MMAPA officials outlined funding concerns and policy considerations for key health program serving over 90% of eligible American seniors on the island
September 6, 2022
WASHINGTON, D.C. – Last week, the Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA) relayed concerns and adjustment requests regarding current funding and resources for Medicare Advantage (MA) in Puerto Rico to the Centers for Medicare and Medicaid Services (CMS) in response to a Request for Information (RFI). The RFI is about the future of the MA Program nationwide, and CMS requested information on Puerto Rico to better ensure the MA program delivers the care needed to underserved populations on the island.
In the letter to CMS, MMAPA leadership discussed ways to advance health equity for American seniors in Puerto Rico enrolled in MA plans, while ensuring MA plans are affordable and sustainable. MMAPA leaders also highlighted that CMS’ vision for Medicare and goal of advancing health equity generally requires addressing the notable disparities facing Medicare funding in Puerto Rico.
The issue of health equity in Puerto Rico is not new. This disparity in MA funding for Puerto Rico has been widening for 13 years, causing Puerto Rico’s average benchmarks to fall 41% below the national average in 2022. Low benchmark rates have caused providers to migrate off the island and made it harder for patients to access the healthcare they need.
“MA coverage is essential for enrollees on the island, and we look forward to the next meaningful action by the Administration to tackle this health inequity for the 638,000 Medicare beneficiaries residing in Puerto Rico,” said MMAPA President and President of MCS Advantage, Roberto Pando Cintrón. “American seniors in Puerto Rico deserve access to healthcare that is equitable, affordable, and sustainable.”
To permanently eliminate disparities in the MA program, MMAPA recommends several policy fixes, including establishing a specific minimum standard Average Geographic Adjustment (AGA) to address increasing disparities in the lowest-cost areas on the island. “Puerto Rico has the lowest AGA rate in the U.S. at 0.50. Comparatively, Hawaii has the lowest MA payment rates in the country and still has a higher AGA rate at 0.82. MMAPA proposes establishing a minimum AGA rate of 0.70, which would best mitigate the current imbalance and improve health equity on the island,” stated Roberto Garcia, MMAPA Board Member and CEO of Triple-S.
MA has quickly become a critical piece of health infrastructure in Puerto Rico, supporting over 630,000 American seniors on the island. Given that Puerto Rico’s poverty levels are three times the national average and the island faces a high Medicaid benefit gap, MA has emerged as a popular and effective resource that plays a crucial role in providing many basic needs for the population.
You can read the full letter here. For more information on Medicare Advantage and health equity in Puerto Rico, please visit mmapapr.org.
The Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA) is a non-profit organization composed of the leading Medicaid and Medicare Advantage organizations in Puerto Rico. Founded in 2009, MMAPA is dedicated to promoting policy solutions to solve Puerto Rico’s health care challenges.
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