THE CNMI government continues to fall short of funding the Health Network Program, according to officials from the Commonwealth Healthcare Corporation.
During the House Ways and Means Committee’s budget hearing on Wednesday, CHCC Chief Financial Officer Purita Santos told the committee chairman, Rep. John Paul Sablan, that the hospital has already spent a total of $3.8 million on HNP, formerly known as the Medical Referral Program.
The program received an allocated funding of $1.2 million in fiscal year 2025, but CHCC received only $820,000 from the central government to date.
Asked by Sablan where CHCC got the funds to cover the government’s shortfall, CHCC Chief Executive Officer Esther L. Muna said it came from hospital revenue.
According to Public Law 22-33, which established HNP, one of the duties and responsibilities of the program is to “operate in a manner that does not exceed the CNMI general fund appropriation for HNP. If appropriated funding for the Health Network Program is exhausted prior to the end of the fiscal year, CHCC shall submit a request to the governor and the Legislature for supplemental appropriations.”
In its 2025 HNP analysis submitted to the Office of the Governor and Legislature on March 1, 2025, CHCC reported that “the cumulative balance owed to CHCC for the HNP is $2,015,870.” The report added, “CHCC has shouldered financial responsibility for too long, despite clear legal obligations for government support.”
For FY 2026, CHCC has requested a $4.2 million budget for HNP. However, in his April budget submission, Gov. Arnold I. Palacios proposed only $1.2 million.
“So what would happen if you do not get your $4.2 million?” Rep. Roy Ada asked Muna.
Muna responded, “Like what CFO Santos said earlier, CHCC has already spent $3.8 million on the program. So we are moving money from the hospital to pay for this.”
“But we often ask ourselves,” she continued, “do we continue to do this, considering that the law requires it to be funded by the local government?”
Muna said CHCC is often forced to make difficult decisions, such as using hospital revenues to fill the funding gap — especially because housing for inter-island medical referral patients remains a concern.
“We don’t want our patients to be evicted from the apartments that we are paying for,” she said. Oftentimes, she added, CHCC pays for patients’ hotel accommodations using “whatever cash we have.”
A significant amount of HNP funds, Muna said, is allocated to subsistence.
“At the end of the day, we don’t want our patients to go hungry or lack basic needs while they’re receiving care,” she said.
Due to insufficient funding from the CNMI government, CHCC is also falling behind on paying hotels.
“When managing the limited HNP funds,” Muna told lawmakers, “we have to decide what to pay right away — and the highest priority we pay is the subsistence.”
“It becomes challenging,” she added, “and that’s why we appear before the Legislature to request more funding — so we don’t have to take away even subsistence support.”
In her opening remarks, Muna acknowledged the government’s budget constraints but emphasized the real-world consequences of underfunding.
“We understand that these are challenging times, and I know you’ve heard this many times during budget hearings,” she said. “We just want to express that we witness it every day — when patients struggle to attend their crucial follow-up appointments.”
“We also know that you’re aware of the minimal funding we receive annually. But like others, we ask that you provide us the support we need to deliver quality healthcare to our people. We have done so much with so little — just imagine what we can do with more.”
