Puerto Rican Health Secretary Carlos Mellado has sounded the alarm bells in Congress about a looming Medicaid funding crisis that threatens hundreds of thousands of Puerto Ricans on the island who could lose access to health care soon. September.

Mellado visited Washington this week to meet legislators and federal health officials to advocate for more funding.

“If they don’t approve the budget, we fall into the cap and that means we’ll only have $ 300 million to fund our Medicaid spending. It’s impossible to do with that amount,” Mellado said in an interview with NBC News.

As a US territory, Puerto Rico has uneven access to Medicaid funding. Although the poverty rate in Puerto Rico is more than twice as high as in Mississippi, the poorest state in the country, the federal government covers 55 cents of every dollar Puerto Rico spends on Medicaid, compared to 76 cents in the country. Mississippi.

This is because unlike the 50 states – where Medicaid funding is unlimited – Puerto Rico gets a limited spending cap, essentially a block grant, and the island must bear the rest of the costs. In fiscal 2020, the island’s Medicaid funding was capped at $ 375 million, while Medicaid spending is expected to reach $ 2.8 billion, according to the Center on Budget and Policy Priorities, a progressive think tank. This gap between funding and spending has been a constant problem for the island government, across different administrations.

While Congress has in the past created certain mechanisms to allow the island to access temporary funds to cover deficits, Mellado said the recurring uncertainty in the accessibility of funding has contributed to the deterioration of the system. health of the island over time.

Puerto Rico relied on a smaller number of doctors during the pandemic, according to a report from the Urban Institute, a political think tank in Washington, after a decade of exodus of doctors to the continent. According to the Federal Administration of Resources and Health Services, 72 of the island’s 78 municipalities are considered medically underserved and face “unmet health care needs”.

“We have a lot of disparities in services, and it’s difficult because in Puerto Rico there are problems getting durable medical equipment and long-term care for patients,” Mellado said. “They don’t have access to it under existing Medicaid coverage.”

He also spoke about the cases of four children in Puerto Rico who need a bone marrow transplant. Under existing Medicaid coverage, these children cannot get treatment on the island, Mellado said. Instead, Puerto Rico must seek money from the federal government’s “catastrophic $ 12 million fund” to have these families travel to the United States to get transplants.

“How can a child not have access to them? It’s difficult. We still don’t have access to these services,” Mellado said.

Uncertainty of funding leads to instability, fewer doctors

Mellado said that having a rigid system of funding Medicaid services in Puerto Rico makes it difficult to negotiate contracts with providers because it is difficult to predict how much money they will get. This, along with Puerto Rico’s low Medicaid rates, has contributed to the exodus of doctors from the island, affecting the services and treatments patients can get.

“This creates great health and economic instability. We have already seen many health professionals, doctors, nurses, pharmacists, who come to the United States because they get better prices and better working conditions and security, ”Mellado said.

According to Mellado, 46% of the population of Puerto Rico uses Medicaid. About 1.4 million U.S. citizens on the island live below the poverty line, many of them children, pregnant women, the elderly, and people with disabilities.

During the pandemic, Puerto Rico received a temporary increase in federal funding, which helped fund programs to make Medicaid prices more competitive to get more doctors to accept these patients. It has also helped the island fight hepatitis C and expanded the Medicaid eligibility pool to ensure more islanders have access to a health care plan.

Mellado is concerned that Congress will not approve enough money to keep these new programs afloat.

“Imagine if they give us less funding than they already gave us. That means I have to withdraw or delay these programs that we have worked so hard to put in place,” Mellado said. “It would be devastating for Puerto Rico.”

Mellado says that’s a reason to advocate that Puerto Rico have equal access to Medicaid funding. The island’s health secretary is to reduce and adjust services and programs every two years based on funding Congress allocates to the island’s Medicaid system.

“It would be ideal if Puerto Rico could have Medicaid funding parity,” Mellado said. “It would be the most permanent solution to this problem.”

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