Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff

Issue Brief
  1. Puerto Rico data are available for 2019. U.S. Virgin Islands data are available for 2016.

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  2. National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), How CDC Prevents Chronic Diseases and Promotes Health for US Territories and Affiliated Pacific Islands (Atlanta, GA: Centers for Disease Control, April 2019), https://www.cdc.gov/chronicdisease/resources/publications/factsheets/island-health.htm

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  3. Ibid.

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  4. U.S. Army Corps of Engineers, Facilities Condition Assessment Guam Memorial Hospital (Washington, D.C.: U.S. Army Corps of Engineers, April 2020), https://www.doi.gov/sites/doi.gov/files/uploads/oia-guam-memorial-hospital-facility-assessment.pdf

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  5. U.S. Department of the Interior, Office of the Inspector General, Insular Area Health Care: “At the Crossroads of a Total Breakdown” (Washington D.C.: U.S. Department of the Interior, Office of the Inspector General, September 2008), https://www.doioig.gov/sites/doioig.gov/files/2008-G-0040.pdf

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  6. U.S. Department of the Interior, Office of the Inspector General, Insular Area Health Care: “At the Crossroads of a Total Breakdown” (Washington D.C.: U.S. Department of the Interior, Office of the Inspector General, September 2008), https://www.doioig.gov/sites/doioig.gov/files/2008-G-0040.pdf

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  7. Averting A Crisis: Protecting Access To Health Care In The U.S. Territories, 117th Cong. (2021) (testimony of Congressman Gregorio Kilili Camacho Sablan).

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  8. Peter Georgiev and Adiel Kaplan, “American Samoa’s coronavirus conundrum: No Way to test,” NBC News (May 2020), https://www.nbcnews.com/health/health-care/american-samoa-s-coronavirus-conundrum-no-way-test-n1167776

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  9. Ibid.

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  10. Dánica Coto, “Missteps mar Puerto Rico’s response to coronavirus,” AP News (April 2020), https://apnews.com/article/e5ba6c2639ee52dad5e367d2228ac764

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  11. Patricia Mazzei, “Puerto Rico Lags Behind Everywhere Else in U.S. in Virus Testing,” The New York Times (August 2020), https://www.nytimes.com/2020/04/21/us/puerto-rico-coronavirus.html

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  12. Haidee Eugenio Gilbert, “Lack of nurses could slow community testing as COVID cases rise again,” The Guam Daily Post (August 2020), https://www.postguam.com/news/local/lack-of-nurses-could-slow-community-testing-as-covid-cases-rise-again/article_6a7808b8-d79d-11ea-9cd1-370bce05a80d.html

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  13. Emily Palmer, “Moored in a Fragile Paradise,” The New York Times (April 2020), https://www.nytimes.com/2020/04/17/travel/coronavirus-stjohn-caribbean.html

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  14. Michael Walsh and Elsie Lange, “How the tiny Pacific island of Guam became one of America’s coronavirus hotspots,” ABC News Australia (September 2020), https://www.abc.net.au/news/2020-09-11/guam-hospitals-under-pressure-after-coronavirus-outbreak/12637704

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  15. Nicole Acevedo, “FEMA acknowledges Puerto Rico lacks rebuilt homes and a hospital to survive COVID-19,” NBC News (July 2020), https://www.nbcnews.com/news/latino/fema-acknowledges-puerto-rico-lacks-rebuilt-homes-hospital-survive-covid-n1234810

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  16. Michael Walsh and Elsie Lange, “How the tiny Pacific island of Guam became one of America’s coronavirus hotspots,” ABC News Australia (September 2020), https://www.abc.net.au/news/2020-09-11/guam-hospitals-under-pressure-after-coronavirus-outbreak/12637704

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  17. U.S. Department of the Interior, The Trump Administration is Supporting the People of the U.S. Virgin Islands (Washington, D.C.: U.S. Department of the Interior, 2020), https://www.doi.gov/sites/doi.gov/files/uploads/oia-covid19-wh-fact-sheet-usvi.pdf

