Kilili: $360 million proposed for Marianas Medicaid

Jul 11, 2019

WASHINGTON, DC – Congressman Gregorio Kilili Camacho Sablan signed off yesterday on new legislation to fund the Marianas Medicaid program with $360 million over the next six years. Currently, the Marianas only receives $7 million per year. In addition, the new legislation, H.R. 3631, does away with the need for any local match of federal dollars for its first two years. The local match will then be 17 percent for three years and 24 percent in the final year, the best matching rate available to any U.S. state. Chairman Frank Pallone (D-New Jersey) has said he wants his Energy and Commerce Committee to report the bill by the end of July to the House for passage.

      “This is more good news for the Marianas Medicaid program and the 15,136 people who depend on Medicaid for their health insurance,” said Congressman Sablan. “I have held off introducing my own legislation or cosponsoring others’ in this Congress, while we negotiated with Republicans and Democrats on a solution to the Medicaid cliff.

      “The bill we have now introduced takes a different approach from past legislation. That, together with its bipartisan support, gives the bill a much better chance of being enacted into law.”

Bill exceeds Marianas Medicaid request 

      The Territories Health Care Improvement Act lifts annual federal Medicaid funding for all the insular areas, but the Marianas will receive the largest percentage increase. The CNMI Medicaid office had asked for $59.43 million per year. Congressman Sablan got the Marianas an even $60 million in the introduced bill.

      He was also able to negotiate six years of funding for the Marianas and the other three insular areas with small populations. The most populated territory, Puerto Rico, will only get four years of guaranteed funding.

      Chairman Pallone recognized Sablan’s leadership on the Medicaid issue. “I commend Congressman Sablan for his tireless advocacy and dedication to ensuring that Congress fix the federal funding shortfall for Medicaid in the Northern Mariana Islands as well as the other U.S. territories.

      “Congressman Sablan has worked closely with bipartisan members of the Energy and Commerce Committee to draft the Territories Health Care Improvement Act that will avert the looming funding cliff, ensure residents have access to health care, and provide the certainty and sustainability that the territories deserve.

      “I thank him for all his hard work and look forward to advancing the bill out of the Energy and Commerce Committee to avoid the Medicaid funding cliff and, more importantly, to significantly improve health care for people in the insular areas.”

      Extra Medicaid money that Congressman Sablan worked to get into the Affordable Care Act—or Obamacare—in 2010 is no longer available after 2019, creating a funding “cliff.” The Marianas ran out of its Obamacare money, $109 million, in March this year. But Sablan worked with the Centers for Medicaid and Medicare Services to free up $8.2 million in unused Medicaid funding for the Marianas in April. He also added $36 million for Marianas Medicaid to the Additional Supplemental Appropriations for Disaster Relief Act, Public Law 116-20, enacted in June. That federal money is already being paid out to the Commonwealth Healthcare Corporation and other health care providers for current services and past bills.

Using seniority to stay focused on a Medicaid solution

      Congressman Sablan used his position as Vice Chair of the Natural Resources Committee responsible for insular issues to hold a hearing on Medicaid in May. He invited Medicaid Directors from all five island jurisdictions to testify, along with Commonwealth Healthcare Corporation CEO Esther Muna. “Being able to focus attention on a specific issue, such as Medicaid, now that I have the gavel and Democrats are in the majority makes a big difference for the Marianas,” the Congressman said.

      Marianas Medicaid Director Helen Sablan testified at the May hearing that “the CNMI is at a disadvantage in their Medicaid financings in two ways; 1) a low FMAP requires a territory to contribute more local funds than a state is required to provide in order to run a Medicaid program; and 2) a cap on federal Medicaid contributions stifles the overall ability of CNMI Medicaid to function.”

      The Territories Health Care Improvement Act addresses both those concerns. The Federal Medical Assistance Percentages, the federal-local matching rates raised by Obamacare from 50-50 to 55-45, will become 100 percent federal and zero percent local in 2020 and 2021. Then, the FMAP goes to 83-17 in 2022, 2023, and 2024, and, finally, 76-24 in 2025. The funding cap for the Marianas, currently $6.7 million, will be lifted to $60 million in every year.

      Congressman Sablan’s hearing was quickly followed by another in June, held by California Representative Anna Eshoo who chairs the Energy and Commerce Health Subcommittee. Again, all the Medicaid Directors were called to testify. The Health Subcommittee has jurisdiction over the Territories Health Care Improvement Act and will be the first place the bill comes to a vote.

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