V.I. seeking more Medicaid funding

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ST. CROIX - The V.I. Human Services Department is working on a report that - if accepted - would result in the federal government temporarily picking up a higher share of Medicaid costs in the territory.

The proposed increase to the federal share has two different components - one a small overall increase, and the other a large increase in the federal match for a particular patient population. The more the federal government pays, the less the territory has to pay for the program.

According to a statement Human Services released last week, officials are considering the next steps so that the Medical Assistance Program - the territory's Medicaid program - can be expanded to include low income adults who are not pregnant and who do not have children.

Last week, Human Services received news that the federal government would be picking up a higher percentage of the tab for that population, once the Medicaid program is expanded to include them.

"As Human Services planned Medicaid expansion, we always intended to add this group to the rolls of low income children, parents, seniors and persons with disabilities. With the news of the increased federal match, Human Services will try to more quickly add this group," Human Services Commissioner Chris Finch said in the release.

Medicaid is the nation's health care program for the poor.

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

Under a funding formula, the federal government picks up a higher percentage of Medicaid costs for poorer states. But for the territories, the federal match was set by law at 50 percent - the lowest level. The Affordable Care Act raised the federal matching percentage for the territories to 55 percent.

Human Services was informed of these two changes recently:

- If the territory expands its Medicaid program to include the new group - childless adults who are not pregnant - the federal government will pick up 78 percent of the cost for that new group, leaving the territory with only 22 percent to pay, Finch said in an interview. That increase would be effective until the Affordable Care Act expires in 2019, he said.

- The federal government will increase its matching percentage from 55 percent to 57.2 percent for all patients in the program if the territory can prove that it meets the criteria to be considered a "Medicaid Expansion State" under the Affordable Care Act, Finch said. That increase would last for two years.

A report that would show that the territory can be considered a Medicaid Expansion State will be due in mid-February, and if it is accepted, the higher 57.2 percent rate would be retroactive to Jan. 1, Finch said. Meeting that criteria is necessary for both increases, he said.

The territory does not have a lot of data on the proposed new group at this point, he said, adding that the plan had originally been to expand Medicaid by raising the income limits for the traditional groups first, and then proceed with this group afterward.

"We don't how big this group is. There are some special ways under Affordable Care Act that their income has to be treated," Finch said.

Finch said that before expanding Medicaid in the territory to include this group, officials have to be sure they are ready and that the territory has the funding in place to pick up its portion of the tab.

Among the things they need to find out is how many people in the territory are in this group and what their health care costs are likely to be, he said.

"Prior to this week, we thought our match would be 45 percent. This drops our match for this population to 22 percent, which alleviates some of the concerns," Finch said - although he noted that, like many other components of Medicaid, the states get a better deal with the federal government initially picking up 100 percent of the costs for this population.

"It's a welcome change. I don't want to sound ungrateful," Finch said. "But it doesn't hurt to point out that it is different than the deal offered to the states."

Finch said the territory had always planned to add this population to its Medicaid eligibility, but now officials have to figure out how much it will take to do it.

"We're making it a priority," Finch said.

Demonstrating that the territory meets the definition of a Medicaid expansion state involves developing a structure of how the territory provided health benefits coverage since 2010 to persons who are not pregnant and who are childless, a task that will take considerable time to accomplish, according to the Human Services press release.

- Contact reporter Joy Blackburn at 714-9145 or email jblackburn@dailynews.vi.

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