Fiona prompts financial pleas for Puerto Rico’s beleaguered Medicaid program

Puerto Rican officials are pleading for more Medicaid dollars post-hurricane

Top Puerto Rico officials are pushing for increased federal funds to boost their fragile Medicaid program after Hurricane Fiona ripped through the island last month.

The asks come from Gov. Pedro Pierluisi (D) and Rep. Jenniffer González-Colón (R), each of whom recently sent congressional leaders separate letters obtained by The Health 202. Some of the requests are similar to funding lawmakers approved after Hurricane Maria devastated the island and put pressure on its medical system in 2017.

The demands for more cash underscore concerns that the recent hurricane could have a sustained impact on the island’s health-care safety net. And it highlights the complex financing mechanism for Puerto Rico’s Medicaid program, which officials and experts say has long been underfunded.

The storm wreaked havoc when it made landfall last month, causing severe flooding and knocking out power for more than 3 million residents. Much of the power has since been restored, and 99 percent of Level 1 hospitals are back on the electrical grid after running on generators. But the recovery efforts will take time — a reality President Biden alluded to when he told Puerto Ricans he was “committed to this island” in a visit to the territory earlier this week.

Why does Puerto Rico need more money? Medicaid funding for the U.S. territories is structured much differently than it is for the states. That can result in shortfalls, fiscal cliffs and dollars for the program getting caught in the political crosshairs.

• In the states: There isn’t a limit on the cash the federal government can put toward states’ Medicaid programs.
• But such a limit exists for the territories. There’s a cap on the amount of money the territories’ Medicaid programs can receive from the federal government each year.
• Congress has some discretion here. Lawmakers typically boost the floor for how much the federal government must match the territories’ Medicaid dollars. They also usually raise the cap on how much federal funds the safety net gets each year.

Currently, the island receives a 76 percent match from the federal government on its Medicaid dollars. Puerto Rico now must receive at least $2.9 billion in total from the feds each year, the result of a recent Biden administration increase. (Read more on how a government watchdog says such a move was wrong.)

Top island officials say they were already anticipating a funding shortfall for its Medicaid program this year. Carmen Feliciano, the executive director of the Puerto Rico Federal Affairs Administration, said the government had estimated the deficit would amount to $400 million — and that was before Hurricane Fiona hit.

Now, they’re…