Guam officials eye Medicaid cliff

MM Curator summary


Guam’s FMAP will go from 89% to 55% for FY 2022.


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HAGÅTÑA (The Guam Daily Post) — Local health officials are keeping a keen eye on the expiration of expanded Medicaid assistance as they map out their budgetary needs for the next fiscal year.

The federal government covers a certain share of Medicaid expenses based on the Federal Medical Assistance Percentage for the state or territory.

The FMAP for Guam has fluctuated recently but has been 55% in the past, meaning the local government needed to put up a 45% share to get the federal government to cover the rest.

In fiscal year 2019, Congress raised the FMAP to 100%. In fiscal 2020 and 2021, the FMAP was set to 83% and then to about 89%, due to the Covid-19 pandemic. Moreover, the island’s Medicaid cap was lifted to about $130 million for fiscal year 2020 and 2021.

About $122 million of federal funding was spent out of Medicaid in fiscal 2020, while Guam spent only $12 million.

But these expansions last up to the end of this fiscal year, and as Department of Public Health and Social Services Director Arthur San Agustin stated Thursday, the U.S. Congress has not set any additional funding after fiscal year 2021.

This means that for fiscal 2022, Guam is expected to revert to a prior Medicaid cap of about $19 million to $20 million, and a match of 55% for Guam’s 45%.

“An ongoing fiscal challenge of this program is to determine the amount needed to match Medicaid federal funds without knowing the percent of Guam’s required match. Unlike other programs, their match levels have remained constant for years, which allows for better fiscal planning and decision-making,” San Agustin said, referring to the uncertainty about where numbers will ultimately land.

This is just as much a concern for the Guam Memorial Hospital Authority.

“We’re also kind of concerned that, come Sept. 30, if the Medicaid FMAP goes back to the 55%/45%, that’s really going to have a significant impact on our Medicaid reimbursements,” GMHA Administrator Lillian Perez-Posadas told lawmakers Thursday. “So I hope you’re all paying attention to that situation and maybe we can find a way to collectively make sure that doesn’t happen.”

DPHSS noted a drastic decrease in federal funding for its Division of Public Welfare within its fiscal 2022 budget. According to Tess Arcangel, the division director, this was due to lower anticipated Medicaid funding. Arcangel said there is a federal proposal to remove the Medicaid cap but it doesn’t include the FMAP.

She didn’t name the proposal, but may have been referring to the Insular Area Medicaid Parity Act, of which Guam Delegate Michael San Nicolas is a co-sponsor.

San Nicolas did not comment about any specific bills but stated that he and his colleagues are working closely “to secure full and permanent inclusion of Guam and all territories in Medicaid, and are confident that we will achieve that in this 117th Congress.”

When asked if he foresaw at least an interim solution before the Medicaid expansions expire, San Nicolas said an interim solution is “very likely” but so is a permanent one.

Because of concerns caused by temporary fixes to Medicaid issues for the territories, San Nicolas and other territorial representatives have called for a permanent solution.

Meanwhile, a positive note for Guam has been the inclusion of citizens of Freely Associated States in Medicaid, as part of the $900 billion federal relief package signed into law in December. There is no Medicaid cap on residents under the Compacts of Free Association, although the match may still revert to 55%/45%, according to Arcangel.

Currently, DPHSS has about 8,000 COFA migrants under the local Medically Indigent Program. The department submitted a statement amendment to shift them to Medicaid effective Jan. 1, but has not received approval from the Centers for Medicare and Medicaid Services, Arcangel said.

If the transfer occurs, then funding intended for MIP could be used as a local match for Medicaid, she said.


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