Medical Referral to start enforcing income eligibility

The former Medical Referral program, now known as the Health Network Program, will now be strictly enforcing eligibility requirements, including income eligibility based on the federal poverty guidelines.

Commonwealth Healthcare Corp. CEO Esther Muña said that CHCC, which took over the former Medical Referral Program last year, said they were still following the outdated income requirement and they determined it was necessary to update poverty level guideline.

“The income eligibility requirement—we changed it to match the current year. When we were looking at the regulations, I believe we were still following the 2011 or 2012 income requirement. So we updated the federal poverty level to the current year,” she said.

Since taking over the Medical Referral Program last year, CHCC has since made some drastic changes in order to both bring the program into compliance with federal regulations, as well as make it sustainable for years to come.

“The public auditor reports previously stated that we were not following federal regulations, so since [the program is] in our hands now, we will be doing that. The commitment we made when we took on this program is that we have to base it off of regulations to make it fair and justifiable so we have something to refer to when deciding if an individual should get benefits,” Muña added.

The federal poverty guidelines are adjusted every year according to the rate of inflation.

As of January 2023, the federal poverty level for a household of one is about $18,210 while a family of five is about $43,930.

In 2011, the federal poverty guidelines for a household of one was about $13,600 while a family of five was about $32,720.

“Updating the eligibility requirement would increase the number of individuals eligible for HNP,” said Muña.

According to CHCC chief financial officer Perlita Santos, the difference now is that CHCC and HNP will be strictly enforcing these guidelines as it hadn’t been done in the past.

“The difference now is that we are heavily enforcing income requirement, which wasn’t entirely being done in the past. We’re enforcing the updated poverty level,” she said.

The good news is that, with the updated poverty level eligibility requirement, more individuals will qualify for the HNP program.

“Following the 2011 poverty level guidelines would have disqualified most of everyone in the CNMI. We are enforcing the 2023 income requirement, which now makes more people eligible,” Santos said.