Kilili: Medicaid reforms for CNMI in Health Equity and Accountability Act

WASHINGTON, D.C.—Ending the cap on federal Medicaid payments to the Marianas and other insular areas and lowering the local match for these federal funds are among the improvements included in the new Health Equity and Accountability Act, introduced in the U.S. House of Representatives last Thursday.

The legislation is a joint project of members of the Congressional Tri-Caucus, composed of the Congressional Hispanic Caucus, the Congressional Asian Pacific American Caucus, and the Congressional Black Caucus. There are 105 members of the House in the Tri-Caucus.

“We know the Republican-controlled Congress will not pass this legislation,” said Delegate Gregorio Kilili C. Sablan (Ind-MP), who is a member of both the Hispanic and Asian Pacific American caucuses. “But it is important that my constituents and the 125 million other Americans, who are represented by the Tri-Caucus, know exactly what our goals are for the day that we do control what legislation passes the House.”

The HEAA permanently eliminates Medicaid funding limitations for the Northern Marianas, Puerto Rico, the Virgin Islands, Guam, and American Samoa.

In fiscal 2016 the funding limit for the Marianas was $6 million. States have access to unlimited funding.

The Act also provides parity in the local match for federal Medicaid funds that insular areas pay. For the 50 states the local match is based on the income level in a state and can be as low as 24 percent of total funding. In the insular areas the local match is set by law at 45 percent, even though incomes in the islands are among the lowest nationwide.

In a statement announcing the introduction of the bill, the Tri-Caucus described the Health Equity and Accountability Act as its vision “for addressing persistent ethnic and racial health disparities and improving health outcomes in communities of color. By improving care for the families who need it most, we can ensure that all Americans—no matter their race, ethnicity, gender identity, sexual orientation, age or language background—can stay healthy.”

There are significant differences in the quality of health care among Americans. Cancer, diabetes, HIV, heart disease, and hepatitis disproportionately affect African American, Latino, Asian American, Pacific Islander, and Native Hawaiian populations. The risk of being uninsured is also higher for many in these groups.

In addition to the changes in Medicaid, the Health Equity and Accountability Act requires the federal government set up 110 health empowerment zones—at least one in each state and insular area—and provides $100 million to help improve health outcomes in the zones. A separate grant program would provide direct financial assistance to health providers and centers in the all the U.S. insular areas, including Hawaii.

“We have made important steps toward parity for the Marianas and the territories in education and other federal programs over the last years,” Sablan noted. “And Obamacare gave the Marianas an extra $109 million in Medicaid funding to work with. Those funds expire at the end of 2019, however. So, federal healthcare programs are going to be a focus for us in the year ahead.

“Having the backing of the 105 members of the Tri-Caucus for these reforms puts us ahead of the game, when the next Congress convenes in January 2019.” (PR)