Medicaid ‘fiscal cliff’ averted

Delegate Gregorio Kilili C. Sablan (Ind-MP) announced Saturday that the federal government will allocate $64 million for the CNMI’s Medicaid program in fiscal year 2022, averting a looming “fiscal cliff” that would have meant a loss of $55.1 million for the CNMI’s Medicaid program come Oct. 1, 2021.

“We have been working with the Biden administration for months on this issue,” Sablan said in a press statement last Saturday. “We asked the President to make a commitment to Medicaid for the insular areas in his 2022 budget proposal; and he did. I am very grateful to his support and to my former House colleague, HHS Secretary Xavier Becerra, for this week’s decision to permanently increase funding.”

Next up for the CNMI is to push for a longer-term solution for the CNMI and other U.S. territories’ Federal Medical Assistance Percentage, or FMAP, according to Commonwealth Healthcare Corp. chief executive officer Esther Muña yesterday.

The FMAP determines the percentage of Medicaid expenses that the federal government will reimburse a U.S. state or territory for, with the remainder being paid for by a state or U.S. territory’s local government.

Muña wrote last week an opinion piece for Washington, D.C.-based publication The Hill. In it, she cited that FMAP is capped at 55% by law for U.S. territories and that legislation to increase these caps frequently expires. Muña had pointed out that no such federal Medicaid percentage cap exists for all 50 states and Washington, D.C., and called for a permanent solution to the issue.

When asked for thoughts and comments regarding Sablan’s announcement, Muña Sunday said that FMAP still needs to be addressed, as CHCC needs proper reimbursement from the federal government to support its expanded services.

“The FMAP still needs to be addressed. Since CHCC expanded services, we’re generating close to $50 million in Medicaid expenses. Without addressing the FMAP, we will only be reimbursed about $27 million—that’s about $13 million less than what would have been received if the FMAP was addressed, [and] that still means we need to analyze how we can continue the expanded services without appropriate reimbursement,” said Muña.

She pointed out that the number of CNMI residents struggling to pay their medical bills is on the rise. With CHCC being a safety net provider—which means it is not allowed to deny anyone medical services—a lack of proper reimbursement toward the CNMI’s Medicaid program creates further challenges and complications for CHCC.

“Every year, we’re seeing an increase in CNMI residents struggling to pay for their health care. As a safety net provider, we can’t deny services to these individuals, and Medicaid was keeping the lights on at the hospital and bringing these much-needed services to them. The loss of $13 million is a significant challenge for the CHCC and the Medicaid program. …FMAP allows us to maintain services. We still need to fight for the FMAP,” Muña added.

The CNMI got $62.3 million for Medicaid in fiscal year 2021. Without the federal government’s intervention, that would have dropped to $7.2 million in fiscal year 2022.

U.S. Public Law 116-9 gave the Biden administration the basis for its decision last week to apply a statutory inflation factor to the current amount and award the Marianas with $64 million beginning Oct. 1 and to use $64 million as the basis for calculating future year increases.