Dear Speaker Pelosi, Majority Leader Hoyer, Majority Whip Clyburn, and Chairman Pallone:
Almost two years after the devastation of Hurricanes Irma and Maria, Puerto Rico now faces a powerful category 5 man-made storm: the Puerto Rico Medicaid Cliff (“Medicaid Cliff”). Experts agree that unless Congress acts, none of the territories will have enough federal funds to support their Medicaid programs in
2020. In the case of Puerto Rico, funds are expected to run out by December of this year.
In the past, Congress acted to avert a crisis in Puerto Rico’s Medicaid Program with a temporary increase in the federal cap to $4.8 billion with 100% FMAP through FY19 to keep Puerto Rico’s Medicaid program operational. However, these additional sources of federal funding for Puerto Rico’s Medicaid program will
expire by September 30, 2019.
For Puerto Rico, the Medicaid cap set by statute for FY20 will be approximately $375 million, with no additional source of federal funding available. To put this into perspective, this means a federal spending level of $285 per enrollee in Puerto Rico, as compared to $7,672 per enrollee in Mississippi (the State withthe highest percentage of its population living under the poverty level); $7,942 per enrollee in South Dakota (the State with the most similar FMAP); and $7,654 per enrollee at the national level.
We understand the U.S. House of Representatives is considering taking up legislation by way of a continuing resolution (“CR”) to keep the federal government open through November 21, 2019. As Chairman Pallone stated earlier this summer: “While Congress has provided some time-limited increases to the territories’ Medicaid funding, we need a longer-term solution. Doling out federal funds in dribs and drabs has led to uncertainty about the financial future of the programs and calls into question the long-termsustainability of the territories’ Medicaid programs if Congress fails to act.”
As you prepare to move forward with our Democratic agenda for the remainder of the year, we urge you to take all necessary measures to assure that the people of Puerto Rico and other territories are protected throughout this legislative process. We fear that if the Medicaid Cliff is not addressed at this juncture, it could fall victim to a complicated and extensive congressional agenda at the end of the year. Accordingly, as fellow Democrats, we respectfully ask that you protect the lives of hundreds of thousands of people in the territories who will lose their health care coverage if no immediate action is taken.
Congress must not delay action on this delicate matter. The risk is simply too high to ignore. We thank you again for all of your work and efforts to improve the lives of the American people and we reiterate our commitment to support you every step of the way.