Jenniffer González-Colón introduces bill to remove the matching requirement under Medicare Part D for Puerto Rico

by | May 7, 2019 | Congress | Comments

Puerto Rico Resident Commissioner Jenniffer González-Colón (NPP, R) introduced HR 2172, a bipartisan bill to remove the matching requirement for Medicare Part D drugs for low-income individuals.

Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage prescription drug plan (MA-PD), mainly HMOs and PPOs, that cover all Medicare benefits including drugs.

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, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, or $18,210 for individuals/$24,690 for married couples in 2018) and modest assets (less than $14,100 for individuals/$28,150 for couples in 2018).

Residents of Puerto Rico are ineligible to receive LIS to subsidize their Part D premiums.

Instead of LIS, Puerto Rico receives a grant from the US Department of Health and Human Services to be used to provide prescription drug benefits to Medicare enrollees who are also beneficiaries of Medicaid.

This grant is subject to the matching requirement of the applicable 55% statutory FMAP.

The matching requirement is not present for the States, whose residents receive the benefits of LIS directly from the federal government.

For the past 5 years, Puerto Rico has been able to draw down approximately 35 percent of its available federal funding for prescription drugs for low-income Medicare beneficiaries because of a struggle to comply the matching requirement.

HR 2172 will eliminate the matching requirement for Puerto Rico, alleviating the government financial burden.

HR 2172 is co-sponsored by Representative Darren Soto (D) of Florida and Delegate Aumua Amata Coleman Radewagen (R) of American Samoa and amends title XIX of the Social Security Act to remove the matching requirement before a territory can access and draw down the territory’s federal funds for Medicare Part D drugs. This bill is consistent with the recommendations made by the Congressional Task Force on Economic Growth in Puerto Rico.