe Biden administration’s interpretation that Puerto Rico is guaranteed a $3 billion annual appropriation in Medicaid funds “in perpetuity.”

According to a CRS memo dated November 2, a “literal reading” of the December 20, 2019, law - which mandated Medicaid funding for federal fiscal years 2020 and 2021 - indicates that, without a new statute, funding for Puerto Rico would fall back to the 2019 appropriations level, about $400 million annually.

Under the law that was in effect on December 19, 2019, the Medicaid funding cap for the current federal fiscal year, 2022, would be about $400 million, rather than the $2.943 billion proposed by the U.S. Department of Health and the Centers for Medicaid and Medicare Services (CMS).

Besides, without a new law, the Federal Medical Assistance Percentage (FMAP) for Medicaid services would drop from the current 76 percent to 55 percent, which even with an allocation of $3 billion annually would require a larger allocation from the Puerto Rican government for its Vital health plan.

At least since Obamacare, Puerto Rico’s government health plan - which benefits about 1.4 million people - relies primarily on Medicaid appropriations.

Right now, Medicaid funding for Puerto Rico is under a budget resolution that expires December 3 and until then maintains the same level of appropriations of the federal fiscal year 2021, which ended in September, during that year the island received about $2.8 billion.

Following the release of GAO’s legal analysis - dated November 15 - House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) reaffirmed that he wants the issue resolved through the budget reconciliation bill which includes President Biden’s social agenda and would allocate $3.6 billion annually to Puerto Rico in Medicaid funds, with an FMAP of 76 percent through September 2022, rising to 83 percent beginning in the federal fiscal year 2023.

The CRS memo, which has been circulated in congressional offices, does not change that position. Like the GAO report, it is not a binding decision, however, it underscores the fragility of the White House’s interpretation in the face of some court challenge.

Due to the uncertainty in the Senate surrounding the bill with Biden’s social agenda and the lack of an agreement on the 2022 federal budget, Congress will likely have to decide soon to extend the same level of current Medicaid appropriations since the temporary budget resolution expires on December 3.

Energy and Commerce Committee Republican Minority Leader Cathy McMorris Rodgers (Washington) has urged the Biden administration to set aside the Medicaid language in the budget reconciliation bill and return to last summer’s bipartisan agreement in her committee, which would maintain roughly the same level of current appropriations for five years.

Soto sees two ways forward

Puerto Rican Democratic Representative Darren Soto (Fla.) – a member of the Energy and Commerce Committee - thinks that in addition to the budget reconciliation bill, Congress can include language from the summer bipartisan agreement, which he authored, in a potential budget omnibus bill that could be considered in December if there is a final agreement on federal spending for the federal fiscal year 2022.

“That bipartisan agreement passed with unanimous support in the committee,” Soto said.

Although the CRS rejects that the current permanent law allows Puerto Rico to receive close to $3 billion annually, it does believe that the language of the December 2019 law authorizes the increase proposed by the White House for the other territories.

For example, according to CRS, the U.S. Virgin Islands may receive about $128 million this federal fiscal year 2022, instead of the $19.6 million it would be entitled to if it were to receive the same as Puerto Rico.

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