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  • By Mar-Vic Cagurangan

US territories welcome increased Medicaid funding


Territorial leaders says bill will avert Medicaid 'cliff'

President Trump is expected to sign into law this week a federal spending bill that increases Medicaid funding for U.S. insular areas

and raises the federal share to 83 percent.

Territorial leaders welcomed the U.S House of Representatives’ passage of Further Consolidated Appropriations Act of 2020, which would give Guam $127 million and the CNMI, $120 million in Medicaid until September 2021. American Samoa is expected to lock in a new increased spending cap of $84 million each year for the next two years, which is a 600 percent increase over the former $12 million, according to Congresswoman Aumua Amata. Puerto Rico’s Federal Medical Assistance Percentage will be 76 percent for that time.

About 1.6 million Americans in U.S. territories rely on Medicaid, a federal and state program that helps with medical costs for some people with limited income and resources.

“I join governors from the territories of the United States in thanking the House for its passage of a measure that would help millions of Americans keep the healthcare they need. After months of effort, we now have meaningful progress,” said Guam Gov. Lou Leon Guerrero.

“While this measure only provides for a two-year deal, the alternative was a clear and present danger to our people and millions of others in Puerto Rico, the CNMI, the U.S. Virgin Islands and American Samoa. This shows you that while our individual voices may be too small to hear, together, the Blue Continent can make an impact.”

Medicaid in the territories helps to finance public and private hospitals and clinics, some of which face resource challenges. The federal government made a total of $7.3 billion in additional funds available across all five territories under the ACA, but most of these funds were set to expire at the end of September 2019.

The House-passed $1.4 trillion spending deal has bipartisan backing to avert a government shutdown and is now headed to the Senate.

“This is welcoming news for many of our residents and our healthcare providers. Our Medicaid residents will continue to receive the care they need, while ensuring that our entire community of healthcare providers can provide services for them again instead of just through CHCC due to our Medicaid shortfall,” CNMI Gov. Ralph Torres said.

“This was important work that we have prioritized for a long time, and I thank our partners in the U.S. Congress, my fellow territorial governors, our CHCC CEO Esther Muna and her staff, and Ms. Helen Sablan and our CNMI Medicaid Office staff for their partnership. I look forward to working with CHCC and our private healthcare providers on expanding Medicaid services once again with the new funding,” Torres said.

Source KFF

“It’s encouraging to see our voices being heard. I hope we can keep this momentum going to find a permanent solution to this perennial problem. The healthcare of our people and those living in the territories deserve the same treatment no matter what part of the U.S. we live in,” Leon Guerrero said.

Unlike state Medicaid programs, financing for territorial Medicaid programs is capped, meaning territories can only access federal funds up to an annual ceiling. Additionally, although the federal matching rate for states is based on per capita income and ranges from 50 to 76 percent, the rate for the territories is set by statute at 55 percent. Historically, the amount of allotment funding has been insufficient to fund Medicaid in the territories.

Congressman Gregorio Kilili Camacho Sablan said the increased funding averts a funding “cliff” caused by the end of special Obamacare grants to the insular areas this year. The CNMI Medicaid for fiscal 2020 was previously set at just $6.93 million for the year.


The increased Medicaid money does not come without strings. All the insular areas will have to report annually to Congress on how they have spent their new funds and what new benefits have been added for those Medicaid insures. Each of the Pacific insular governments will also have to demonstrate progress toward creating a Medicaid Fraud Control Unit and implementing the statistical information systems that states, Puerto Rico, and the Virgin Islands already use.

Congresswoman Aumua Amata of American Samoa said the Medicaid deal, which is expected to become law later this week, “is a steep improvement over the previous federal cost share of 55 percent, which the territories argued was not equitable with the states.”

“Those key numbers are expected to stay the same as the Senate breakthrough agreement announced last weekend, except for the duration, which became two years under the compromise reached by House and Senate leaders to fund the federal government,” Amata said.

“This action delivers major increases to American Samoa. We now have important equity with the states in the FMAP formula at the maximum 83 percent, which establishes a precedent to preserve higher rates in the future” she added.

Amata said the new Medicaid provision is the result of “years of long work and cooperation by all the territorial representatives and all of the territorial governors.”

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