Faced with rising operating expenses, Medicare and Medicaid shortfalls, debilitating cyberattacks and costly boarders, the Schneider Regional Medical Center is poised to begin another fiscal year without the funding it needs to maintain the level of care it’s mandated to provide, according to officials.

Schneider Chief Executive Officer Tina Comissiong told lawmakers on the Senate Budget, Appropriations and Finance Committee Monday that the hospital provides $36.2 million worth of uncompensated care to un- and underinsured Virgin Islanders, and the local Medicaid match for 2026 is estimated at $3.6 million.

“So when you consider that 60 percent of the patients are covered either by Medicare or Medicaid and another 15 percent are without any form of health care insurance at all,” she said, “then 75 percent of the care SRMC provides is either undercompensated for or not compensated for at all.”

The budget ceiling recommended by the Executive Branch for 2026 is under $32 million.

“The hospital will continue to struggle and owe vendors. It is too big a burden to offset with our operations. The GVI must cover uninsured and uncompensated care,” she said, putting the real cost closer to $40 million.

During her prepared testimony, Comissiong said the hospital spends approximately $6 million every year to care for boarders — patients who no longer require hospital care but who cannot be released because they are unable to care for themselves. Emergency department beds are also frequently occupied by people with nowhere else to go.

“Despite calls to the Department of Human Services Adult Protective Services, there is frequently no timely response and no placement options for these individuals,” she said. “These individuals — who are homeless, who have nowhere else to go — then tend to remain on or around the SRMC RLSH campus after being discharged, after they have gotten all of the hospital care or emergency care they need from us.”

Comissiong said DHS has no bed placement options in the territory for people who need total care or “significant help with activities of daily living.”

“And so despite our repeated advocacy, there are still not enough DHS or Medicaid-contracted long-term care beds outside the territory either,” she said. “The hospital, again, is not the appropriate setting for these individuals, and proper placement for these individuals needs to be an immediate priority for the Department of Human Services and the GVI.”

Senate President Milton Potter noted that the central government’s recommended budget presented the hospital with an $8 million shortfall.

“What specific services will be cut or delayed if this gap isn’t filled,” he asked. “And how will patient care ultimately be affected by this?”

Comissiong said the emergency room doors will remain open, but the deficit “will slow things down.”

“It will slow the care that happens in the emergency room, we’ll have less staffing, the supplies that we need to take care of patients won’t always be on hand — to be able to run tests that we need to run in the lab, to be able to make decisions about patients,” she said. “Things on the floor, I’m sure, will slow down too, in terms of not being able to pay for the temporary traveling physicians or traveling support that you need because you can’t keep up with the staffing vendors… there will be real impacts on the care that we can deliver and the amount of services that we can provide if the funding is not adequate.”

The Water and Power Authority is projecting a $9.6 million shortfall in its current fiscal cycle, lawmakers on the Senate Budget, Appropriations and Finance Committee heard Monday, an estimated 75-percent decrease over last year’s. The utility’s chief executive, Karl Knight, said there are a number of things lawmakers could do to take WAPA out of the red.

“In prior years, the appearance of the authority at budget hearings in the Senate was just a formality,” he said, because WAPA does not receive an appropriation from the government’s General Fund. “However, given the precarious fiscal state of the authority, we will surely take full advantage of the opportunity to discuss potential legislative action to support the authority’s fiscal stability.”

Those included: paying for streetlighting services, for which the central government underpaid in 2025 by $4.7 million; adjusting a legislative mandate to read meters every thirty days, which Knight said occasionally forced the utility to check meters twice in one month; modifying a restriction on back-billing; implementing a flat water charge, regardless of usage; placing a liability cap on the authority except in cases of gross negligence; upping fees for electric disconnections when they’re done at the pole; and raising an antiquated $10,000 cap that currently requires competitive bidding on purchases or contracts.

Knight also asked lawmakers to subsidize a recent mandate to increase minimum annual salaries to $35,000, a move by the Government Employees Retirement System to increase employer contributions by three percent, and $2.8 million the authority owes to the Public Services Commission for assessments.

The authority’s fiscal year runs from July 1 to June 30, unlike other government agencies which start the fiscal year on Oct. 1. On Monday, Knight told lawmakers that the utility’s expected $325.2 million in revenues this year will not keep pace with an estimated $334.8 million in expenses, which include nearly $31 million for debt service and a half-million-dollar payment in lieu of taxes, or PILOT. WAPA is expecting an additional $2.5 million from the Federal Emergency Management Agency to cover administrative costs associated with disaster recovery projects.

Knight said the authority has been operating with a structural deficit for years, primarily because of fuel rates that don’t fully recover the utility’s expenditures. The PSC permits WAPA to include a 33-cent per gallon LEAC rate, Kight said, but the authority regularly spends 59 cents per gallon in transportation costs under its current liquid petroleum gas contract.

“I want to make sure the Senate is aware of our challenges, how far behind we are — which, we are closing the gap,” he said. “We still have a little bit more to close. We’ve laid out how we think we get that gap closed over the course of the current fiscal year that we’ve already started. There are some legislative things that we feel can expedite our closing of that gap — some of those are things that you can consider as part of the upcoming markup of the executive budget. Others are just general legislative actions that we think would have… a positive financial impact on the authority. So if there’s an ask, it would be to consider those initiatives.”

During his prepared testimony, Knight stressed that the budget projections assumed no rate reductions for the next 12 months. In June, the PSC voted to lower electric rates from 22 cents per kilowatt/hour to 17 cents. The authority called the move a “deliberate, ill-considered decision” in a statement and petitioned for a stay.

“I fully understand the desire to provide rate relief to the customers of the Virgin Islands Water and Power Authority,” Knight said at the time. “We all share that same desire, and WAPA has been working aggressively to get to that point, but we must do so in a responsible manner that does not immediately jeopardize our ability to provide electric and potable water services in the Virgin Islands.”

The PSC is scheduled to hear WAPA’s petition Tuesday. If commissioners reaffirm their June decision, WAPA will have 60 days to appeal the decision in V.I. Superior Court.