Puerto Rican activists.
Puerto Ricans protest. Photo: Tom Williams/CQ Roll Call

Medicaid benefits for Puerto Rico included in Congress spending bill

Senate members are urging their colleagues to see this bill through to avoid a possible system collapse on the island.


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The United States Senate reached a deal on Tuesday, Dec. 20, to increase Medicaid funding in Puerto Rico to keep federal dollars steady over the next five years as part of the congressional omnibus bill, set for a vote this week. 

If the bill endures another round of voting, Puerto Rico will receive increasing allotments year-over-year to account for inflation costs, NBC News reported. 

The allotment begins this fiscal year with $3.28 billion, $3.33 billion for fiscal year 2024, $3.48 billion for fiscal year 2025, $3.65 billion for fiscal year 2026, and $3.83 billion for fiscal year 2027.

These funds match federal dollars allocated to the island at the outset of the pandemic, approximately $3 billion annually for Medicaid, based on funding provisions stemming from the Social Security Act. 

The provision estimates topple the $400 million Puerto Rico was originally scheduled to obtain based on needs estimated by pre-pandemic levels. 

If the funding provisions are reversed, and the bill fails to pass, Medicaid funding on the island will plunge to $400 million. 

Throughout negotiations, lawmakers have impressed on their colleagues the need to keep Medicaid well-funded in Puerto Rico to avoid falling short of what is required on the island, especially in a post-pandemic economy.

In the U.S., Medicaid funding is flexible and can be adjusted according to specific needs over time, whereas Puerto Rico — along with the rest of the U.S. territories — receives a fixed amount in addition to a spending cap. 

New Jersey Sen. Bob Menéndez, one of the bill’s lead negotiators, said the funds "will provide Puerto Rico with federal dollars that will enable the island to make critical investments that will help stabilize their health care system, retain health care providers, and improve access and quality of care for all of its residents," according to NBC News. 

Currently, the federal government covers 55 cents of every dollar spent on Medicaid on the island, despite poverty rates that surpass those of Mississippi, the poorest state in the nation, which received 76 cents of every dollar. 

“A key part of the problem is that Puerto Rico’s Medicaid program differs significantly from state Medicaid programs in ways that make it much harder for Puerto Rico to ensure that its residents, who are U.S. citizens, can get the health care they need,” a report by the Center on Budget and Policy Priorities reads. 

Puerto Rico also grapples with a monumental $70 billion debt that has forced the Fiscal Oversight and Management Board — which is Congress-imposed — to slash Medicaid on the island dramatically to make up for other costs. 

As such, economists have suggested that adequate funding means 83 cents of every dollar spent. 

Failing in Congress would entail a massive loss of benefits for millions of low-income Puerto Ricans or losing health care coverage altogether. 

It would also mean that Puerto Rico would need to make up for the deficit at the heels of a deepening deficit that is already eating its way into a multitude of public services on the island.


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