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  • By Mar-Vic Cagurangan and Jonathan Perez

Bill seeks to avert forfeiture of Medicaid funds

Sen. Therese M. Terlaje is proposing a supplemental appropriation of $5.6 million to the Department of Public Health and Social Services to cover the local match for Medicaid expenditures through the end of fiscal 2019. Unless Guam meets the local matching requirement, the department is at risk of forfeiting $61 million in federal funds that are set to expire on Sept. 30.

“Clearly this situation was a priority months ago and today it is a potential crisis,” Terlaje said in introducing Bill 78-35 that would amend DPHSS’ current fiscal year budget.

The public health department has a current budget of $62.5 million. Of this amount, $13 million is allocated to cover Guam’s 45-percent local match for federal Medicaid grant. Approximately 43,549 low-income individuals on Guam are covered by Medicaid.

“Based on claims received, current processing and expenditure projections, DPHSS needs approximately $5.6 million for local matching requirements and only has enough funding through the first week of April for regular Affordable Care Act (ACA) Medicaid and Medicaid Childless Adults claims from private medical providers,” according to a press release from Terlaje’s office.

For the period of July 1, 2011 through September 30, 2019, Section 2005 of the Affordable Care Act provided an additional $268.34 million funding to Guam. Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage rate for that state, in Guam, the federal rate is applied until the Medicaid ceiling funds and the Affordable Care Act available funds are exhausted.

The shortfall in Medicaid funding was first raised by Terlaje during a Feb. 7, 2019 informational briefing with DPHSS and with her introduction of Bills 35-35 and 36-35.

“At that time, DPHSS reported a potential $13.3 million shortfall for local matching funds for Medicaid,” states a press release from her office.

This prompted Gov. Lou Leon Guerrero to issue an executive order transferring $7.7 million of the FY 2019 Guam Memorial Hospital’s pharmaceutical funds back to DPHSS to pay GMH Medicaid claims.

Bill 78-35 would cover the remaining $5.6 million shortfall to enable the public health department to use the $61 million in federal ACA Medicaid funds before they expire in September 2019.

“This year Guam has already used $13.1 million of local funds to access $15.6 million of the ACA funds for Medicaid claims. A $10.5 million decrease in federal funds is indicated in the governor’s 2020 budget request, and $3 million in Compact Impact funds are allocated towards Medicaid,” according to Terlaje’s office.

Terlaje underscored the need to prioritize health care for Guam’s most vulnerable sector. “There is an urgent need to invest in the local match requirement for Medicaid in this fiscal year, in order to access federal grant funds to pay for Medicaid claims,” Terlaje said. “If we do not prioritize this now, we may lose our opportunity to tap into those federal ACA grant funds and many of our low-income families may not get the care that they need.”

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