By Jane Anderson

Funding that has kept Medicaid programs afloat in Puerto Rico and the U.S. Virgin Islands following the devastating hurricanes that hit two years ago is set to expire in September. And that could lead to steep enrollment cuts, budget shortfalls and increases in the uninsured population, a Kaiser Family Foundation report warns.

If Congress does not take steps to extend the funding, the two territories will face a health care fiscal cliff that could drive residents to the mainland U.S. to obtain Medicaid coverage.

In addition, if the crisis isn’t resolved in time, “the local government will run out of money to finance the Medicaid program, risking access to care for hundreds of thousands of vulnerable U.S. citizens,” says Orlando González Rivera, president of Medicare Advantage Medicare and Mucho Más, a subsidiary of InnovaCare.

If Puerto Rico reverted to pre-ACA Medicaid financing, available funds would fall short of projected program costs by $1 billion in fiscal year 2020 and $1.5 billion in fiscal year 2021, which is equal to half of Medicaid projected program costs, the Kaiser report said.

In the Virgin Islands, meanwhile, a return to traditional financing would leave the territory with a projected $31.3 million shortfall in fiscal year 2020, which represents about 40% of projected program costs.

González Rivera says he expects a temporary solution to be in place by the end of September 2019, when the current agreement expires. However, “from what we have heard the solution will not be sufficient as it will be a temporary fix and not a permanent solution for the long-standing issue of inadequate funding for the Medicaid program to more than 1.3 million vulnerable U.S. citizens,” he says.