MMAPA to ask for an adjustment in Puerto Rico's Medicare Advantage rates as part of joint campaign

Wednesday, January 17, 2018 General News
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MMAPA Joins the Puerto Rico government and a group of congressional leaders including the resident commissioner in seeking a redress to cuts in Medicare Advantage that have created dramatic disparities in the treatment of beneficiaries in Puerto Rico as compared to the states

SAN JUAN, Puerto Rico, Jan. 17, 2018 /PRNewswire/ -- Medicaid and Medicare Advantage Products Association of Puerto

Rico (MMAPA) and its members have joined with the Government of Puerto Rico and congressional leaders to advocate for Medicare Advantage patients in Puerto Rico after the passing of hurricane Marķa. They are urging the federal government to take the appropriate action to grant rate equality to American citizens residing in Puerto Rico.

"The pressures and lack of resources in our system were exacerbated by cuts of more than 20 percent to Medicare Advantage, which started in 2012, and have directly affected more than 580,000 beneficiaries. These cuts led to the recent crisis in our system, whose underlying problem is that we invest only $3,500 per capita in healthcare annually, while operating within a federal system that averages an annual investment of $10,000 per person for healthcare services," explained Rick Shinto, CEO of MMM and new president of MMAPA.  

In anticipation of the issuance of the MA Advance Notice and Draft Call Letter for 2019, 16 congressional members, including Puerto Rico's Resident Commissioner, issued a letter to CMS, and the Puerto Rico House of Representatives adopted a resolution, seeking to redress these disparities.  In early January, the Governor of Puerto Rico followed up on these requests, specifically asking the Acting Secretary of the U.S. Department of Health and Human Services and the CMS Administrator to use the national average for MA rates, or at least the U.S. Virgin Islands rate, as a proxy to establish the Puerto Rico MA rate. Puerto Rico is currently 39 percent lower than the MA rates in the state with the lowest rates, and 26 percent below the U.S. Virgin Islands. 

Cuts in MA rates have accentuated disparityAt the national level, Medicare Advantage benchmark payments for 2017 average $826 per member per month. In Puerto Rico, the benchmark averages $473, which is 43 percent below the national average. CMS bases benchmarks for Medicare Advantage on fee-for-service experience. In the states, fee-for-service Medicare has much higher participation than the Medicare Advantage programs, yet in Puerto Rico MA enrollment represents more than 75 percent of the eligible population. Thus, basing the benchmark on the fee-for-service experience is not representative of the program's costs on the island.

The Medicare funding cuts enacted by the Affordable Care Act (ACA) represent a major problem for Puerto Rico's healthcare system. Between 2012 and 2017, cuts to MA rates have represented $4 billion.  The loss of these funds has triggered dramatic disparities in provider payments that are spurring the emigration of doctors and other health care professionals looking for better salary opportunities in the United States. As a result, U.S. citizens residing in Puerto Rico are losing access to both primary care physicians and specialists. In addition to lowering provider payments and access to health care services, these funding cuts also result in reduced benefits for beneficiaries. 

Approximately 70 percent of the funding for the Puerto Rico health system relies on Medicare, Medicaid and Puerto Rico government funds.  Any cuts to these programs have a wide-ranging impact on the island's health system.

According to Shinto, MMAPA members and the Puerto Rico healthcare community are grateful for the actions taken by congressional leaders and the Governor, Resident Commissioner and Puerto Rico House of Representatives.

About MMAPA MMAPA ( is a non-profit association composed of the leading Medicaid and Medicare Advantage organizations in Puerto Rico, including First Medical, Humana, MCS, MMM, Molina and Triple-S.  Established in 2009, MMAPA is dedicated to educating policymakers about Puerto Rico's healthcare system and addressing the inequities in current law. The Association's members serve nearly two million Puerto Ricans in the Medicaid and Medicare Advantage lines of business.

Media Contact:Suzie BolandRFB Communications


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SOURCE Medicaid and Medicare Advantage Products Association of Puerto Rico

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