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  18. U.S. Department of the Interior, Commonwealth of the Northern Mariana Islands Uses Interior CARES Act Funding to Strengthen COVID-19 Emergency Preparedness and Response Capabilities (Washington, D.C.: U.S. Department of the Interior, July 2020), https://www.doi.gov/oia/press/commonwealth-northern-mariana-islands-uses-interior-cares-act-funding-strengthen-covid-19

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  19. Data are a KFF analysis of Johns Hopkins University Centers for Civic Impact for the Coronavirus Resource Center (CRC), https://github.com/govex/COVID-19/tree/master/data_tables/vaccine_data.

    Average daily number of cases are calculated as the average cases per million as a seven-day rolling average. For this analysis, the daily change in cases per million residents is averaged for the previous seven days. All data were pulled on May 12th, 2021.

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  20. Edmy Ayala and Patricia Mazzei, “Puerto Rico Orders Coronavirus Lockdown. Violators Could Be Fined,” The New York Times (March 2020), https://www.nytimes.com/2020/03/15/us/coronavirus-puerto-rico.html

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  21. Yanira Hernández Cabiya, “Dramatic economic reopening after 88-day lockdown,” Caribbean Business (June 2020), https://caribbeanbusiness.com/52221-2/

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  22. Associated Press, “Puerto Rico will close schools amid COVID surge,” NBC News (April 2021), https://www.nbcnews.com/news/latino/puerto-rico-will-close-schools-covid-surge-rcna632

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  23. Edmy Ayala and Patricia Mazzei, “Puerto Rico Just Had Its ‘Worst Moment’ for Covid-19,” The New York Times (April 2020), https://www.nytimes.com/2021/04/23/us/coronavirus-puerto-rico.html

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  24. United States Virgin Islands, COVID-19 – Path to a New Normal (United States Virgin Islands, March 2021), https://www.vi.gov/covid/phases/

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  25. National Governors Association, Coronavirus State Actions (Washington D.C.: National Governors Association, July 2020), https://www.nga.org/coronavirus-state-actions-all/

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  26. Reopening efforts were analyzed on May 12th, 2021. At that time, USVI had not made any changes from its previous “Safer at Home” phase.

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  27. Simon Romero, “A Place in the U.S. With No Covid-19? Look at American Samoa,” The New York Times (May 2020), https://www.nytimes.com/2020/05/06/us/coronavirus-american-samoa.html

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  28. Associated Press, “American Samoa Repatriation Program Detects 5 Virus Cases,” U.S. News (January 2021), https://www.usnews.com/news/best-states/hawaii/articles/2021-01-28/american-samoa-repatriation-program-detects-5-virus-cases

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  29. Rates were compared using “Total Doses Delivered Rate per 100,000” and data were analyzed on March 26th, 2021 and May 4th, 2021. See: Center for Disease Control, COVID Data Tracker (Centers for Disease Control, March 2021), https://covid.cdc.gov/covid-data-tracker/#vaccinations

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  30. Steve Limtiaco, “CNMI outpaces United States in COVID-19 vaccine rollout,” Pacific Daily News (January 2021), https://www.guampdn.com/story/news/2021/01/06/cnmi-covid-19-vaccine-rollout-best-us-cdc/6574087002/

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  31. RNZ (Radio New Zealand), “Close to 24,00 Covid-19 vaccines rolled out in American Samoa,” RNZ (March 2021), https://www.rnz.co.nz/international/pacific-news/437798/close-to-24-000-covid-19-vaccines-rolled-out-in-american-samoa

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  32. Manatt Health, The American Rescue Plan: An Overview of Medicaid Provisions and State/Local Relief (Manatt Health, March 2020), https://www.shvs.org/wp-content/uploads/2021/03/FINAL-ARP-Medicaid-and-State_Local-Relief-Deck.pdf

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  33. Ibid.

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