— NWS (@NWS) September 6, 2017
Puerto Rico is line to be hit hard. It is in line for massive destruction and disruption of its public health infrastructure. It is in line for a potential health crisis.
Puerto Rico’s Medicaid system is pervasive and unusual when compared to how Medicaid is run in states. MedPac has a good summary:
Federal Medicaid funding to Puerto Rico is subject to an annual funding ceiling specified in statute, which
grows with the medical component of the Consumer Price Index for Urban Consumers (CPI-U) (§1108(g))….
In general, once Puerto Rico exhausts its annual Medicaid and CHIP ceilings, it must fund its program with
territory funds. …
The Consolidated Appropriations Act of 2017 (P.L. 115-31) provided Puerto Rico with an additional $295.9 million. Puerto
Rico must contribute a non-federal share to access these funds, which is matched at its FMAP rate (CMS
2016a). After these funds expire or are exhausted, Puerto Rico will generally not be able to spend federal
dollars beyond the ceiling for Medicaid.6
Puerto Rico receives a fixed amount of money from the Federal government. After it goes through that money, it is out of luck. In good years, that money should be sufficient. In bad years when there is an external shock to the system like a Category 5 hurricane, who knows if that is sufficient. There may be additional money released by an emergency federal appropriation. There might not be additional money. The local cushion to mobilize resources is constrained by the block grant policy.