‘Private providers may now serve Medicaid beneficiaries’

The CNMI Medicaid program said Friday that all private providers in the CNMI may begin receiving and providing on-island outpatient primary care services to its 15,000 adult and children Medicaid beneficiaries in the Commonwealth effective yesterday, March 1, 2020.

The CNMI Medicaid program received the official grant award notification, dated Feb. 20, 2020, from the Centers for Medicare and Medicaid Services.

In December 2019, U.S. Congress increased the budget and the FMAP in the Further Consolidated Appropriations Act for fiscal year 2020. For two years, the CNMI Medicaid program will receive $120 million in federal funding. The act further increased the Federal Matching Assistance Percentage or “FMAP” from 55% to 83%. This means that the CNMI funding has been substantially lessened but nonetheless is required since federal funds may not be disbursed without the CNMI share. The CNMI is receiving the maximum provided to any state or territory in accordance with Title XIX of the Social Security Act.

For fiscal years 2020 and 2021, the CNMI Medicaid will require an increase from the local appropriations and allotments to be able to pay for the matching funds for the FMAP programs for medical services. The required local matching for FMAP is now 17%.

The CNMI Medicaid program anticipates that there will be sufficient funding for the CHIP beneficiaries for the current fiscal year that ends on Sept. 30, 2020. For adult beneficiaries, however, be advised that the Medicaid program may need to rescind the ability to seek treatment from a private provider should there be insufficient funding for the CNMI match for the federal funds as required by law.

At the same time, U.S. Congress attached conditions on the funding because of the significant increase in funding to ensure that the territories manage the Medicaid program in a manner similar to the United States. Specifically, Congress requires that the territories to:

• Make “Reasonable and Appropriate” progress to submit data to the Transformed Medicaid Statistical Information System);
• Establish a Medicaid Fraud Control Unit, and
• Submit reports directly to the chairs and ranking member of the U.S House of Representatives and Senate Committees of Jurisdiction.

The Further Consolidated Appropriations Act, FY 2020 further provides for penalties if the territories are unable to make reasonable and appropriate progress in achieving the requirements. The penalties include a .25% reduction in the federal share for each quarter that the CNMI does not make progress. This will require additional action by CNMI Legislature and funding of a “Program Integrity” function Medicaid Fraud Control Unit and program.

“I want to acknowledge and express my deep gratitude to Delegate [Gregorio] Kilili [C.] Sablan (Ind-MP) for raising and diligently pursuing the problem of the ‘Medicaid Fiscal Cliff’ in the CNMI and other territories. His leadership was absolutely essential in encouraging his colleagues and staff that are behind the scenes to hold two unprecedented hearings on the Medicaid funding problems in the territories,” said Helen Sablan, director of the Medicaid program. “I also want to acknowledge and appreciate the efforts of Gov. Ralph [DLG] Torres for raising the issue directly with Secretary Alex Azar III of the U.S. Department of Health and Human Services. Finally, I want to thank the many individuals such as Esther Muña and Kaitlyn Neisis of the [Commonwealth Health Care Corp.] and the many organizations that supported and provided information to the U.S. Congress about the Medicaid program in the territories. The funding provided will benefit over 15,000 Medicaid and CHIP beneficiaries in the Commonwealth, help our health care system to be sustained, and aid our economy and government with tax and health care expenses for the CNMI.”

Sablan further said, “I would like to remind all private providers that the Medicaid claims must be submitted in the manner and timetable required by the Medicaid program. The data is required to meet the requirements of federal reporting and will be provided to the federal and CNMI Medicaid Fraud Control Unit.” (PR)