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HHS Pushes Congress to Rescue Puerto Rico's Medicaid Program

By Melanie Zanona, CQ Roll Call

February 18, 2016 -- The administration is pressing Congress to strengthen Puerto Rico's ailing health care system as lawmakers weigh a slate of proposals to help the financially troubled territory.

The Health and Human Services Department (HHS) is seeking to gradually expand eligibility for Medicaid, the federal health insurance program for the poor, to 100 percent of the federal poverty line in Puerto Rico, as well as lift an annual cap on federal Medicaid contributions. The cap was $329 million in 2015.

HHS officials said on a press call Thursday that the current limit leaves the territory unable to effectively respond to public health emergencies, such as the Zika virus that is being spread by mosquitoes in Latin America and poses a threat to pregnant women and babies.

The White House is pressuring lawmakers to raise the federal matching rate in Medicaid from 55 percent to 60 percent, and eventually raise the federal share of Medicaid funds to 83 percent. The rates for U.S. territories are statutorily set at 55 percent, while the rates for states in the U.S. range from 50 to 75 percent.

HHS Secretary Sylvia Mathews Burwell and Treasury Secretary Jack Lew met with Puerto Rican labor leaders, religious officials, and business executives this week. HHS officials emphasized that a permanent solution to make the territory financially stable must include health care changes. There are 1.6 million Medicaid enrollees in Puerto Rico, but 600,000 people are at risk of losing their health care coverage because of expiring Medicaid funding and 3.5 million people on the island don't have access to routine treatments, according to officials.

The administration already moved to lower prescription drug costs earlier this year by providing Puerto Rico access to the Medicaid drug rebate program, but it is seeking additional legislative action from Congress, which did not provide financial aid to Puerto Rico in the fiscal 2016 omnibus spending law (PL 114-113). Lawmakers are still weighing how to address the commonwealth's debt crisis, including a plan (HR 4199) that would allow Puerto Rico to use the bankruptcy process in exchange for the creation of an oversight council.

Separately, President Barack Obama is requesting $250 million in an emergency supplemental funding package to help pregnant women in Puerto Rico combat Zika, which has been linked to birth defects. HHS officials say the women and children on the island are being primarily served by Medicaid.

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