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Last updateThu, 21 Nov 2019 12am







    Wednesday, November 20, 2019-2:47:38A.M.






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Thousands on Guam could lose Medicaid

HAGÅTÑA (The Guam Daily Post) — Thousands of residents who rely on Medicaid could see a reduction in health care funding for medical needs unless more funds are made available, via a cap increase or a federal cost share increase.

As of August 2017, 35,559 people, or 21 percent of Guam’s population, were enrolled in Medicaid or Children’s Health Insurance Program, according to a July 2019 Report to Congress.

Guam received about $268 million under the Patient Protection and Affordable Care Act of 2010, or ACA, which increased the government of Guam’s ability under Medicaid to help pay for the health needs of primarily the island’s poorest — those without health insurance or ability to pay for health care.

“Our expenditure for this year was more than $145 million, almost $150 million, for Medicaid,” Tess Arcangel, the administrator of the Department of Public Health and Social Services Division of Public Welfare, said last month. Most of that was in federal funds made available through the ACA, which expired Sept. 30.

However, only $15.47 million in federal funds will be available in the new fiscal year, according to the fiscal 2020 budget. The fiscal year began Oct. 1. And even with local matching funds added, falls far short of the expressed need in fiscal 2020.

Arcangel said as the ACA expires and the Medicaid cap, which Gov. Lou Leon Guerrero and governors before her have asked to be lifted, comes back into play, GovGuam will be left with a huge chunk of the liability of health care costs for the island’s uninsured or underinsured population.

Arcangel said Guam’s cap for Medicaid alone, not including CHIP, is at $18.38 million.

A July 2019 Congressional Research Service report noted that “Once the cap is reached, the territories assume the full cost of Medicaid services or, in some instances, may suspend services or cease payments to providers until the next fiscal year.”

Affordable Care Act

The ACA provided for a temporary increase in Medicaid funding beyond the Medicaid cap. And with the passage of the disaster relief fund earlier this year, Guam was able to access about $45 million of the remaining ACA funds without having to pay a local match.

But even that will provide little help as only about $100,000 remained — barely enough to pay for Medicaid costs until the newly approved November deadline.

“There was another bill in Congress to lift the cap and make other changes…but it was shelved as far as I have seen,” Arcangel said.

Without federal legislation to lift the cap and with local payments exceeding $145 million in fiscal 2019, GovGuam’s liability in terms of helping those without insurance soars.

“And even removing the insurance for children under CHIP,” which Arcangel said falls under Medicaid but has a budget separated out from Medicaid, “the local liability for the government will be about $85 million for the new fiscal year.”

According to the fiscal 2020 budget, the following is appropriated to DPHSS for:

  • • MIP: $4.35 million
  • • Medicaid Program: $7.95 million from fiscal 2020 revenues — $3.67 million from the Healthy Futures Fund and $4.28 million from the General Fund — as the local match for the federal grants. An additional $6 million from the fund balance of Healthy Futures Funds from fiscal 2018 also was appropriated.
  • • Children’s Health Insurance Program: $4.92 million from the General Fund as the local match for the $19.66 million for federal matching grants.

Arcangel said those who can no longer receive assistance through Medicaid because of the reduction in funds will likely apply to the fully locally funded Medically Indigent Program.

“And they are all eligible under MIP,” she said, because of the income levels. And that’s perhaps more problematic considering the funding levels for MIP are less than half that of Medicaid. “Whether you put them under Medicaid or you put them under MIP, it’s the same local funding. So technically if they don’t give us funding it’s still government liability.”

Providers will be informed

Arcangel said, with the changes to Medicaid, DPHSS will have to inform providers that funding will be limited. She stopped short of saying that some local clinics may no longer accept Medicaid for this reason, although this has occurred in the past.

“However, the clients can go to DPHSS (in Mangilao), or to the Northern or Southern Clinics, and, of course, the Guam Memorial Hospital,” she said.