The Department of Public Health and Social Services is shown in Hagåtña on Sept. 9, 2024.
Photo by Jonah Benavente/The Guam Daily Post
HAGÅTÑA (The Guam Daily Post) — Congressional Democrats are warning that Medicaid, a federal program that provides health coverage to millions of low-income Americans and about one-third of Guam residents, could be gutted by some $880 billion in the next federal budget.
But Guam Department of Public Health and Social Services Director Theresa Arriola said she is cautiously optimistic that the 51,000 local beneficiaries will be spared from any of the projected cuts.
“We’re not worth cutting if it comes to that. We are so small in the bigger Medicaid budget, and so I pray that it really stays that way,” Arriola said Tuesday in an interview with The Guam Daily Post.
She just returned from a meeting of the Association of State and Territorial Health Officials in Washington, D.C., where she said “everybody was on (Capitol Hill). We had three to four meetings that day with both the House and the Senate, and the majority and the minority,” Arriola said.
“One thing’s for sure, nothing is certain, nothing has been decided,” she added.
Guam has a Medicaid cap of $141 million, and currently the federal government pays 83% of the costs to GovGuam’s 17% local match.
Arriola said she’s praying that the Trump administration does not decide to lower the Medicaid federal reimbursement cap or slash costs on a percentage basis. “That could hurt us,” Arriola said.
“I’ve been in constant communication with Gov. Lou Leon Guerrero and the administration about putting together scenarios of ‘what if the cap was cut? What if our net was reduced?'” she said.
Among the contingencies is identifying and earmarking any government of Guam budget surplus to cover a shortfall, and also prioritizing funding for life-and-death services over less critical needs.
“You can’t live without dialysis, so we’re going to make sure that the roughly 100 patients that are currently in dialysis are still covered,” she said.
Arriola said Public Health officials are reviewing utilization rates and establishing a hierarchy of what services to cover.
“We’re looking at all our services and trying to balance that with some primary care preventative services that might be needed,” she said.
Arriola said she and her state counterparts have discussed the Trump administration’s focus on fraud, waste and abuse, which is in line with what she has been doing during the past six months since taking over DPHSS.
“I have been really focused on modernization and technology enhancement and process improvement in the Medicaid space,…and that kind of falls in place, ironically, to everything that they’re wanting states and territories to do. That’s to tighten up any leaks,” Arriola said.
Arriola said she also supports a proposed bill announced by Leon Guerrero during her State of the Island address on March 12 to offer business privilege tax exemptions to local physicians and clinics for Medicaid services revenue.
This follows the restored Medicaid program eligibility of citizens from island nations with Compacts of Free Association.
Arriola said Public Health has employees stationed at Guam Memorial Hospital to “aggressively” sign up eligible COFA migrants for Medicaid.
“So when you push them into Medicaid, then at least Medicaid dollars pays for them, and they don’t seek services at the hospital where it’s the most expensive, right? So everybody needs to be seeing a clinic or a primary care doctor,” she said.
“You don’t want people to go to the hospital for things that they can go to clinics and private providers, too,” Arriola said.
But in the current climate, she said, she admits that medical service providers “might think twice about it.”
However, she believes the BPT exemption will incentivize doctors, along with the fact that DPHSS has addressed their main concern about accepting Medicaid in the past, which has been payment delays.
“We’re already processing anywhere between 45 days to 60 days on the claim submission of clean claims, … we are happy to say that we’ve made a very concerted effort to make sure that we are not backlogged. So claims are on time,” Arriola said.
Still, the specter looms of a massive cut to the Medicaid program.
Arriola conceded that while Republican congressional leaders have stated that there is no plan to cut Medicaid, they also have pushed for nearly $900 billon in reductions at the Department of Health and Human Services, which administers the program.
“If they want an $880 billion cut, there’s no way. And that’s why those state and territory directors, despite the fact that they’re saying they’re not going to touch Medicaid, it’s just not adding up,” Arriola said.
