Medical Center, Patients Claim US Is Underfunding Health Care Programs

MIAMI (CN) – A medical center in Puerto Rico and two of its patients claim in court that the Trump administration is underfunding the health care programs in the U.S. territory, placing nearly 1 million people at risk of losing their health care coverage.

In a federal complaint filed Monday in Miami, the plaintiffs claim Puerto Rico’s residents are burdened with a “second rate health care system” that is about to collapse.

The plaintiffs, who are represented by Jose Oswaldo Coll and Ignacio Fernandez de Lahongrais in Puerto Rico, say the federal funding the island gets for Medicaid, Medicare and the Children’s Health Insurance Program, or CHIP, comes to far less than U.S. states receive.

“The United States’ disparate treatment in health care funding directly targets the most vulnerable of its citizens residing in Puerto Rico: the poor, elderly and unprivileged children,” plaintiffs say.

Med Centro, a community-based nonprofit in Puerto Rico, says it receives federal grant funds, and provides health care services to patients eligible for Medicaid, Medicare and SCHIP.

The Medicaid program, which was enacted in 1965, provides medical services to indigent families with dependent children, disabled, blind and aged individuals, and its funded by the federal and state governments.

In 1994, Puerto Rico established an obligatory enrollment for Medicaid beneficiaries through a healthcare plan called “La Reforma.” The program has since been renamed “Mi Salud.” The plan offers health services through separate managed care organizations in the island, the complaint says.

According to the complaint, as of 2016 almost half of the population of Puerto Rico is covered by Medicaid, and 11 percent are covered by Medicare.

“Although Puerto Rico is required to comply with all federal Medicaid requirements as if it were a State, Puerto Rico’s Medicaid program is funded as an unincorporated territory. Thus, Puerto Rico’s Medicaid program is not adequately funded for discriminatory and constitutionally inform reasons,” the complaint says.

The lawsuit says federal funding of Medicaid for states and the District of Columbia is open ended, but Puerto Rico has an annual cap imposed by Congress of less than $400 million.

The complaint says that in 2011, Puerto Rico obtained $6.4 billion through the Patient Protection and Affordable Care Act, but according to the Department of Health and Human Services the island will possibly exhaust such funds by the first quarter of 2018.

If the government continues to fund the Medicaid program with the same amount, the total spending would decrease to less than is needed to serve the program’s current enrollment, and as a result, as many as 500,000 U.S. citizens living in Puerto Rico would lose health care coverage, the complaint says.

The situation is the same for Medicare and CHIP beneficiaries in Puerto Rico, the plaintiffs claim.

 

Puerto Ricans pay the same amount of social security and Medicare taxes as any other U.S. citizen, bur their Medicare reimbursement rates are lower than in any state, the complaint says.

“Medicare’s per person per month rates for Puerto Rico beneficiaries of Medicare Advantage is 43 percent below the U.S. average,” the plaintiffs claim.

Moreover, the health care funding cuts in Puerto Rico have contributed to reductions in benefits and provider compensation, which have caused over 3,000 physicians to move to the mainland states, they say.

Med Centro claims that even though it’s required to provide health care services as any other medical center in the U.S., it receives “depressed and discriminatory reimbursement rates.”

“Congress’ disparate and discriminatory treatment in Medicaid funding against United States citizens residing in Puerto Rico is subject to strict scrutiny under equal protection grounds,” the complaint says.

Plaintiffs are seeking declaratory and injunctive relief under claims of violations of the Equal Protection Clause.

A representative of the U.S. Department of Health and Human Services did not immediately respond to a request for comment.

%d bloggers like this: