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  • Writer's pictureNerieth Moreno-Santana

Op-Ed: Puerto Rico Needs Federal Equity In Medicare Advantage

Featured in El Nuevo Dia here.

March 19, 2022


This column was written by the Board of Directors of the Medicaid and Medicare Advantage Products Association (MMAPA): Roberto Pando (MCS), Roberto García (Triple-S), Orlando González (MMM), Juan Domínguez (First Medical), Ricardo Hernández (Mennonite) and Luis Torres Olivera (Humana).


Last week, Congress, President Joe Biden, and his Secretary of Health Javier Becerra adopted the necessary measures to give continuity to the Medicaid program on the island, known as the Vital Plan. Although there is still a long way to go, we celebrate this news as an important event after multiple efforts aimed at increasing the funds allocated to Medicaid on the Island.


CMS has the legal authority to increase payment rates for Puerto Rico, which have historically been the lowest in the entire nation. The time has come to correct these inequities, write members of the Board of Directors of the Medicaid and Medicare Advantage Products Association (MMAPA).


However, now it is time to do justice to the 630,000 Medicare Advantage (MA) beneficiaries who reside in Puerto Rico. The federal Department of Health and the Centers for Medicare and Medicaid Services (CMS) have the power to adopt administrative policies to alleviate the inequality that currently limits the operation of the Medicare Advantage (MA) program in Puerto Rico.


When we speak about inequity, we mean that the current formula for setting MA rates severely affects Puerto Rico. To put it in perspective, in 2011, MA rates in Puerto Rico were 24% below the US average. Eleven years later, these rates have continued to decline, now standing at 42% below the national average. That's 37% below the state that receives the least amount of MA funding in the nation, which is Hawaii, and 23% below the next lowest jurisdiction, which is our neighbors the Virgin Islands. These data reflect that, despite the efforts of CMS, the inequality gap has continued to expand over the years.


In Puerto Rico, the MA program has become one of the main pillars of the health system, especially for our elderly. CMS has the legal authority to increase payment rates for Puerto Rico, which have historically been the lowest in the nation. The time has come to correct these inequalities. Although the health industry in Puerto Rico has learned to do more with less, fair treatment would reinforce services and benefits for the population that needs it most, in a Medicare Advantage platform that is developed, mature, and highly regulated by the federal government.


What are we looking for with these measures for MA in Puerto Rico? More resources will (1) markedly improve the quality of care for the most vulnerable Medicare beneficiaries, (2) encourage residents and key health care providers to stay on the Island, and (3) encourage future investment in infrastructure. of the health system in Puerto Rico.


Each of these objectives is necessary and we can achieve them with the proper administrative response from the Biden administration, as explicitly included in its government plan for Puerto Rico. This is the opportunity to make real the Federal Health promise to address inequity in health programs. This is the federal health agenda that we must address without delay, united, as a people. This is the moment.

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The Medicaid and Medicare Advantage Products Association (MMAPA) is a non-profit organization made up of the main Medicaid and Medicare Advantage organizations in Puerto Rico: First Medical, Humana, MCS, MMM/PMC, Plan de Salud Menonita, and Triple-S Advanta

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