July 30, 2021

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JCF Proposes Temporary Expansion of Medicaid Under Certain Conditions


Photo: CyberNews

SAN JUAN – The Fiscal Control Board (JCF) proposed several conditions, this Friday, to the Government of Puerto Rico to temporarily expand Medicaid coverage to more than 200,000 Puerto Ricans during the COVID-19 pandemic.

Federal funds are not guaranteed at the levels Puerto Rico receives at this time.

“Without these funds, the Government of Puerto Rico cannot afford to expand eligibility,” said Natalie Jaresko, executive director of the JCF in written communication.

“That is why the Government must be direct and clear: the extension of Medicaid eligibility ends in September 2021, unless Congress approves a fair long-term solution for Puerto Rico’s Medicaid funds,” he added.

He explained that the temporary expansion of Medicaid -the equivalent of Vital in Puerto Rico-, due to COVID-19, would end on September 30, 2021 when the increase in Medicaid funds provided by the federal government expires.

By law, the Federal Government covers only 55 percent of Puerto Rico’s Medicaid expenses with an annual maximum limit, currently set at 390 million dollars, but temporarily expanded that coverage to the current 82.2 percent. The potential loss of federal funds makes a permanent expansion of Vital, at an estimated cost of between 300 million and 600 million dollars, unaffordable for the Government of Puerto Rico in the current fiscal crisis without a permanent or long-term equitable increase in federal Medicaid funds for Puerto Rico.

“Medicaid has been a lifesaver for almost 40 percent of Puerto Ricans, and the global pandemic has shown how important reliable health insurance is, particularly for many families struggling to find affordable medical services,” said Jaresko.

“When federal funds are available, we agree that we must try to find a way to maximize their use in an efficient and fiscally responsible manner. Together with the Government, we believe that we have found a way to do it during the current health crisis, “he added.

The JCF proposed a temporary expansion through a special program linked to the declaration of National Emergency by the President of the United States and the Declaration of Public Health Emergency of the Secretary of Health and Human Services, in relation to COVID-19.

  • The Public Health Emergency allows the Government of Puerto Rico to use Section 1135 of the Social Security Law, which exempts from certain requirements for a State Plan Amendment (SPA) with the Federal Government, defining how administers Medicaid. The Government will seek approval from the Centers for Medicare and Medicaid Services to quickly approve a SPA that would temporarily increase the eligibility of Medicaid coverage in Puerto Rico.
  • The SPA linked to the Section 1135 exemption would expire at the end of the declaration of Public Health Emergency or on September 30, 2021. If the Public Health Emergency ends before September 30, 2021, the Government of Puerto Rico would present a SPA to increase the income threshold to that date.
  • The Government would amend Vital’s contracts with managed care organizations (MCOs) to reflect that SPA coverage would end on September 30, 2021.
  • The Board would require the Government of Puerto Rico to launch a campaign to inform eligible individuals and families, as well as health care providers and MCOs about the temporary program.
  • The Government must now identify the funds necessary to pay Puerto Rico’s share of the federally funded health insurance program known in Puerto Rico as Vital.

After meeting with Governor Wanda Vázquez Garced; the Secretary of Health, Lorenzo González Feliciano and the executive director of the Financial Advisory Authority and Fiscal Agency (AAFAF), Omar Marrero Díaz, the Board awaits detailed information from the Government that describes the specific way in which the proposed expansion would change with respect to entry qualifications, as well as the expected increase in temporary enrollment.



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