‘NMI Medicaid in freefall’

CNMI healthcare officials pleaded with lawmakers for help in the Medicaid cliff facing the islands when they testified in the nation’s capital last week.

Helen Sablan, CNMI Medicaid Program director, said in her testimony to a U.S. Congress committee that the CNMI is in a “desperate and dire situation.”

“…We are humbly pleading for the U.S. Congress to please help treat the U.S. citizens of the U.S. Commonwealth of the NMI equitably, and if I may humbly ask, quickly,” she said in her testimony before the U.S. House of Representatives’ Natural Resources Committee last May 24.

Federal funding for Medicaid that was a cornerstone of Obamacare will expire at the end of the year, resulting in a “Medicaid cliff,” which could result in nearly one million U.S. citizens—and thousands of CNMI residents—losing their health care coverage.

“…The CNMI Medicaid Program has fallen off the cliff and is currently in freefall,” Sablan said, describing the situation of the CNMI.

Sablan, along with Commonwealth Health Care Corp. chief executive officer Esther Muña, spoke for improved Medicaid services in insular areas at the invitation of Delegate Gregorio Kilili C. Sablan (Ind-MP).

Both Muña and Sablan joined Guam’s, American Samoa’s, Puerto Rico’s, and the U.S. Virgin Islands’ health care representatives to testify.

In her testimony, Helen Sablan noted that there are 15,316 U.S. citizens in the CNMI who are enrolled in both the Medicaid and Child Health Insurance Program—61 percent of the total population of the CNMI.

“Medicaid and CHIP provides critical healthcare services for about 46 percent of the total U.S. citizens in the CNMI today,” she said.

As it currently stands, Helen Sablan said, the estimated shortfall for the CNMI Medicaid Program in fiscal year 2019 is around $42 million. Yet the Congress-approved H.R. 2157 only estimates the shortfall at $36 million—a $6-million difference.

“This will result in another carry-over of accounts payables,” Helen Sablan said.

In reaction to the seemingly inevitable shortfall, she said that the CNMI Medicaid is already in the process of “severely curtailing services, limiting choice of providers in the program, and are making decisions knowing full well the adverse short and long-term effects consequences”.

“It is very hard to explain to those that come to our office asking whether the health services that they are receiving will be cut. It is very hard to listen to their stories,” she said.

‘Scaled back services’

In her own testimony, Muña explained that, without the continued support of the Medicaid program, the lone hospital in the CNMI would not have the means to continue its “positive trajectory,” forcing it to consider even scaling back its services.

She cited several accomplishments at the hospital, thanks to continued Medicaid funding.

“We took full advantage of the opportunity presented to us [by the Affordable Care Act] to stabilize our health care system. …A return to the low statutory cap on federal contributions and the low fixed federal share endangers the very existence of our health care system, threatens to further erode our economy, and puts at risk the health and well-being of our people,” she said.

Muña said she is eager to demonstrate the potential of CHC when provided with regular reimbursements from a stable Medicaid program and asked Congress to eliminate the caps on federal assistance to CNMI Medicaid.

Currently, the CHCC could get through until September 2019 only through the passage of H.R. 2157 after it passed the U.S. Senate.

H.R. 2157 provides an additional $36 million to the CNMI Medicaid program for fiscal year 2019.

“This will help the CNMI get through September this year, but after that we will still need further congressional action or adequate local appropriation to enable the Medicaid program to make reimbursements to medical providers,” Muña said.

The CNMI Medicaid Program announced in early May that it has exhausted its federal and local funding and would only reimburse outpatient primary care provided only at CHCC.