[Congressional Record Volume 169, Number 80 (Thursday, May 11, 2023)]
[Extensions of Remarks]
[Page E427]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





 INTRODUCTION OF THE NORTHERN MARIANA ISLANDS MEDICAID EQUIVALENCE ACT

                                 ______
                                 

                  HON. GREGORIO KILILI CAMACHO SABLAN

                    of the northern mariana islands

                    in the house of representatives

                         Thursday, May 11, 2023

  Mr. SABLAN. Mr. Speaker, Medicaid funding for the Marianas was $6.5 
million when I first came to Congress in 2009. This year, the Medicaid 
block grant is $66 million. We have made significant progress.
  But the Marianas is like the runner who begins the race 400 yards 
back from everyone else's starting line.
  In 1983, when limited Medicaid block grants for the territories were 
established in law, the Marianas lacked congressional representation. 
The impact was evident: our grant was the smallest.
  In subsequent years, though the grant increased with the percentage 
of inflation or congressional action, that built-in disparity between 
the Marianas and other territories was perpetuated.
  The result is today American Samoa receives $24 million more in 
Medicaid funding than the Marianas despite having the same population 
and income. And American Samoa is able to offer more healthcare 
services to more low-income residents as a result. In 2021, the 
American Samoa Medicaid program served nearly 38,000 residents whereas 
the Marianas Medicaid program served 17,000.
  The time has come to level up and provide funding for the Marianas 
equivalent to a territory with virtually the same population and 
incomes.
  The legislation I am introducing today does just that. It provides 
for a Marianas Medicaid grant that matches what American Samoa receives 
and corrects a historical disparity in Medicaid funding that began when 
the Marianas had no voice in Congress.
  This legislation is not simply an action to rationalize the funding 
for Medicaid. The legislation also is a response to the very real 
shortfall in Medicaid funding for the Marianas that our Governor Arnold 
I. Palacios reported to me in April. I am including his letter in the 
Record.
  Funding for fiscal 2023 has already been allotted. So, today's 
legislation will not aid this year's shortfall. But today's legislation 
will help ensure that in future years, low-income residents in the 
Marianas and American Samoa have equivalent access to federally funded 
healthcare.

         Commonwealth of the Northern Marianas Islands, Office of 
           the Governor,
                                        Saipan, MP, April 4, 2023.
     Re Financial Shortfall.

     Hon. Arnold I. Palacios & Lt. Governor David M. Apatang,
     Governor, Commonwealth of the Northern Mariana Islands, 
         Saipan, MP.
       Dear Governor Palacios & Lt. Governor Apatang: In response 
     to the COVID-19 pandemic, and through temporary authorities 
     provided during the National Public Health Emergency (PHE), 
     the Commonwealth Medicaid Agency (CMA) expanded coverage for 
     up to 30,000 additional CNMI residents, providing vital 
     healthcare access to over 45,000 individuals today. The PHE 
     concludes on May 11, 2023, and although Medicaid expenses 
     will gradually decrease, we still anticipate a financial 
     shortfall by the end of fiscal year 2023 due to the impact of 
     the PHE.
       The CNMI's federal Medicaid funding is capped annually by 
     statute, in section 1108 of the Social Security Act. The CNMI 
     Government bears the responsibility for services to Medicaid 
     beneficiaries when federal funds are exhausted. Despite 
     permanent increases to CNMI's Medicaid cap through the 
     Further Consolidated Appropriations Act of 2020, our current 
     funding of $65,870,000 for fiscal year 2023 is insufficient 
     given the expenditure trends observed in fiscal year 2022 and 
     as of March 30, 2023.
       Medicaid expended approximately $18 million of ARPA funds 
     appropriated by the CNMI Government in addition to the $63 
     million of the 1108 Funding for Fiscal Year 2022. As a result 
     of the additional appropriations, CNMI Medicaid did not 
     experience a shortfall. As of March 30, 2023, Medicaid has 
     expended 61% of its Fiscal Year 2023 section 1108 allotment. 
     No other funding sources are available today to supplement 
     the shortfall.
       The CNMI Medicaid's Section 1108 funding is expected to be 
     depleted before the current fiscal year's end, which 
     threatens our ability to continue providing essential 
     healthcare services to Medicaid beneficiaries. Additional 
     funding is crucial to prevent provider closures, suspension 
     of services and loss of healthcare access for beneficiaries, 
     and increased burden on the Commonwealth Healthcare 
     Corporation (CHCC), which will become the sole provider 
     available to Medicaid beneficiaries when federal funds run 
     out. Moreover, the CNMI's existing shortage of specialty care 
     services will be exacerbated, compromising current and future 
     patients' access to off-island treatments.
       We initially projected a $10 million shortfall in Section 
     1108 funding; this projection has since been revised to $4.8 
     million as of March 30, 2023, following the announcement of a 
     date certain for the PHE's conclusion and additional guidance 
     from the Centers for Medicare and Medicaid Services (CMS). 
     However, this figure may change due to monthly uncertainties 
     in services rendered and accounts receivables. It may also 
     change if monthly payments made to CHCC are adjusted based on 
     any revisions made to the Certified Public Expenditure 
     methodology post-PHE.
       While the Consolidated Appropriations Act of 2023 has 
     permanently secured CNMI's Federal Medical Assistance 
     Percentage (FMAP) at 83%, the 6.2% increase provided by the 
     Families First Coronavirus Response Act will be phased out, 
     resulting in higher local shares for CNMI. Additionally, as 
     we have learned from your FY 2023 revised budget message 
     transmitted to the Legislature on March 8, 2023, Community 
     Disaster Loan funds are no longer available to support the 
     CNMI's local match requirement for Medicaid. Insufficient 
     local matching funds jeopardizes our ability to utilize 
     federal funds.
       To avoid the fast-approaching fiscal cliff and the 
     healthcare crisis that will follow, the Commonwealth's 
     Medicaid program is in urgent need of two critical 
     interventions in the current fiscal year:
       1) a waiver of the local match requirement; and
       2) additional federal funding of at least $4.8 million, 
     based on current projections.
       These measures are essential to address our outstanding and 
     anticipated obligations for the remainder of the fiscal year 
     and will ensure the continued provision of vital healthcare 
     services to our constituents.
       Please feel free to contact me for further discussion.
           Sincerely,
                                                    Vicenta Borja,
     Acting Medicaid Director.

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