Puerto Rico presses Congress to prevent ‘Medicaid cliff’

Puerto Rico Gov. Pedro Pierluisi (D) said Thursday that a looming “Medicaid cliff” and a slew of political and economic challenges all come back to the island’s status as a U.S. territory.

The debate over status will remain at the core of the island’s politics indefinitely, he said, unless Puerto Rico becomes a state or a sovereign nation.

“Whenever I’m told about prioritizing, I say the status issue permeates everything else. It is an existential issue. You always have to deal with this issue until you resolve it,” Pierluisi told The Hill in an interview.

The latest issue to shine a spotlight on the deficiencies of the territorial arrangement with the U.S. is the allocation of Medicaid resources to the island’s more than 3 million residents.

Why the concern: Unlike all 50 states and the District of Columbia, Puerto Rico is not guaranteed a certain percentage of Medicaid resources in the federal government’s annual budget. Puerto Rico is subject to capped federal spending and a fixed matching rate, meaning that not only does it get less money from the federal government than states, the formula doesn’t allow for additional funding.

Once the funding is exhausted, there is no more.

Without additional Congressional action, the island will lose the vast majority of its Medicaid financing which could result in reductions in coverage— a major problem given the  long-term health and economic consequences of the COVID-19 pandemic.

Beyond statehood: Many opponents of statehood — those who want to remain a territory or seek independence — have also sought a better deal for territories on Medicaid and other social services, regardless of their opposition to a permanent union between Puerto Rico and the United States.