Provides statistics and figures related to the impact on federal and state spending unless Congress acts to prevent the Puerto Rico Medicaid Funding Cliff. Provides information on specific actions that can be taken by Congress to avert the crisis.

1. The Other Health Crisis:
How the Puerto Rico Medicaid Cliff Affects Your State
July 2017

2. Impactivo is a social impact consulting firm that works with leaders to make health and wellbeing accessible to
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3. 10 Facts About the PR Health Crisis that Impact your State
1. Puerto Ricans are US Citizens since 1917.
2. 8.8 million Puerto Ricans live in USA. 5.4 million live in the 50 States and 3.4 million live in
Puerto Rico (PR).
3. PR’s Medicaid program is subject to an annual funding ceiling specified in statute, but CHIP
allotment is determined using the same methodology used for States. The Medicaid ceiling
and CHIP cover approximately 19% of Government Health Insurance Plan expenses instead
of its 55% FMAP. Approximately 1.54 million people are enrolled in the PR Government
Health Insurance Plan.
4. Puerto Ricans pay the same level of Medicare taxes, but the Island receives 38% less in
Medicare funding.
5. 1.89 million Puerto Ricans are enrolled in another State’s Medicaid Program adding an
estimated $9.7 billion in annual Medicaid expenses to Federal and State Governments. This
far surpasses the total expenses necessary to provide Medicaid parity to the Island.

4. 10 Facts About the PR Health Crisis that Impact your State
6. PR currently receives $1.5 billion in federal funding to cover the difference between the
funding ceiling and its statutory 55% FMAP. This funding is slated to run out by December
2017 if no action is taken by Congress.
7. This loss in Medicaid Funding puts at risk the coverage for at least 817,742 Medicaid and
296,527 beneficiaries who are all eligible for coverage in many of the 50 States.
8. Enrolling these beneficiaries in Medicaid and/or Medicare programs in the States would cost
Federal and State governments $4.2 billion in Medicaid and $1.7 billion in Medicare.
9. The States receiving the most Puerto Ricans include: Florida, New York and Pennsylvania.
10.If Puerto Rico had Medicaid Parity it would receive 83% FMAP which would have covered the
PR Government’s ENTIRE primary fiscal balance.

5. Puerto Rico Government Health Insurance Plan Spending
YEAR
MEDICAID CHIP
Federal
Ceiling
Under
§1108
Federal
Spending
Puerto
Rico
Spending
Total
Spending
Federal
Allotment
Under
§2104
Federal
Spending
Puerto
Rico
Spending
Total
Spending
FY 2015 $329.0 $1,521.5 $840.5 $2,362.0 $183.2 $128.9 $55.1 $184.1
Source: CMS 2016c; MACPAC 2016; MACPAC 2015b.

6. Puerto Rico Health Insurance Enrollment Estimates
Puerto Rico Population
3,474,182
Insured
3,251,088
Veterans
Administration
93,240
Commercial
Plans
1,332,439
(only
Commercial
731,945)
Medicare
782,685
Medicare Fee For Service
213,000
Part A
Part A & B
64,185
Medicare Advantage
575,046
MA
Commercial
Plans
278,519
Medicare
Advantage
Duals/SNP
296,527
Government Health Insurance Plan/Medicaid
1,545,641
CHIP
87,203
Medicaid Eligible
Mandatory
Categorically
Needy
Optional
Categorically
Needy or
Medically
Needy
659,280
State
Funded
158,462
Uninsured
196,706
Legend
Population at High Risk of
Loosing Coverage
Uninsured/Underinsured
Sources: ACS 2015 (1 YR Estimates), VA 2014, PR Medicaid Database July 2017, Interviews with Medicaid Staff, 2017 CMS 2013 & 2015.

7. Estimated Cost to Federal and State Governments for
Stateside Coverage of PR Populations at Risk
Population at Risk of
Loosing Coverage
Additional Cost to Federal and
State Governments
Per Beneficiary Total
Medicare Eligible 296,527 $5,790 $1,716,891,330
Medicaid Eligible 817,742 $5,157 $4,217,095,494
TOTAL 1,114,269 $10,947 $5,933,986,824
Health Spending in Puerto Rico as Compared to the US for 2015
PR US
Yearly Savings to the Federal and State
Government per Beneficiary living in Puerto Rico
Medicaid $1,571 $5,790 $5,790*
Medicare $5,208 $10,365 $5,157
* Puerto Rico cannot enroll more patients in Medicaid due to the cap.

8. 10 Ways Congress can Help
1. Include PR in Health Care Reform bill with a Medicaid formula on par with that provided to the States.
2. Change the formula for the federal ceiling under section 1108 to be more closely tied to the size and
needs of the low-income population.
3. Reduce/eliminate Medicaid program requirements that increase costs.
4. Eliminate Affordable Care Act requirement for Medicare Advantage to be 115% of Medicare FFS.
5. Adjust the GPCI to 1.25, on par with treatment to other Territories.
6. Automatically enroll PR Medicare beneficiaries in Part B coverage.
7. Adjust Disproportionate Share Hospital (DSH) Formula to appropriately reflect the inapplicability of SSI.
8. Extend Part D Low Income Subsidy (LIS) for the Territories and eliminate enhanced allotment program
(EAP).
9. Eliminate HIT Tax for Territories since they do not manage Health Insurance Exchanges.
10. Provide the Centers for Medicare and Medicaid Services (CMS) with flexibility to make reasoned and
justifiable adjustments for any formula that is dependent in whole or in part on data that are not
available or not reliable or dependent on factors inapplicable to the Territories.

9. Thanks
• PMB 140
1357 Ashford Avenue
San Juan, PR 00907
• (787) 993-1508 (t)
• Email: maria.levis@impactivo.com
• Web: www.impactivo.com
• https://www.facebook.com/Impactivo/
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10. Additional Support Slides

11. Florida:
Source:JELConsulting.

13. Funding Ceiling
Puerto Rico’s Medicaid program is subject to an annual funding ceiling specified
in statute, which grows with the medical component of the Consumer Price
Index for Urban Consumers (CPI-U) (§1108(g)). Puerto Rico’s CHIP allotment is
determined by the Centers for Medicare & Medicaid Services (CMS) based on
prior year spending, the same methodology used for States.