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Resident Commissioner pursues equality in Medicare Part D for P.R.

Puerto Rico’s Resident Commissioner in Washington, Jenniffer González introduced the Territories Medicare Prescription Drug Assistance Equality Act, a bipartisan bill to make premium and cost-sharing subsidies available to low-income Medicare Part D beneficiaries who live in Puerto Rico and other U.S. territories.

Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. In 2018, more than 43 million of the 60 million people with Medicare were enrolled in Part D plans.

Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing, through the Part D Low-Income Subsidy (LIS) Program. Dual-eligible beneficiaries who qualify for Medicaid based on income and assets are automatically deemed eligible for Part D low-income subsidies, as are individuals who receive premium and/or cost-sharing assistance from Medicaid through the Medicare Savings Program (MSP) or Supplemental Security Income (SSI) cash assistance.

While this assistance is available for Medicare beneficiaries in the States and in the District of Columbia, Medicare beneficiaries who reside in the territories are not eligible for the LIS.

In lieu of LIS, territorial governments are allotted a fixed amount of funding through grants pursuant to Section 1935(e) of the Social Security Act, to provide prescription drug assistance to low-income Medicare beneficiaries, in other words, only for dually eligible beneficiaries.

Currently, annual funding for Puerto Rico is only $59 million, which is substantially less than the aggregate amount that low-income Medicare beneficiaries in Puerto Rico would receive if eligible for LIS, she said.

Moreover, before accessing the federal funds, each territory government is required to contribute, or “match “funds toward the payment of the Medicare Part D covered drugs. Thus, for every dollar that Puerto Rico spends providing Medicaid coverage for prescription drugs to low-income Medicare beneficiaries, it draws down 55 cents from its allotted Section 1935(e) funding, up to the annual limit, and is responsible for the remaining 45 cents.

This matching requirement for prescription drug benefits is not imposed upon the U.S. mainland states or Washington D.C. The territories — to varying degrees — have struggled to comply with the matching requirement and thus are not able to access the federal funding. Between Fiscal 2010 and Fiscal 2016, Puerto Rico was only able to draw down only about 51% of its available federal funding for prescription drugs for low-income Medicare beneficiaries, she said.

“The current situation means that the impoverished elderly and disabled living in Puerto Rico receive far less prescription drug assistance that their fellow citizens in the states and DC, despite a significant need for it,” González said.

“In addition, because coverage for prescription drugs is provided through the territory’s Medicaid program, Medicare beneficiaries who are ineligible for Medicaid are ineligible for any assistance, even if they would be eligible for assistance under LIS,” she added.

The Territories Medicare Prescription Drug Assistance Equality Act makes applicable the Part D Low Income Subsidy Program in the territories in the same manner it is applicable in the States and in DC. It is co-sponsored by Darren Soto (D-FL).

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This story was written by our staff based on a press release.

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