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

    Issue Brief

    More than a year into the public health emergency, the COVID-19 pandemic continues to impact the lives of Americans including those living in the U.S. territories. Differences in Medicaid financing, including a statutory cap and match rate, have contributed to broader fiscal and health systems challenges for the territories. While additional federal funds have been provided over the statutory caps, these funds are set to expire at the end of September 2021. Without additional Congressional action, the territories will lose the vast majority of Medicaid financing which could result in reductions in coverage, services, and provider rates which could negatively impact the territories as they deal with the long-term health and economic consequences of the pandemic. This brief looks at how the pandemic is affecting the territories as well as issues related to the upcoming Medicaid fiscal cliff.

  • Health Care in Puerto Rico and the U.S. Virgin Islands: A Six-Month Check-Up After the Storms (Report)

    Issue Brief

    Puerto Rico and the U.S. Virgin Islands suffered significant damage to their infrastructure and health care systems from Hurricanes Irma and Maria in September 2017. Drawing on interviews with residents and key stakeholders as well as public reports, this brief provides an overview of the status of the recovery efforts six months after the storms, with a focus on the health care systems.

  • Views and Experiences of Puerto Ricans One Year After Hurricane Maria

    Report

    This partnership survey from The Washington Post and the Kaiser Family Foundation explores how Puerto Ricans are faring one year after Hurricane Maria struck the U.S. territory. This face-to-face survey of those living in Puerto Rico examines the impact the hurricane had on their lives, including their housing situation, financial status, and mental and physical health. It also covers issues of access to water and electricity and Puerto Ricans' views of the government’s response to the storm and its recovery. This is the first, and only, comprehensive, island-wide representative survey to assess a broad array of impacts from Hurricane Maria and hear directly from the people of Puerto Rico about what they experienced and what the ongoing needs are.

  • Un año después de las tormentas: la recuperación y la atención de salud en Puerto Rico y las Islas Vírgenes de EE.UU. (Informe)

    Issue Brief

    Un año después que los huracanes Irma y María tocaran tierra, Puerto Rico y las Islas Vírgenes de EE.UU. (USVI) todavía sienten los efectos de las tormentas. Basándose en entrevistas con partes interesadas clave y en informes públicos, este reporte proporciona una visión general del estado de recuperación y los esfuerzos de preparación para la actual temporada de huracanes, un año después de las tormentas, enfocándose en los sistemas de atención de salud de los territorios.

  • Medicaid: What to Watch in 2019 from the Administration, Congress, and the States

    Issue Brief

    Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and other eligibility restrictions. States are also likely to continue to pursue initiatives to address the opioid crisis, and the recent passage of bi-partisan legislation with new tools and financing could bolster these efforts. Primary areas of federal policy to watch in 2019 with implications for Medicaid include the expiration of temporary funding for Puerto Rico and the US Virgin Islands in the absence of legislative action as well as potential regulatory changes to public charge policies that would likely lead to Medicaid enrollment declines among immigrant families. Finally, reforms in benefits, payment and delivery systems continue to evolve as states and the federal government focus on managed care, social determinants of health, prescription drugs, and community based long-term care. While beyond the scope of this brief, Congress and states could also consider broader health reform that could expand the role of public programs in health care including Medicare for All or Medicaid buy-in programs that could have significant implications for Medicaid.

  • Medicaid Financing Cliff: Implications for the Health Care Systems in Puerto Rico and USVI

    Issue Brief

    This brief provides an overview of the status of the health care systems and Medicaid programs in Puerto Rico and the U.S. Virgin Islands (USVI) about one and a half years after Hurricanes Irma and Maria struck the islands in September 2017. The hurricanes exacerbated the territories’ existing economic and health care challenges by accelerating outmigration of residents and health care providers and destroying homes, schools, health care facilities, and other infrastructure. After the storms, the territories’ Medicaid programs have served as important resources for addressing residents’ health care needs, but they have operated under longstanding financing challenges. This brief focuses on these challenges and includes KFF analysis of the implications for the territories’ Medicaid program finances, as most of the temporary federal Medicaid funds provided through the Affordable Care Act (ACA) and disaster relief are set to expire at the end of September 2019. The other U.S. territories (American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam) also face challenges tied to the scheduled expiration of ACA funds.