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Coalition calls on Congress to improve health equity in U.S. territories

Insular Area Medicaid Parity Act lifts Medicaid funding cap

March 18, 2021

By Jennifer Garvin

Washington — The Partnership for Medicaid, of which the ADA is a member, is asking Congress to pass legislation to address the longstanding inequities in Medicaid affecting the U.S. territories.

The partnership sent a letter to the leadership of the House Committee on Energy and Commerce’s Subcommittee on Health ahead of its March 17 hearing, Averting a Crisis: Protecting Access to Health Care in the U.S. Territories. The coalition commended lawmakers for their past work to increase Medicaid funding and support but urged the committee to consider HR 265, the Insular Area Medicaid Parity Act. If enacted, the bill would lift the Medicaid funding cap in the territories and provide a “long-term solution for Medicaid beneficiaries residing in the U.S. territories, while ensuring that territorial governments are given fiscal relief to stabilize the health and economic security of their jurisdictions.”

“The Medicaid program continues to be a vital lifeline for vulnerable individuals, families and children,” the coalition wrote. “Our members see the value that Medicaid provides to ensure the optimal health and well-being of beneficiaries enrolled in the program. Unfortunately, due to limitations in the funding statute, the Medicaid program operates differently in the U.S. territories compared to those of the states through capped funding and a fixed federal medical assistance percentage.”

This discrepancy results in fewer federal dollars supporting territorial governments which, in turn, affects the financial viability of their Medicaid programs, the coalition wrote. It added that territory Medicaid directors have linked the existence of capped Medicaid funds and the detrimental effects it has on reimbursing providers fairly with negatively affecting access to care.

“Numerous reports detail the health and economic disparities that exist for residents of the U.S. territories, whose geographic locations and isolation contribute to more disparities,” the groups said.

The coalition also pointed out that the current COVID-19 pandemic as well as natural disasters — including hurricanes and earthquakes — have also highlighted the need to improve health equity in the territories.

“We all understand the importance of Medicaid during these natural disasters, which have provided states with matching funds to help offset unanticipated costs associated with disasters and in some cases has allowed the program to provide a heightened response, for example by facilitating short-term changes to program rules affecting eligibility, benefits and provider payment,” they wrote. “In terms of economic conditions, all these jurisdictions have experienced prolonged fiscal challenges resulting in rising levels of unemployment and poverty, only made worse by the global pandemic.”

“Lastly, addressing the Medicaid funding limitation in the territories will help advance health equity and aim to correct longstanding disparities in health. The unequal treatment of Americans residing in the territories, of whom 98% are racial or ethnic minorities, is only exacerbated by the capped Medicaid funding which deprives some of the most marginalized populations of the federal support their counterparts living stateside enjoy,” the letter concluded. “We hope that the committee moves to enact policies to promote health justice and advance health equity for Americans in the territories.”

The Partnership for Medicaid is a nonpartisan, nationwide coalition made up of organizations representing clinicians, health care providers, safety net health plans and counties.

Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.