WASHINGTON, D.C. U.S. Senators Bob Menendez, Cory Booker (both D-N.J) and Bill Nelson (D-Fla.) today urged Senate leaders to boost Medicaid resources for Puerto Rico and the U.S. Virgin Islands while they negotiate a disaster relief package.

In a letter sent to Senate Majority Leader Mitch McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY), the Senators highlighted the urgent need to bolster Medicaid programs in U.S. territories devastated by recent hurricanes.

“Among the many challenges facing the territories are medical and public health concerns that range from managing chronic conditions, preventing the spread of disease, and supporting those experiencing mental health issues, like depression and post-traumatic stress disorder,” the Senators wrote. “As we continue to support investments in public health infrastructure, response, and surveillance, it is imperative that residents of Puerto Rico and the U.S. Virgin Islands also maintain access to Medicaid coverage and services.”

The Senators also highlighted the Medicaid funding disparities that exist between the territories and states, and how those disparities exacerbated the damage caused by the hurricanes. The Senators asked leadership to increase the federal matching rate for the territories’ Medicaid programs from its current level of 55 percent to 100 percent, and to eliminate the cap on Medicaid spending in the territories.

The Senators also asked leadership to work with states and territories to ease Medicaid’s documentation requirements for those who have been displaced by the hurricanes and may have lost personal documents needed to apply for Medicaid coverage.

The letter was also signed by Senators Patty Murray (D-Wash), Richard Blumenthal (D-Conn.), Kirsten Gillibrand (D-N.Y.), Ben Cardin (D-Md.), Elizabeth Warren (D-Mass.), Ed Markey (D-Mass.), Mazie Hirono (D-HI), Bob Casey (D-Pa.), and Chris Van Hollen (D-Md.).

Full text of the letter is below.

December 6, 2017

The Honorable Mitch McConnell The Honorable Chuck Schumer

Senate Majority Leader Senate Minority Leader

U.S. Senate U.S. Senate

Washington, DC 20510 Washington, DC 20510

Dear Leader McConnell and Leader Schumer:

As Congress continues to work on disaster relief legislation to aid all disaster afflicted areas in 2017, we write to urge your support for policies that will bolster the territories’ Medicaid programs and ensure that those impacted by Hurricanes Irma and Maria have access to the health coverage they need.

Our fellow Americans in Puerto Rico and the U.S. Virgin Islands are in their moments of greatest need as they recover from the devastation caused by Hurricanes Irma and Maria. Among the many challenges facing the territories are medical and public health concerns that range from managing chronic conditions, preventing the spread of disease, and supporting those experiencing mental health issues, like depression and post-traumatic stress disorder. As we continue to support investments in public health infrastructure, response, and surveillance, it is imperative that residents of Puerto Rico and the U.S. Virgin Islands also maintain access to Medicaid coverage and services.

Puerto Rico and the U.S. Virgin Islands have long experienced disparities in Medicaid funding as compared to the 50 states and D.C. For example, in the mainland, federal funding is open-ended, with the federal contribution ranging from 50 percent for wealthier states to 83 percent for the poorer states. In the territories, federal Medicaid funding is capped and the federal contribution is statutorily set at 55 percent—well below the rate the island would receive if its rate were calculated the same as in the states. This has led to funding challenges and shortfalls that have only been exacerbated in the aftermath of the hurricanes.

At a minimum, Congress must temporarily increase the federal matching rate for the territories’ Medicaid programs from its current level of 55 percent to 100 percent. Puerto Rico and the U.S. Virgin Islands have limited ability to provide their share of the Medicaid funds needed to draw down federal dollars, and this action would temporarily relieve them of immense fiscal pressure. Providing additional federal support for the non-federal Medicaid share would also be consistent with congressional action following Hurricane Katrina.

Increasing the federal matching rate on its own is insufficient. Congress must also eliminate the cap on Medicaid funding for the territories in order to provide the islands with necessary relief to recover. Even with an increased federal matching rate, Puerto Rico and the U.S. Virgin Islands would not be able to access the funds necessary for their Medicaid programs once they reach the funding caps.

In addition, since the hurricanes made landfall, it is estimated that more than 140,000 individuals have left Puerto Rico alone, many joining their families in the states.[1] Therefore, Congress should work to ensure that those who are displaced to the states in the aftermath of the storms have access to Medicaid coverage. Similar to action taken following Hurricane Katrina, Congress should work to ensure that individuals displaced Americans from Puerto Rico and the U.S. Virgin Islands can access needed care and that providers are reimbursed accordingly.

Furthermore, we encourage Congress to support the implementation of a streamlined and abbreviated process to reduce barriers to Medicaid eligibility and enrollment for those impacted by the hurricanes. Many of the islands’ residents have been displaced and may have lost their personal belongings, including the documents needed to apply for Medicaid coverage. Allowing for self-attestation or to delay redeterminations for Medicaid eligibility will go a long way to helping displaced individuals get back on their feet.

We appreciate your consideration and look forward to working with you on this important issue.

Sincerely,

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[1] Danica Coto, “Hurricane Maria relief efforts set off fierce debate about leaving Puerto Rico,” USA Today, November 9, 2017, https://www.usatoday.com/story/news/nation/2017/11/09/hurricane-maria-puerto-rico-debate/850820001/.