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(GFR Media)
(GFR Media)

Washington - The Puerto Rican government and health industry sectors warned a congressional advisory committee that they are running out of time to avert a fiscal cliff of about $1.2 billion annually, in the island´s health care system.  

Last Friday, Angela Ávila, executive director of the Health Insurance Administration (Ases, Spanish acronym), led a panel of Puerto Rican representatives who appeared before the Medicaid and CHIP Payment and Access Commission (MACPAC).

Although Congress allocated $ 4.8 billion in Medicaid emergency funds earlier this year to help mitigate the catastrophe caused by Hurricane María, the funds may dry up by September 2019.

By then, Puerto Rico will only have the regular $325 million in  Medicaid allocation (through a permanent law), the funds granted through the Child Health Insurance Plan (CHIP), and possible remaining funds allocated through the health reform known as Obamacare.

“If there is something left from those $4.8 billion –although it doesn´t seem possible- then there could be something, some continuity for October,” said Ávila, however she said that the $4.8 billion are expected to have been fully used by the end of September. 

Ávila could not specify when exactly, during federal fiscal year 2020, the government will have exhausted all Medicaid funds or whether the government of Ricardo Rosselló received the required certification stating that the island has implemented proper anti-fraud measures for the use of $ 1.2 billion from the $4.8 billion allocated.

One way or the other, sometime during the first months of federal fiscal year 2020 - which begins in October 2019 - Medicaid additional funding will dry up. 

Unlike the permanent law that grants Medicaid funds, the $ 4.8 billion allocation has exempted the government of Puerto Rico from the 45 percent contribution for service costs to each Medicaid patient. In October, however, that requirement will come back into effect.

During the meetings that Rosselló held  last Thursday in Congress with the Democratic leadership, he sought support to include a $3.18 billion Medicaid allocation for federal fiscal years 2020 and 2021 in any budget measure to be voted this week, before the end of the 115th Congress.

According to Ávila, about 900,000 patients –the most vulnerable and poorest people- may loose access to health care services and the system will colapse if they don´t receive some $1.2 billion annually in new allocations.

Medicaid funding for the Puerto Rican health system grew as a result of the Obamacare law, which as of 2011, allocated $ 6.3 million.

Puerto Rican authorities have stressed that, by spring, they need certainty regarding the future of Medicaid funds in order to be able to sign the future contracts for the government health plan and to get the approval of the Oversight Board overseeing the island´s public finances.

Although Puerto Rico is number 12 in the ranking of  federal jurisdictions with the most Medicaid-dependent population segments, it falls to number 48 in terms of the compensation it receives from the program.

"They ask us to comply with all the regulations, but they do not provide us with the same amount of funding," said Orlando González,  former director of Ases who testified as president of the MMM health plan and stressed that only between 2015 and 2016, 1,100 doctors left the island.

Gloria Amador Fernández,  executive director of the center Salud Integral en la Montaña (SIM), stated that a quick action of Congress is required and said that 20 percent of Medicaid patients are treated through 330 Health Centers, which provide special attention to the most vulnerable.

The MACPAC commission is scheduled to submit a report to Congress in June, when the fiscal cliff for Puerto Rico's health system will be dangerously close. Its directors have meetings scheduled  in January and March, and did not rule out making some comments to Congress about the situation in Puerto Rico before the summer.