‘Medicaid used up $31M in over 3 months’

In just over three months, the CNMI Medicaid Office already used up its $31 million additional supplemental federal appropriations, according to Gov. Ralph DLG Torres.

In a letter to Sen. Chuck Grassley (R-IA) and Sen. Ron Wyden (D-OR)—chairman and ranking member for the U.S. Senate Committee on Finance respectively—Torres stated his support for H.R. 2328, which would reauthorize and extend the America’s Community Health Act, or REACH Act, emphasizing the CNMI’s need for Medicaid support.

“Without this legislation, the Marianas and other U.S. insular areas face a fiscal cliff, as supplemental Medicaid funding provided for us in the Patient Protection and Affordable Care Act [or Obamacare] is exhausted,” he wrote the senators.

The REACH Act raises the annual block grant for the Marianas from $6.95 million to $60 million and results in a Federal Medicaid Assistance Percentage reportedly “comparable” to the U.S. state with the lowest per-capita income.

“[The REACH Act] would fund the Medicaid program in the CNMI for another six years,” Torres wrote. “…While these are significant changes, they are not out of line with our need.”

CNMI Medicaid through the Additional Supplemental Appropriations for Disaster Relief Act of 2019, or H.R. 2157, was enacted in early June 2019. The legislation provided $36 million in additional Medicaid funding for the CNMI.

“In just over three months’ time, $31 million of that money has been expended,” Torres said.

“The REACH Act also extends community health centers, the special diabetes program, and family to family health information centers for four years. The Marianas participates in all these programs and they contribute significantly to the health of our people,” Torres wrote to the senators.

While the REACH Act extends several programs the CNMI participates in, Torres also pointed out that two other programs funded by the REACH Act does not include the CNMI.

“As written, the Marianas would not be eligible for the Disproportionate Share Hospital Program and the All-Payer Claims Database Program unless ‘territories’ is included in the definition of the state,” Torres wrote. “Inclusion in both programs would have significant positive impacts on our healthcare system, especially with cost containment and quality improvement, a major benefit of the All-Payer Claims Database Program.”

He emphasized that the CNMI being a remote Pacific territory, there is only one hospital serving a “disproportionate number of low-income patients.”

“In 2018, our hospital recorded more than $11 million in gross revenue, yet closed the year with a $7-million deficit due to uncompensated care,” Torres wrote.

In a separate letter dated Sept. 12, 2019, Torres joined governors of the U.S. Virgin Islands, American Samoa, Guam, and Puerto Rico for a fairer Medicaid reimbursement compared to the U.S. states.

“If Congress does not act before Sept. 30, 2019…our enrollees may lose their Medicaid coverage and access to compensated care aimed at treating life-threatening disease and conditions and preventing needless deaths,” the letter noted. “It is our hope that Congress will work with the U.S. territories to reverse course and resolve the Medicaid funding cliff. Failure to do so will constitute a man-made disaster and a blot on the human rights record of the United States,” the letter continued.

All five territory governors signed the letter.