America's 'Shame': Medicaid funding In the U.S. Territories
Washington, D.C. — Right now, there are dozens of patients — U.S. citizens — in New Zealand hospitals who are fighting the clock. They have only a few weeks to recover and get home to the tiny island of American Samoa, a U.S. territory in the South Pacific.
"We have a cancer patient that is coming back in December," says Sandra King Young, who runs the Medicaid program in American Samoa. "We can only give him six weeks of chemo, radiation and surgery. He has a good chance of survival if he has the full year of treatment, but not six weeks. The patient and family understand, and since they have no money, they have agreed to come back." As a consequence, the off-island referral program to treat conditions that the territory doesn't have the local capacity or facilities to treat — the program that brought these patients to New Zealand — is getting shut down.
The federal money to fully fund the Medicaid program in American Samoa and in all other U.S. territories is about to run out.
(Editor's note: Congresswoman Aumua Amata announced yesterday a 30 day reprieve with American Samoa’s 100 percent federal Medicaid match rate now extended another 30 days through December 20, 2019. Read the release in today's issue.)
"It's devastating for those people who need those lifesaving services," King Young says. "People who need cancer treatment won't get it. Children with rheumatic heart disease won't get the heart surgeries that they need."
All five of the U.S. territories affected — collectively home to more than 3 million Americans — are now desperately trying to figure out how to keep Medicaid running with only a fraction of the money they've had for the last several years. If Congress doesn't increase the amount of designated money by the end of the year, the U.S. Virgin Islands and Guam say they would need to cut their Medicaid rolls in half; Puerto Rico says it would need to cut back dental and prescription drug services.
This is what people working on the issue have come to call the "Medicaid cliff."
HOW DID WE GET HERE?
When it comes to Medicaid, the federal government treats U.S. territories differently from how it treats states.
In U.S. states, the amount that the federal government contributes to Medicaid varies based on a formula in the law that relies on per capita income in each state. For instance, Alabama has a match rate of 72%; what this translates to is that for every dollar Alabama spends on Medicaid, the federal government contributes about $2.57 to the program.
But that's not how it works in the territories, where even though the populations are all low income, the federal government's match rate is set in statute at 55%. What this translates to is that for every dollar a U.S. territory spends on Medicaid, the federal government contributes $1.25.
The other significant difference is that the federal contribution to Medicaid in the territories is capped, with a set allotment of federal funds every year. Federal spending on Medicaid in states is not.