The territory is continuing to move forward with implementing the Affordable Care Act, which the Supreme Court affirmed in a decision Thursday.

"I'm riding on that excited wave that ACA is OK, and we can continue with the work we had planned," said Taetia Phillips-Dorsett, health reform coordinator for the Governor's Office.

The Affordable Care Act - sweeping legislation that contains wide-ranging provisions for health care reform - uses a phased approach, with reforms being implemented through 2019.

Britt Weinstock, an aide to V.I. Delegate to Congress Donna Christensen, said that there are "so many great things in this law that people lack of awareness about. They're still very much still there."

Much of the law applies to the entire nation, including the territories.

But several provisions do not apply to the territories and some are funded by tax breaks. Because residents of the territory do not pay federal income tax, the funding for tax breaks come out of the territory's coffers.

A prepared statement Government House released Thursday provides some updates on the status of the territory's implementation of certain provisions of the law.

More than half of uninsured Virgin Islanders are between the ages of 18 and 24, and if the Affordable Care Act had been struck down, those without employer sponsored coverage or Medicaid eligibility would have few options for obtaining insurance, because no carriers are writing individual policies in the territory, according to Government House.

The release notes that the Affordable Care Act allows the territory to pursue about $300 million in additional funding to expand Medicaid - the nation's health care program for the poor - over a nine-year period.

The goal is to expand the Medicaid rolls from the 8,500 Virgin Islanders currently using the program and make the insurance available to 25,000 by 2019, according to Government House.

However, getting access to the additional federal dollars and accomplishing the Medicaid expansion that the law allows for brings its own set of challenges for the territory - mostly, finding the money to pay for the territory's share of the program.

Each state or territory has its own Medicaid plan and shares the cost of Medicaid with the federal government.

In the territory, the federal government pays 55 percent of Medicaid costs, while the territory is responsible for paying the remaining 45 percent.

Although there is a cap on federal Medicaid dollars to the territory, the problem at this point is finding the local money to cover the local share of the costs, so that all of the federal money can be spent.

"Historically, we've only been able to appropriate about $6 million a year as a local match," Phillips-Dorsett said.

The limited money appropriated for the local share in turn limits the amount of federal Medicaid money that the territory can tap into.

Phillips-Dorsett also pointed out that the territory has to fully expend on an annual basis the entire amount of its regular federal Medicaid allotment - typically about $14 million - before it can go after all or a portion of the extra money available through the Affordable Care Act.

The press release from Government House on Wednesday indicated that the administration hopes to use the full amount available under the regular federal allotment in 2013.

The administration "has committed an additional $9 million from the General Fund to the territory's Medicaid Program in the Fiscal Year 2013 budget," the release said.

That funding, in addition to the $6 million already dedicated to Medicaid, would bring the local contribution to $15 million, which would allow the territory to "fully expend the $14 million in federal money that's on the table every year," Phillips-Dorsett said.

Then, the territory could decide what to do with the additional Medicaid expansion funds available to it under the Affordable Care Act, she said.

Phillips-Dorsett noted that the territory also is exploring different, non-traditional ways to be able to count some existing General Fund expenditures - such as the appropriations to the hospitals - toward its local match for Medicaid. Doing so would require a waiver from the Center for Medicare and Medicaid Services.

"We're looking at every single different angle to count more General Fund expenditures as matching funds so we can go after that $300 million," she said.

The Government House release notes that "the centerpiece" of the Affordable Care Act - the individual mandate requiring Americans to purchase health insurance - was not an official requirement for the Virgin Islands and other territories.

Another key provision, the implementation of health insurance exchanges, also was not mandatory for the territory, according to the release.

The territory has the option to use its health insurance exchange allotment to develop a territorial exchange, to partner with another state to develop a regional exchange or to use the allotment to further expand Medicaid, Phillips-Dorsett said.

The territory received a $1 million grant to explore the feasibility of setting up a health insurance exchange, which essentially is a marketplace in which individuals and small business owners could purchase affordable health insurance plans.

The Health Reform Implementation Task Force and the health insurance exchange team are continuing to gather data about the local insurance landscape and the territory's information technology infrastructure to support the development of a territorial or regional health insurance exchange, according to Government House.

The group eventually will make a recommendation to the governor on which option to take.

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