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  • Writer's pictureNerieth Moreno-Santana

MMAPA President Addresses Puerto Rico’s “Medicaid Cliff” and Medicare Funding Disparities

García alerted Congressional staff that, without action, a $1 billion funding shortfall for Puerto Rico’s Medicaid program will affect hundreds of thousands of people on the island amid a global pandemic

February 22, 2021

WASHINGTON, D.C. — Last week, MMAPA President Roberto García participated in a webinar on Puerto Rico’s health care system hosted by Resident Commissioner Jenniffer González to educate congressional staff on the challenges facing the island and the dire need for reform. In his remarks, García noted that Puerto Rico has both the highest Medicaid and Medicare Advantage penetration rates in the country, as well as lower per-capita federal funding levels than all 50 states. He emphasized the upcoming “Medicaid Cliff,” which could lead to a $1 billion loss in Puerto Rico’s federal Medicaid funding, putting the health and safety of hundreds of thousands of American citizens in jeopardy amid the COVID-19 pandemic. His full remarks are included below.

In addition to García and the Congresswoman González, the virtual event featured Jorge Galva of ASES, Puerto Rico Secretary of Health Carlos Mellado, Puerto Rico Hospital Association President Jaime Plá, Puerto Rico Physicians Association representative Kenneth McClintock, MCS President Roberto Pando, MMM President Orlando González, and former Congressman and Governor of Puerto Rico Luis Fortuño.

MMAPA extends its appreciation to Resident Commissioner González for convening this valuable and timely webinar. MMAPA is committed to serving as a resource for policymakers and collaborating with other stakeholders to advance the goal of parity for Puerto Rico’s health care system.

MMAPA President Roberto García’s Remarks

Resident Commissioner Gonzalez’s webinar on the Puerto Rico Health Care System

February 17, 2021

Good afternoon and thanks so much, Resident Commissioner González, for convening this important webinar and for all of her efforts on behalf of Puerto Rico’s health system.

I am Roberto García, President and CEO of Triple-S, and President of the Medicaid and Medicare Advantage Products Association—better known as MMAPA. MMAPA is a non-profit organization composed of the leading Medicaid and Medicare Advantage organizations in Puerto Rico, including First Medical, Humana, MCS, MMM/PMC, Plan de Salud Menonita, and Triple-S.

MMAPA member companies have an essential responsibility to the people of Puerto Rico to ensure they have access to the health care they need, when they need it. Together, we insure nearly two million people under Medicaid and Medicare Advantage in Puerto Rico, but we are only one piece of the puzzle. Our organization advocates for increased federal investment to shore up the Puerto Rican health care system and works to advance and implement comprehensive, long-term solutions that address the historical underfunding of the Medicaid and Medicare Advantage programs on the island.

We all know how critical it is—now more than ever—for policymakers in Washington to understand the needs of patients and providers on the island. That’s why MMAPA believes it’s essential that we serve as a resource for policymakers, both in Puerto Rico and in Washington. We want to offer Congress our expertise, collaboration, and support to inform your decision-making and develop the best policy solutions for Americans in Puerto Rico.

In 2019, Congress and the Trump Administration provided full Federal Medicaid Assistance Percentage (FMAP) benefits to Puerto Rico for the Medicaid Program, averting a $1 billion shortfall, otherwise known as the “Medicaid cliff.” Unfortunately, these short-term solutions not only continue the succession of “Medicaid cliffs” that we have seen for many years, but they also create uncertainty and unpredictability in the system broadly. Without congressional action, Puerto Rico’s crucial federal Medicaid spending will drop by 86 percent on October 1st amid the worst global health emergency ever.

Moreover, Medicaid’s penetration on the island is among the highest in the country. Puerto Rico is home to approximately 1.4 million Medicaid beneficiaries, representing nearly half of the island’s population. However, per capita Medicaid spending is only 26% of the mainland average. Those born in Puerto Rico are American citizens. However, these fellow Americans are not only receiving one-quarter of what Americans in the mainland receive on average, and they will once again be threatened with the loss of that coverage as the end of the fiscal year approaches.

We need Congress to act now.

We also want to urge our federal policymakers to explore steps to close the Medicare Advantage rate gap in 2022, which would support our providers and over 600,000 Medicare Advantage beneficiaries in Puerto Rico. Puerto Rico’s MA penetration rate of over 80% (90% when accounting for beneficiaries of both Part A and Part B) is the highest in the nation. With MA becoming the cornerstone of health care services for seniors across the nation, especially those living on low or fixed incomes, it is imperative to not only address this issue in Puerto Rico, but also across the country.

Puerto Rico is the tip of the spear in terms of confronting the issues that arise when MA enrollment greatly outpaces fee-for-service enrollment. In Puerto Rico, the vast majority of Medicare beneficiaries have chosen Medicare Advantage, and many other counties around the country are seeing the same trend. Basing MA benchmarks on ever-smaller fee-for-service enrollment doesn’t make sense in Puerto Rico or elsewhere.

MA plans have been able to “do more with less” to serve beneficiaries in Puerto Rico, implementing value-based compensation and addressing social determinants of health within a population that has the highest proportion of dual eligible beneficiaries in the nation. However, the disparity in MA base rates is simply too high and continues to be our biggest barrier to developing the resilient health system that the seniors in Puerto Rico deserve.

Thankfully, President Biden recognizes this issue and, during his campaign, promised his administration would address the island’s historically low MA payment rates. We stand ready to work with policymakers and health care stakeholders in the coming year to develop and implement comprehensive, long-term solutions for the island and around the country.

As we continue these conversations, it’s important to highlight that consistency should also be a priority for reform. The treatment of the Puerto Rico health care system under federal law is highly inconsistent; sometimes the island is treated like a territory, sometimes it’s treated like a state. This contributes to funding gaps and has other unintended consequences. The best way to achieve consistency is to simply treat the island like everyone else. This approach would address the funding issues while also bringing badly needed certainty and stability to the island’s health care system.

MMAPA is here to be a resource for health care policy leaders, and to the administration, so we can all work to ensure people on the island have access to the health care they deserve.


MMAPA, the Medicaid and Medicare Advantage Products Association, is a non-profit composed of the leading Medicaid and Medicare Advantage organizations in Puerto Rico: First Medical, Humana, MCS, MMM/PMC, Plan de Salud Menonita, and Triple-S. Founded in 2009, MMAPA advocates for increased government investment in the Puerto Rican health care system.

Follow MMAPA on Twitter at @mmapapr or visit our website,

Media Contact: Meghan Pennington Hamilton Place Strategies

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