‘Life-or-death decisions’ loom

Esther Muña

Come Sept. 30, if U.S. Congress fails to extend expiring legislations that temporarily increased the amount of Medicaid funding for the CNMI and other U.S. territories, that would trigger what’s being called a “funding cliff” that would greatly affect many in the CNMI and other U.S. territories who avail of Medicaid.

That was the warning raised by Commonwealth Healthcare Corp. chief executive officer Esther Muña on Tuesday in an opinion piece for Washington, D.C.-based news publication The Hill, where she wrote about the looming “Medicaid funding cliff” in the CNMI that would greatly affect CHCC’s daily operations.

In it, she warned that, without congressional action to extend the Sept. 30 expiration of legislations that temporarily increased the amount of Medicaid funding for U.S. territories, the CNMI could see a steep drop in federal funding allocation for the CNMI’s Medicaid program from $62.3 million in fiscal year 2021 to $7.2 million in fiscal year 2022. Another change is that the matching rate from the federal government will also drop from 83% in fiscal year 2021 to 55% matching rate in fiscal year 2022.

The 55% matching rate would mean that the federal government would reimburse the CNMI just $0.55 for every $1 of Medicaid services availed in the CNMI, with the local government having to match the remaining amount.

The “Medicaid funding cliff” that Muña writes about is similar to a “fiscal cliff,” which according to an online definition is defined as “a situation in which sudden changes in government spending and tax have a big and sudden effect on a country’s economy.” In this case, the severe and sudden drop in federal Medicaid funding for the CNMI would have severe effects on the services CHCC can offer and the number of patients it can serve.

“We will be forced to make life-or-death decisions; how many patients can be served, what benefits are offered, how much providers are paid, and many other systemic supports,” wrote Muna.

“When care is not provided at home on our islands, many islanders will travel to the continental United States, away from their family and community, to seek care at a higher cost to the U.S. taxpayer. All of this, of course, during the COVID-19 pandemic,” she added.

Muña wrote that the House Energy and Commerce Committee passed in July a bipartisan bill known as the “Supporting Medicaid in the U.S. Territories Act of 2021.” If passed by the Senate and signed into law by President Joe Biden, five more years of additional Medicaid funding for Puerto Rico and eight more years for the U.S. other territories will be authorized.

“If approved by Congress and signed into law by President Biden, the U.S. territories’ Medicaid programs would be on solid ground for the near future and provide a runway for the health programs on the islands the opportunity to expand current services to improve health outcomes,” wrote Muña.

Muña ended her opinion piece with a call to action for Congress to “treat all U.S. citizens equitably,” and to improve the lives of the 3.5 million Americans that live in U.S. territories.

“Congress has the power to treat all U.S. citizens equitably when it comes to Medicaid and the health care services the program provides. However, the current funding and reimbursement structures underfinance care in these jurisdictions where the need is immense, and population health challenges are significant. The moment is now for Congress to improve the lives of 3.5 million Americans,” wrote Muña.

When asked for additional thoughts and comments on her opinion piece, Muña said Wednesday that a majority of the CNMI avails of Medicaid and that the severe cut in funding to the CNMI will put CHCC in very difficult positions.

“Seventy percent of our patient population [avails of] Medicaid, and [this is increasing] with the pandemic. If we’re spending money without reimbursement [from the federal government], we have to make the tough decision to choose [what] services we can afford to provide,” said Muña.

Muña’s opinion piece for The Hill can be found at https://thehill.com/blogs/congress-blog/healthcare/572227-devastating-decisions-loom-for-the-territories-if-congress?rl=1.