Abismo en el financiamiento de Medicaid: Implicaciones para los sistemas de atención de salud de Puerto Rico y las Islas Vírgenes de los EE.UU.

Resumen ejecutivo
  1. KFF Interview with USVI Medicaid Director, Department of Human Services (Feb. 26, 2019).

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Informe
  1. The Kaiser Family Foundation worked with PerryUndem Research/Communication to help organize and conduct the focus groups with enrollees and key on-the-ground interviews.

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  2. July 2018 estimates from The World Factbook (Washington, DC: Central Intelligence Agency, accessed May 2019), https://www.cia.gov/library/publications/the-world-factbook/geos/rq.html#field-anchor-people-and-society-population.

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  3. July 2018 estimates from The World Factbook (Washington, DC: Central Intelligence Agency, accessed May 2019), https://www.cia.gov/library/publications/the-world-factbook/geos/print_vq.html.

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  4. U.S. Virgin Islands Hurricane Recovery and Resilience Task Force. “USVI Hurricane Recovery and Resilience Task Force: Report 2018” (St. Thomas, U.S. Virgin Islands: Sept. 6, 2018), https://reliefweb.int/report/united-states-virgin-islands/usvi-hurricane-recovery-and-resiliency-task-force-report-2018.

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  5. MACPAC, “Medicaid in Puerto Rico: Financing and Spending Data Analysis and Projections” (Washington, DC: March 2019 Public Meeting), https://www.macpac.gov/wp-content/uploads/2019/03/Medicaid-in-Puerto-Rico-Financing-and-Spending-Data-Analysis-and-Projections.pdf, p.6; Interview with USVI Department of Human Services, Medicaid Director.

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  6. Financial Oversight and Management Board (FOMB) letter to Rep. Darren Soto, U.S. House of Representatives (Washington, DC: October 13, 2018), https://drive.google.com/file/d/12WdHN8iGjSa0AbHr7phjHwtAFH0f_ZZt/view.

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  7. After this initial increase, Puerto Rico’s Medicaid enrollment was trending downward beginning in mid-2018 due to expiration of a delayed redetermination period, outmigration, economic recovery that may increase residents’ incomes enough to make them ineligible for Medicaid, transition to MAGI Medicaid eligibility determination methods, and some confusion stemming from the managed care reforms.

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  8. U.S. Virgin Islands Department of Human Services, “Medicaid & CHIP Programs in the U.S. Virgin Islands” (Feb. 26, 2019).

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  9. Ibid.

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  10. MACPAC, “Draft of Mandated Report: Medicaid in Puerto Rico” (Washington, DC: April 2019 Public Meeting), https://www.macpac.gov/wp-content/uploads/2019/04/Draft-of-Mandated-Report-Medicaid-in-Puerto-Rico.pdf.

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  11. Financial Oversight and Management Board (FOMB) letter to Puerto Rico Gov. Ricardo Rosselló (Washington, DC: March 15, 2019), https://drive.google.com/file/d/1sbw4T59Ez9YTKlg_KA0trQMIrYmGFeQo/view.

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  12. Government of Puerto Rico, as certified by the Financial Oversight and Management Board for Puerto Rico. “New Fiscal Plan for Puerto Rico: Restoring Growth and Prosperity” (Oct. 23, 2018), https://drive.google.com/file/d/17ca0ALe7vpYn0jEzTz3RfykpsFSM0ujK/view.

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  13. Puerto Rico Gov. Ricardo Rosselló letter to Chairman and Ranking Member, Committee on Energy & Commerce, U.S. House of Representatives (Washington, DC: May 1, 2019); Puerto Rico Gov. Ricardo Rosselló letter to Chairman and Ranking Member, Committee on Finance, U.S. Senate (Washington, DC: May 1, 2019).

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  14. MACPAC, “Medicaid in Puerto Rico: Financing and Spending Data Analysis and Projections” (Washington, DC: March 2019 Public Meeting), https://www.macpac.gov/wp-content/uploads/2019/03/Medicaid-in-Puerto-Rico-Financing-and-Spending-Data-Analysis-and-Projections.pdf, p.19.

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  15. Ibid. at p.18.

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  16. KFF Interview with USVI Medicaid Director, Department of Human Services (Feb. 26, 2019).

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  17. Puerto Rico Gov. Ricardo Rosselló letter to Chairman and Ranking Member, Committee on Energy & Commerce, U.S. House of Representatives (Washington, DC: May 1, 2019); Puerto Rico Gov. Ricardo Rosselló letter to Chairman and Ranking Member, Committee on Finance, U.S. Senate (Washington, DC: May 1, 2019).

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  18. Puerto Rico Gov. Ricardo Rosselló, “Critical Sustainability Measures to Provide Essential Health Services to Puerto Rico’s Medicaid Recipients,” Enclosure with letters to U.S. Senate and U.S. House of Representatives (Washington, DC: May 2019).

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  19. Ibid.

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  20. MACPAC, “Medicaid in Puerto Rico: Financing and Spending Data Analysis and Projections” (Washington, DC: March 2019 Public Meeting), https://www.macpac.gov/wp-content/uploads/2019/03/Medicaid-in-Puerto-Rico-Financing-and-Spending-Data-Analysis-and-Projections.pdf, p.11.  The MACPAC per-enrollee spending calculations include both federal and state funds and exclude long-term services and supports, since those services are not covered in Puerto Rico’s Medicaid program.  The MACPAC analyses also adjust for differences in enrollment mix.

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  21. Gabriela Martinez, “Why this disaster relief bill is stuck on a debate over Puerto Rico food stamps,” PBS Newshour (Arlington, VA: March 28, 2019), https://www.pbs.org/newshour/politics/why-this-disaster-relief-bill-is-stuck-on-a-debate-over-puerto-rico-food-stamps.

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  22. Jeff Stein, “More than 670,000 Puerto Rico residents have received cuts to food stamp benefits amid congressional impasse,” Washington Post (Washington, DC: March 12, 2019), https://www.washingtonpost.com/us-policy/2019/03/08/puerto-rico-starts-cutting-food-stamp-benefits-used-by-more-than-million-people-amid-congressional-impasse/?utm_term=.20f2c42e1fcd.

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