WITH the federal government now permanently covering 83% of the cost of Medicaid in the Northern Marianas, the Commonwealth Healthcare Corporation is hopeful that the CNMI government will be able to pay the 17% local match.
CHCC Chief Executive Officer Esther L. Muna said there are two healthcare cliffs that the CNMI is facing: capped funding and the Medicaid match.
“If you look back and you really look at every year that the CNMI government provides a budget for Medicaid, it doesn’t even come close to what is required to match [the federal funds], just to give a little perspective there. If they couldn’t afford the 45% local matching fund], we’re hoping that they could afford the 17% because it does really help the CNMI.”
She added, “We’ve always had, in the past, the struggle of finding the local matching fund. We used to be at 50% [federal match], and then it was at 55%, so it required the [CNMI] government to come up with the 45% of [local] funding. That obviously was very difficult, so for CHCC, it’s better to get [this 83%] federal share than nothing at all… As far as savings for the CNMI, well, the CNMI, they’re saving, for sure. They’re going to be spending only 17% of funding.”
In late December, U.S. Congressman Gregorio Kilili C. Sablan said in a press release that the 83% federal share for the Northern Marianas Medicaid is the highest for any state or territory. It has been in place on a temporary basis since 2019.
Without the extension in the fiscal year 2023 spending bill, the federal share would have dropped back to 55%, requiring the Commonwealth to spend an additional $40 million to completely draw down available federal funds.
Speaking to reporters during a press conference on Wednesday, Muna said the Association of State and Territorial Health Officials or ASTHO wrote a letter in November 2022 to the U.S. lawmakers, advocating for the federal match to be permanent.
“We’ve been advocating for it. We’ve been really working with Congressman Sablan’s office. Even in the Association of State and Territorial Health Officials, that has become a top priority… I did get a call from Congressman Sablan right before it was announced that we’re getting 83% and it’s permanent. That’s obviously great news. It’s been something that we’ve been fighting for: equitable funding [and] financing for the territories,” she said.
She noted that this is a great opportunity for the CNMI to look at how it addresses healthcare access and specialty services.
“This is a great opportunity for us to plan better, project funding better, and also to really address the health issues of the CNMI, and even for public health. The ASTHO is really focusing on public health,” she said.
“Why are they looking at this — to Medicaid — as a priority? Because a lot of services that should be covered in public health are not, because a lot of the spending is really on treatment, and so this is an opportunity to bring some services that haven’t been thought about here in the CNMI because of the lack of funding. It is a great opportunity for us to start working on that, and working with the Medicaid Agency, of course, because they are the ones that will submit the proposals of whatever we plan on proposing for this community.”
Muna noted that the omnibus bill also focuses on full funding for data improvement to ensure that equitable funding to the territories also has equitable accountability.
“We make sure that patient number one is going to get the same treatment for the same disease, for the same illness as patient number two. Those are things that we take into account, and we’ve been doing our very best to try to make sure that the funding is utilized,” she added.
But she said in order to spend federal funds, there must be funds for the local match. She said this is one of the reasons that CHCC opted to adopt the certified public expenditure, or CPE, methodology, which she said the Medicaid agency agreed to because it increases Medicaid funding.
“At the end of the day, 83% is better than nothing,” she reiterated.
