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U.S., V.I. MEDICAID INEQUITIES DESCRIBED

March 20, 2002 – After seven years of lobbying, Priscilla Berry-Quetel told the Senate Finance Committee on Tuesday, she feels the federal government's response has been unsympathetic to her requests to change the congressionally mandated cap on Medicaid payments to Virgin Islands residents and the split between local and federal contributions.
Berry-Quetel, executive director of the V.I. Bureau of Health Insurance and Medical Assistance, testified on behalf of Health Commissioner Mavis Matthew at the committee hearing on a bill to petition President Bush and Congress to increase the average Medicaid expenditure per eligible population in the territory from $436 to the national per capita level of $3,862.
"Eliminating the Medicaid cap and raising the percentage of distribution of Medicaid dollars will revolutionize the entire health-care system in the Virgin Islands," she said.
Medicaid is the major public financing program to provide health and long-term care coverage for the nation's low-income residents, and one in 10 Americans is covered, Berry-Quetel said. "Medicaid is a means entitlement program," she said, and assistance is available to those with income of not more than $8,500 for a family of four and combined savings, including stocks and bonds, of not more than $1,800. Those eligible, she said, include low-income children, pregnant women, the elderly, and the totally disabled.
The total cost of the V.I. Medicaid program was $14,394,410 in FY 2000, with the federal government contributing $5.59 million and the local government the remainder, she said, noting that the program serves nearly 18,000 recipients in the territory "in an absolute bare-bones program."
"In theory," she said, federal law provides for a 50/50 split in federal and state funding for the program. However, for Fiscal Year 2000, the local government financed 61 percent of the Medicaid program in the Virgin Islands and the federal government financed 39 percent. This, she explained, is because $5.59 million is the cap on federal Medicaid funding available for the territory.
Also, she noted, the federal cap is based on the per capita income of a state or territory, and "the average Medicaid expenditure is simply a statistical tool to compare levels of care throughout the country."
"While we have met with the administrator of the Centers for Medicare and Medicaid Services, regional administrators of CMS and the delegate to Congress," Berry-Quetel said, "our progress is slow in convincing the federal government that they need to change."
She said the Health Department recommends an 80/20 federal/local split in Medicaid funding. "Integral to the success of Medicaid is not only removing the cap but changing the federal financial participation percentage," she said.
In FY 2000, 24 percent of the territory's Medicare distribution was to patients from birth to age 20, 48 percent was for ages 21 to 64, and 28 percent was for ages 65 and above. Stateside, the elderly and disabled account for 60 percent of the funding distribution, she said.
The lack of specialized service providers locally means that many patients must be transported to Puerto Rico or stateside for care. But, Berry-Quetel said, the V.I. Medicaid program does not cover transfer by air ambulance or such things as in-patient care for mental illness or physical or occupational therapy.
Katherine Canton, supervisor of social services at Juan F. Luis Hospital, said patients experience hardships when they are treated at off-island facilities and require arrangements for return travel. "My focus is a little different, but it interacts with the Medicaid program," she said.
She said Medicaid does not cover the cost of return travel to the territory for patients released from an off-island treatment center who are not to be re-admitted to a V.I. hospital — even though they were sent to the off-island facility in need of catastrophic treatment not available locally.
"The Virgin Islands is now attracting more board-certified specialists, but those doctors want to be paid for their services," Berry-Quetel said "This is a changing relationship that we are going to face." For example, she said, the government is contracting for the services of a cardiologist and a gastroenterologist.
Another concern Berry-Quetel cited was the "low per diem reimbursement to the local hospitals," which is $805 for St. Thomas. She said the figure is from a system created a long time ago that has not changed to reflect increased costs of providing quality health care.
Sen. Alicia "Chucky" Hansen, Finance chair, urged her colleagues to support the petition to the federal government. "When any group of citizens go without medical attention," she said, "it is a very serious matter." Citing a recent bill to reduce rents for public housing tenants by 30 percent, she said that the elderly have to decide between paying their rent or paying for medicine.
Sen. Donald "Ducks" Cole brought up St. Thomas resident Krim Ballentine's federal lawsuit over the rights of U.S. citizens in the Virgin Islands, saying he supports it. "Exactly what is being testified here today is the result of second-class citizenship and the non-voting rights of our delegate to Congress," he said. "We are U.S. citizens and should not begging and harping for our share."
Other senators, panelist and constituents also voiced support for Ballentine's initiative. Sen. Carlton Dowe spoke of his nephew return from serving his country in Afghanistan and calling home to inquire about housing availability and employment opportunities. "Our people have served in every major war from Korea to the present conflict," Dowe said. "The V.I. lost more people per capita in the Vietnam war than any state. When it comes to war, we are on the front line, but when it comes to benefits, we are on the back line."
Ellie Hirsh of the V.I. Medicaid Task Force said her agency was formed to study the treatment of persons within the Medicaid program and to be advocates for change. The 31-member group of concerned agencies, professionals and individuals includes the Association of V.I. Psychologists, Interfaith Volunteer Caregivers, Massac Nursing Home, the Republican Party of the V.I. and the V.I. chapter of the National Association of Social Workers.
An amendment to the bill was offered to recommend that the federal financial participation be increased to 90 percent with the government of the Virgin Islands being responsible for 10 percent. "The panel recommended 80/20," Hansen said, "but I suggested 90/10. We have a unique location."
The amendment was accepted by the committee members present, who then approved the bill: Sens. Douglas Canton Jr., Cole, Dowe, Norma Pickard-Samuel and Hansen. The other two committee members, Sens. Adlah "Foncie" Donastorg and Norman Jn Baptiste, were excused.
In other action, the committee tabled indefinitely a bill submitted by Government House to amend the Fiscal Year 2002 budget to provide a lump-sum budget for the operations of the executive branch departments and agencies. The fiscal year ends Sept. 30.

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