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  • Writer's pictureNerieth Moreno-Santana

Support Grows For Change To Medicare Advantage Funding For Puerto Rico

Support Grows For Change To Medicare Advantage Funding For Puerto Rico

Sixteen Members Of Congress And Puerto Rico Governor Ricardo Rosselló Have Submitted Letters Calling For Changes To CMS’ Medicare Advantage Payments Proposed for 2020

March 21, 2019

WASHINGTON, D.C. – Earlier this year, the Centers for Medicare and Medicaid Services (CMS) released Part II of its 2020 Medicare Advantage Advance Notice and Draft Call Letter. While CMS’ proposal appears to maintain Medicare Advantage (MA) payments in Puerto Rico at their current levels, fundamental changes are needed to eliminate long-standing federal funding inequities for the island’s health care system.

MA serves over 585,000 beneficiaries on the island, including 280,000 dual-eligible (also with Medicaid). However, MA payment rates have gone from 24 percent below the national average in 2011 to 43 percent below the average in 2019. MMAPA applauds both Governor Ricardo Rosselló and the sixteen members of Congress, led by Rep. Jenniffer González-Colón (R-PR-At Large), who have submitted letters to the U.S. Department of Health and Human Services (HHS) and CMS in support of the U.S. citizens of Puerto Rico. Both letters urge CMS to reconsider its proposal and improve federal health care funding structures for Puerto Rico to stabilize its health care system and address the ongoing exodus of health care professionals from the island.

In his letter, Governor Rosselló explains the harmful consequences of the current proposal for the American citizens of Puerto Rico: “If approved in its current form, the MA rates will continue to perpetuate, and potentially increase, the disparity in funding in contrast to all other jurisdictions, worsening the migration of health care professionals and leaving Puerto Rico’s health care infrastructure further behind.” In their letter, the members of Congress outline key amendments to the CMS proposal that will help “ensure that the U.S. citizens of Puerto Rico have access to the standards of quality health care enjoyed in the mainland.”

MMAPA President Jim O’Drobinak echoed these calls for greater MA support, saying, “Three in four senior citizens in Puerto Rico rely on MA for their health care; it is a vital program to ensure seniors can access the care they deserve. While we appreciate CMS’ previous efforts to improve the treatment of providers and plans in Puerto Rico under Medicare payment formulas, we join these lawmakers in urging the agency’s leadership to amend its latest proposal. Doing so will better protect seniors’ access to care, fortify Puerto Rico’s health care infrastructure, and provide much-needed stability to the island’s economy.”

Though most seniors in Puerto Rico rely on the MA program for their health care, the program has seen a $5 billion loss in federal funding since 2011. The island’s average MA benchmark remains 39 percent lower than that of the lowest state, and 26 percent below the US Virgin Islands. MMAPA will continue to engage with the Governor, members of Congress, and the Trump administration to ensure these inequities are addressed as swiftly and effectively as possible.

MMAPA calls on CMS to make the following amendments to the proposal:

A) Enhance key adjustments for the increasing proportion of zero-claimants in FFS data or at least maintain at current level.

B) Adjust Puerto Rico benchmark to account for unique decreases in 2017 FFS utilization attributable to Hurricane María.

C) Continue the 2019 hold harmless adjustments in the Stars program methodology accounting for ongoing effects of natural disasters.

D) Classify Part B premium support as a core A/B benefit for full benefit dual eligible beneficiaries.

E) Establish a minimum standard MA benchmark at 0.70 Average Geographic Adjustment (AGA), to address the aggravating anomalies in existing FFS data.

F) Apply the 0.70 AGA floor to ESRD MA benchmarks. In its absence, make the adjustments necessary to reflect the new increased wage index floor for Medicare FFS dialysis payments from 0.40 to 0.50, and other recent Medicare FFS pricing changes.

In addition to Rep. González-Colón, the congressional letter was signed by Reps. Rob Bishop (R-UT-01), Darren Soto (D-FL-09), Brian Fitzpatrick (R-PA-01), Nydia Velázquez (D-NY-07), Sean Duffy (R-WI-07), José Serrano (D-NY-15), Cathy McMorris Rodgers (R-WA-05), Mario Díaz-Balart (R-FL-25), Peter King (R-NY-02), Bobby Rush (D-IL-01), Adriano Espaillat (D-NY-13), Sean Patrick Maloney (D-NY-18), Wm. Lacy Clay (D-MO-01), Don Bacon (R-NE-02), and Jaime Herrera Beutler (R-WA-03).

About MMAPA The Medicaid and Medicare Advantage Products Association of Puerto Rico (MMAPA) is a non-profit organization composed of the leading Medicaid and Medicare Advantage organizations in Puerto Rico. Founded in 2009, MMAPA is dedicated to promoting policy solutions to solve Puerto Rico’s health care challenges.

Media Contact: Jim David or Meghan Pennington Hamilton Place Strategies /

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