The federal government just gave the territory $19.94 million in Medicaid "retro claim funds," and Gov. John deJongh Jr. has proposed legislation directing the funds towards pressing health care needs, administration officials told reporters at a press conference Monday.
The Centers for Medicare and Medicaid Services "had asked for the local Medical Assistance Program to go through a comprehensive audit because of some concerns about cleaning up the records of all the requests and drawing down of federal funds," Human Services Commissioner Chris Finch said Monday. "Upon completion, it was determined that the Virgin Islands had this additional almost $20 million that was available to us.”
“This is money we had over the years provided in health care costs, but had not drawn down federal health care money against those charges," he said. The process is complex, with multiple stages, he said. Sometimes local matching levels were reduced after the process began, but the territory was not credited, other times a drawdown of federal funds did not occur, he said.
The audit covered the second half of 2009 through 2012, Finch said.
On Friday deJongh proposed legislation seeking to put the one-time windfall primarily toward public health care, by bolstering the territory’s struggling hospitals and funding mental health care and other initiatives. Asked if the funding could be used for any purposes, Finch said it was the territory’s money, but since it came from health care services and the territory’s health care needs were pressing, it makes sense to devote these funds to health care.
Finch said some of the funds, such as funds to the two hospitals, might also be creditable as local matching funds for expanded Medicaid funding in the federal Affordable Care Act. "So this is going to help us with all of our health care issues, in particular the money we are asking to be designated for mental health," he said.
"The territory is under a consent decree regarding mental health care and we have not heretofore had any money in Fiscal Year 2015 to do this. So we hope the Legislature will agree and allow the money to be used for mental health purposes," Finch continued.
DeJongh’s bill proposes spending the $19.9 million in the following ways:
– $5 million to Gov. Juan F. Luis Hospital, with $2 million for general purposes, $1 million to rebuild and restore the acute care inpatient psychiatric unit, and $1.5 million to pay the V.I. Water and Power Authority;
– $5 million to Schneider Regional Medical Center, with $3.1 million for general purposes, $400,000 to develop a pilot day program for adults with mental illness, and $1.5 million to WAPA;
– $1.5 million to the Department of Health for mental health programs and implementation of care coordination services for the enhanced Medicaid Program;
– $250,000 each to the Frederiksted Health Center and St. Thomas East End Medical Center for care coordination services for the enhanced Medicaid Program;
– $7.9 million to the Department of Human Services, with $3.1 million for four new buildings at the Youth Rehabilitation Center on St. Croix, $2 million for a pilot home-based program for frail seniors, $250,000 to finish the Claude O. Markoe Head Start site and renovate or replace playgrounds at other Head Start sites, and $2.6 million for local matching funds for various Medical Assistance Program initiatives.
In his letter supporting the legislation, deJongh said his proposal centers on the "need in our community to address the interlocking relationships of critical health care coverage, mental health needs, our seniors, early childhood efforts and our juvenile rehabilitation requirements." DeJongh also emphasized the claim funds are a "one-time occurrence based on an audit," and argued that as a result, the money should not be incorporated into the base funding of the government entities singled out for appropriations or become part of the annual budget.
"The proposed use of $12 million of the total follows my administration’s deep-seeded priorities that health care coverage be accessible to those with the most needs, while at the same time reducing uncompensated health care costs and allocating our limited resources in the best possible way," deJongh said. "Funding for the two hospitals includes $1.5 million each to be paid directly to … WAPA for outstanding electricity bills. The remainder of the funds will go to the Department of Human Services to address the need for elder care, complete some Head Start projects, and construct new buildings at the Youth Rehabilitation Center on St. Croix," deJongh said.
