21 professional and health organizations urge HHS to implement 3 specific and immediate initiatives to close the gap in federal funding for MA in Puerto Rico.

San Juan, November 14, 2023 – A group of 20 health-related entities and associations joined the Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) in urging the U.S. Department of Health and Human Services (HHS) to take immediate public policy actions to mitigate the inequity in the budget allocated to the Medicare Advantage program, which covers the island’s population of older adults. The letter, endorsed by the 21 organizations, outlines three specific actions that can be taken before the end of the year.

MMAPA President Roberto Pando-Cintron said, “if we want to close the Medicare inequity gap, the critical time is now, before the Centers for Medicare & Medicaid Services (CMS) proposed Medicare Advantage payment rules for 2025 are finalized."

The first measure advocated by the organizations is to bring the premium payments in line with those paid to the U.S. Virgin Islands, which are currently 21% higher than those paid to neighboring Puerto Rico. The president of MMAPA explained that the current monthly per capita premium payment is currently approximately $672, compared to $847 received by the Virgin Islands’ MA program. Even with this increase, Puerto Rico would still receive payments well below what U.S. residents receive, which averages about $1,102 per person per month.

"We are talking about 650,000 people in Puerto Rico who choose Medicare Advantage, of which 300,000 are dually eligible to Medicaid.  This dual population is our most vulnerable. Closing the economic gap in MA is key to improving their quality of life and can be administratively implemented immediately.” 

The other two proposals focus on Congressional action. One aims to add the Part B premium payment to the Medicaid benefit for dual-eligible beneficiaries (Medicare Savings Program), which amounts to a relief of $164.90 per month. “Currently, the money to pay this premium is deducted monthly from the Social Security checks of the most vulnerable people on the island. We're talking about $1,968 dollars a year that low-income seniors could use to meet so many other needs. The MSP is a program that applies to all other U.S. territories, but not to Puerto Rico," Pando-Cintron explained.

The last proposal would extend the Part D Low Income Subsidy to Medicaid and Medicare beneficiaries with incomes up to 150% of the poverty level in Puerto Rico, which currently excludes approximately 400,000 people who struggle to afford the cost of medications to meet their health needs each month. Both measures were included in a bill submitted by the Resident Commissioner to the bipartisan group of U.S. Senators Bill Cassidy (R), Tim Scott (R), John Cornyn (R), Tom Carper (D), Mark Warner (D) and Robert Menendez (D) earlier this year.

Puerto Rico Medical Association President, Yussef Galib, one of the signatories, said, “Medicare Advantage has become the foundation of our health care system.  If we want to retain our doctors, have more professional support staff, and improve the infrastructure, there's no real way to do it without correcting the huge gap in MA payments.”

Past President of the IPA Association, Dr. Joaquin Vargas added that "the federal government must address this issue in an efficient and permanent manner, regarding the allocation of funds that, by right as U.S. citizens, should apply to all Puerto Ricans living on the island. In Puerto Rico, we have had to learn how to maximize our limited resources, and we have shown that we know how to do things well at the highest levels in the United States, with quality outcomes. But the gap in MA payments is too wide and perpetuates unfair restrictions on Medicare beneficiaries simply because they live in Puerto Rico.”  

By law, since the 1960s, Medicare was implemented with lower rates and unique exclusions in the coverage to U.S. citizens residing in Puerto Rico. This fact, along with anomalies in health data, gives the U.S. Department of Health and Human Services the authority to correct, through an administrative decision, the obvious inequities that continue to be perpetuated.  The critical moment is now, as the 21 organizations call on the Administration to take concrete steps in accordance with this proposal.

"With 94% penetration on the island, the Medicare Advantage program serves more than 650,000 beneficiaries in Puerto Rico, and its financial stability is critical to the entire Puerto Rico health system. For years, we have managed to do more with less, but the financial gap is too large, and the structure of the program exacerbates the problem every year.  For example, health plans pay the same price for drugs as they do in the United States, but they have to do it with 40% less of the budget. We urge the federal government to quickly address these inequities and give Medicare Advantage beneficiaries on the island a fair shot at securing the future of the program and its benefits," Pando-Cintron said.

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About MMAPA

The Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) is a non-profit organization that brings together the major Medicaid and Medicare Advantage entities in Puerto Rico. Founded in 2009, MMAPA is dedicated to advancing public policy solutions to address Puerto Rico's healthcare challenges.