THE Commonwealth Healthcare Corp., an independent public corporation, needs over $22.8 million from the CNMI government for fiscal year 2024.
Of this amount, $9.66 million is for the Health Network Program, previously known as medical referral services, excluding payroll; $1.51 million will address the projected revenue shortfall and support CHCC operations including Tinian Health Center and Rota Health Center; $7.15 million is for the local match for certified public expenditures; and $4.52 million is for capital expenditures.
CHCC Chief Executive Officer Esther L. Muna told the Senate Fiscal Affairs Committee on Wednesday that CHCC is aiming for an adequate workforce and financing in FY 2024.
Joining Muna in the budget hearing were CHCC Board of Trustees Chair Polly Masga, Chief Financial Officer Perlita Santos and Chief Strategy Officer Kaitlyn Neises-Mocanu.
Aside from the Senate Fiscal Affairs Committee chairman, Senate Vice President Donald M. Manglona, the other committee members present were Senate Floor Leader Corina L. Magofna, Sens. Paul A. Manglona, Celina R. Babauta, Karl King-Nabors and Dennis Mendiola.
Muna told the senators that CHCC’s FY 2024 budget approved by its board “was a compilation of health system needs that will bring better health to the CNMI.”
For FY 2024, CHCC’s budget ceiling is $121 million.
CHCC raises its own revenue, which comes from Medicaid reimbursements, private payers, and fees. It also receives federal grants and subsidies from the CNMI government. In FY 2023, the CNMI government appropriated $1.69 million for CHCC.
Muna told the senators that CHCC’s FY 2024 budget will provide “a strong and resilient health system that will serve our people [with] an available workforce, affordable treatments and services, and access to healthcare needs for all.”
Workforce
In response to the Covid-19 pandemic, Muna said healthcare personnel at CHCC worked 2.5 times longer to meet the demands of the community at a wage that was 3.5 times lower than their travel nurse counterparts.
She said the CNMI’s only hospital was not immune to the crisis of staff burnout and staff shortages.
“It was, therefore, necessary to make an unprecedented investment in our workforce as recruitment and retention continue to concern us to this day,” Muna said.
She said adequate patient care staffing is required by the Center for Medicare and Medicaid Services’ Conditions of Participation, which hospitals like CHCC must comply with to get paid by Medicare and Medicaid.
As with other entities in the CNMI, Muna said their workforce shortage is further exacerbated by the “touchback” provision of the federal CW-1 law.
She said CHCC’s laboratory and radiology employees who are CWs are required to leave the CNMI in September and December.
Next year, she said other CWs will have to comply with the touchback rule.
Financial gaps
Muna said CHCC continuously provides services to the uninsured while dealing with several financial gaps as a safety net healthcare provider.
“You have the power to help us with these gaps by providing CHCC with funding for services to the uninsured, financing for the CNMI government’s responsibility to match the cost of providing care for Medicaid patients, and funding for the medical referral program,” she said.
“We need the CNMI government’s funding support. Receiving cost reimbursement only from Medicare and Medicaid is never adequate for any healthcare provider, and it is certainly inadequate for the largest [healthcare] provider in the CNMI. And with cutbacks and funding shortfalls of the Medicaid program, CHCC is experiencing nonpayment and underpayment for the cost of services provided to Medicaid patients in FY 2023,” she said.
The shortfall will total $12 million before the end of FY 2023, Muna said, adding that it is why CHCC cannot take the additional financial burden of the Health Network Program or medical referrals.
“There are many more priorities that keep us up at night. From behavioral and mental health issues that are plaguing the community to lead poisoning and the lack of policies that encourage healthy behaviors and lifestyles. Those priorities are considered in the FY 2024 budget,” Muna said.
She thanked the committee for giving CHCC the opportunity to present its budget. “We understand the financial situation of the CNMI government. But please help us ensure that every resident in the CNMI has equitable access to healthcare and in an environment that helps them achieve that. We appreciate your time and support,” she said.
