On Thursday, Congress extended vital Medicaid funding for the U.S. Virgin Islands by one month, briefly holding off damaging cuts to critical health services to the territory’s most vulnerable, but also to hospital funds and, ultimately, tax revenues and economic activity.
At stake is health care for upwards of 15,000 Virgin Islanders – 14 percent of the pre-hurricane population, probably more today. Just the two financially struggling V.I. hospitals, Schneider Regional Medical Center and Gov. Juan F. Luis Hospital, are projected to lose about $6.2 million apiece, or more than $12 million combined, per year. The territory overall will see a cut of more than $60 million, unless there is a long-term extension.
“Congress is moving an extension of the 100 percent federal matching funds for Medicaid in the Virgin Islands through Dec. 20, 2019,” Delegate Stacey Plaskett’s spokesperson Mike McQuerry told the Source Thursday. The House of Representatives passed the bill Tuesday, after approving an amendment from the Senate.
“The Senate is currently in the process of passing the bill this morning on a bipartisan basis,” McQuerry said. The congressional bill tracking service had no updates on its progress in the Senate as of 6 p.m. Thursday. But since the last action was for the House to adopt changes from the Senate, there is no obvious reason for passage to be in doubt.
McQuerry said President Donald Trump is likely to sign it, saying CQ Roll Call, a news outlet focused on Congress, reports “the President’s chief liaison to Capitol Hill, Eric Ueland, said publicly this morning that he ‘remains on track’ to sign the bill. Thus the territory can expect an extension through Dec. 20, 2019.” (Update: the Senate passed and Trump signed the bill Thursday evening.)
While a reprieve, it is only one month. So what about the long term?
“We won’t know that until we get closer to Dec. 20, but we are hoping for a long-term fix,” McQuerry said.
So what is this money and what is going on? Medicaid is the federal insurance program for those unable to afford other insurance. States manage their programs, which are funded by federal money, supplemented with state money. The USVI program is called the Medical Assistance Program, or MAP. The federal government historically required the USVI to put up 45 cents for every 55 cents in federal Medicaid funding. States with comparable demographics put up 17 cents for every 83 cents in federal money. So to get $100 million in total, Alabama, for example, might spend $17 million of local funds, while the USVI would have to spend $45 million, or $28 million more than Alabama.
The total amount available increased in 2013 with the passage of the Affordable Care Act, but the match did not, limiting the amount of Medicaid the territory could afford to provide through its local Medical Assistance Program. Because the V.I. government’s finances were tight, especially after the 2012 closure of the Hovensa refinery, it was unable or unwilling to cut other programs to pay enough in local matching funds to get every available Medicaid dollar.
But it did get a big bump.
In 2009, before the Affordable Care Act’s Medicaid increases, the USVI had 10,000 residents receiving Medicaid according to data in the 2011 V.I. executive budget. To qualify, a family’s income had to be extremely low. Total funding was just under $15 million in 2009.
In 2015, after the ACA and Medicaid expansion took effect, the USVI had 18,000 people in the program, according to Medicaid’s website.
In early 2018, responding to the 2017 hurricanes, Congress approved $106.9 million in Medicaid funding for the territory and temporarily waived the matching requirement. If it meets certain milestones, the territory could get an additional $35.6 million.
As a result, in June of this year 29,013 Virgin Islanders were getting Medicaid, Human Services Commissioner Kimberley Causey-Gomez told senators in budget testimony.
The 2019 budget had $86 million for the Health and Human Services from the 2018 congressional approval and well over $100 million in total Medicaid funding.
If Congress does not enact legislation to increase the amount of Medicaid funding and increase the FMAP, the USVI will return to a 45 percent local match and local Medicaid funding will be capped at $18.7 million, according to Causey-Gomez’s budget testimony.
“Over 15,000 individuals would lose their Medicaid benefits,” she said.
The FY 2020 Human Services Department budget still projects more than $65 million in Medicaid funding, with $49.6 million for regular Medical Assistance Program, another $9.4 million for children’s health insurance and several million for other costs.
But that is half as much as the territory would get if the 2018 waiver is extended.
Plaskett and Gov. Albert Bryan Jr. are pushing for a bill that would extend the 100 percent federal share for the next year, then gradually go down to the level a state with similar economics would receive.
That bill, the Territories Health Care Improvement Act, proposes to grant a 100 percent federal medical assistance percentage to the U.S. Virgin Islands for fiscal year 2020. The bill, proposed by Florida Rep. Darren Soto, Plaskett and 10 other members, also proposes an 83 percent FMAP for fiscal years 2021 through 2024 and 76 percent for 2025. Puerto Rico, Guam, American Samoa and the Commonwealth of the Northern Mariana Islands would also benefit from the bill.
This would allow the USVI to get around $126 million per year through FY 2025, according to Causey-Gomez.
The congressional bill tracking service govtrack.us cites a Skopos Labs estimate that the bill has a 3 percent chance of being enacted in the current Congress. Skopos predicts the likelihood of passage with a computer algorithm that takes into account factors that have been statistically associated with the likelihood of passage, such as what state its from, what party and what the general subject is. In this case, the fact that a democrat proposed the bill but the Republican Party controls the Senate and the presidency are among the factors Skopos Labs cites.
Skopos Labs may be wrong, since “correlation is not causation,” as it says on its explanation. And if Congress or the presidency changes hands next year, that could impact its future chances.