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  • Medicaid in the Territories: Program Features, Challenges, and Changes

    Issue Brief

    This brief draws on a survey of and interviews with Medicaid officials in U.S. Territories, as well as other research, to examine key issues and trends in their Medicaid programs. Territories differ from the states on key demographic, economic, and health status indicators. Unlike in the states, where federal Medicaid funding is not capped, and the federal share varies based on states’ per capita income, Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate.

  • 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.

  • 8 Preguntas & Respuestas sobre Puerto Rico

    Fact Sheet

    La crisis de $73 mil millones de Puerto Rico ha sido tema de los medios de comunicación nacionales, y de debate en el Congreso en los últimos meses.

  • Puerto Rico: Fast Facts

    Fact Sheet

    Puerto Rico: Fast Facts provides a quick snapshot of the island's demographic, health, and economic characteristics. It also provides some information on federal Medicaid rules, infrastructure, and fiscal challenges ahead.

  • 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.

  • 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.

  • Community Health Centers in the U.S. Territories and the Freely Associated States

    Issue Brief

    The U.S territories and the Freely Associated States (FAS) have faced an array of longstanding fiscal and health challenges, made worse by recent natural disasters and the coronavirus pandemic. Community health centers are an important part of health care system in the territories and FAS, providing access to a range of primary care services to low-income and vulnerable individuals. Based on findings from a survey of health centers, data from the Uniform Data System (UDS), and interviews with Primary Care Associations in those regions, this brief examines the roles of health centers in U.S. territories and FAS during the COVID-19 pandemic.

  • Americans’ Views of Puerto Rico’s Recovery

    Poll Finding

    The November Kaiser Health Tracking poll finds that 70 percent of the public say people in Puerto Rico affected by Hurricane Maria are not yet getting needed help, up from 62 percent in October. Similarly, most of the public (59 percent) says the federal government is not doing enough to restore electricity and access to food and water in Puerto Rico. As with Puerto Rico’s recovery effort, most of the public also reports closely following news about the recovery in the Houston area after Hurricane Harvey.