CNMI Medicaid will experience a financial shortfall this year, its acting director, Vicenta Borja, told Gov. Arnold I. Palacios and Lt. Gov. David M. Apatang.
Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
Last month, Borja informed the governor that she projected a $4.8 million financial shortfall for the local Medicaid program. But she said this figure could change due to the interim monthly payments made to CHCC using the Certified Public Expenditure or CPE methodology.
In Medicaid funding, CPE is an expense that has been incurred by a state or local government entity, and has been verified and certified by the government as being eligible for federal Medicaid matching funds.
In her letter dated May 3, 2023, Borja said as of May 1, 2023, the remaining amount of the CNMI’s federal Medicaid funds totaled $19,325,939.
She said she analyzed the figures and applied them to three different scenarios.
In scenario No. 1, the CNMI government makes a retroactive payment to CHCC for the period of October 2022 to April 2023 in the amount of $3,093,179; and then set aside $11,597,690 for payments for the period of May 2023 to September 2023.
In this scenario, the remaining funds would be exhausted immediately, resulting in a $20,768,516 financial shortfall for the Medicaid program.
In scenario No. 2, the CNMI government will not a make retroactive payment, and will set aside $11,597,690 for the period of May 2023 to September 2023. There will be $7,728,249 in federal Medicaid funds left, but this will be exhausted by June 2023.
In scenario No. 3, the CNMI government will make no retroactive payment and will allocate $8,235,369 for the period of May 2023 to September 2023. There will be $11,072,579 in Medicaid funds left which will be exhausted around July, but no later than August 2023, and the shortfall will be $8,450,398.
Borja reiterated that regardless of which scenario the CNMI government would prefer, the local Medicaid program will experience a financial shortfall. “It is just a matter of when this will occur,” she told Palacios and Apatang.
She said “immediate action” is needed in order for the CNMI Medicaid to comply with the federal rules. She did not elaborate.
If the CNMI government “wishes to stop or limit services otherwise eligible for federal financial participation…a State Plan Amendment…is required that must specify what services will be affected,” and advance notices must be provided the beneficiaries, Borja added.
“I respectfully and kindly urge your immediate attention as…many individuals and families rely solely on Medicaid for their healthcare needs. Additionally, Medicaid providers on and off-island will be significantly impacted by this matter and relationships with off-island providers will be jeopardized which will affect the future of much needed off-island medical treatment,” Borja said.
