Action Required

MMAPA is a non-for-profit association comprised of the leading Medicaid and Medicare Advantage organizations in Puerto Rico: Humana, MCS, MMM/PMC and Triple-S Advantage. This association was born in 2009 to evaluate and act about the implications of new government policy on funding for Puerto Rico’s healthcare system.

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Legislative Proposal 

Specific actionable items MMAPA and the healthcare community in Puerto Rico are requesting from Congress in the short term at the legislative level

1.   Background: The health care sector is a crucial element of the Puerto Rican economy and the 85,000 Puerto Ricans working in health care-related fields.  Notably, the segment is also underfunded when compared to all the jurisdictions within the US healthcare system.  Total resources average $3,400 per capita compared to the national average of $10,000. This difference is naturally of great concern, but also illustrates a clear context where the most cost-effective healthcare will still be provided even after assuming any potential funding increases.

2.   RECENT EFFORTS BY MMAPA AND HEALTH CARE COMMUNITY IN PUERTO RICO BEFORE THE PROMESA ECONOMIC DEVELOPMENT TASK FORCE: Since 2007, Puerto Rico healthcare stakeholders have been actively presenting with other local stakeholders and the government, legislative proposals to resolve health care disparities. As a results of the efforts, in 2016 MMAPA and other Health Care Community stakeholders in Puerto Rico, wrote a letter to offer support and assistant to the members of the Congressional Task Force on Economic Development in Puerto Rico (the “Task Force”) formed pursuant to the Puerto Rico Oversight, Management, and Economic Stability Act (“PROMESA”). Public Law 114-187.

PROMESA specifically mandated the Task Force to examine the Island’s health care system, including “equitable access to Federal health care programs.” 

3.   Proposals: We suggested immediate steps to provide significant relief and economic stabilization to Puerto Rico in the short term. The proposal to assure equitable treatment in Medicaid and Medicare is the principal long term solution request the Task Force.

  • Parity in Medicaid.  As the Medicaid cliff looms, steps must be taken to continue program operations by establishing parity in Puerto Rico’s Medicaid Federal funds matching levels.

  • HIT.  Eliminate the application of the HIT tax to Puerto Rico.

  • Administrative Flexibility.  Allow CMS to utilize data proxies, discretions and other flexibilities under federal health care payment methodologies.  This is important when unique program distinctions in the Territories make traditional formula application unreliable.

  • Minimum Medicare Advantage.  The ACA benchmark reductions are unsustainable in Puerto Rico and should be replaced with a defined minimum benchmark tied to some percentage of the lowest benchmark in the 50 states.

  • Part D Low-Income Subsidy program.  End the exclusion of the Territories from the Medicare Part D LIS program.

We submitted these proposals to the Task Force as recommendations for long and short-term policy, but fully acknowledge the need to offset any costs associated with them under applicable budgetary rules.  We stand ready to work with the Task Force and, ultimately, the Congressional committees of jurisdiction in finding necessary and appropriate funding for the proposals.




Thank you for your interest in MMAPA’s Call to Action.

It is crucial to state that there are also administrative proposals that are been worked with HHS and CMS as well.