Healthcare Medicaid Issue in Puerto Rico Calls for Innovative Solution 

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By Mario Anglada

Mario Anglada, CEO, Hoy Health 

The U.S. territories’ Medicaid programs are about to regress to a state of chronic underfunding unless policymakers take action. Historically, these programs have received unequal treatment compared to Medicaid in the states, which the Affordable Care Act (ACA) sought to address by providing additional funds, the ACA, however, failed to provide a long-term fix to a formula that gave territories – including Puerto Rico — fewer Medicaid funds. 

Instead, it simply provided buffer funding to enable programs to maintain status quo with potential to expand. Unfortunately, these funds are scheduled to expire in September of 2019, creating a highly disruptive healthcare environment at a time when Puerto Rico is still recovering from Hurricane Maria.

Even as Puerto Rico continues to rebuild its infrastructure and get back online, innovative healthcare solutions now enable under- and uninsured individuals to gain access to quality care designed to serve their needs and help mitigate the impact of the pending Medicaid program crisis. 

These solutions are designed to give Hispanics everywhere access to care at an affordable price, whether it’s in the U.S. or Puerto Rico, in either English or Spanish, and without the need for any type of insurance or third-party payment. 

Puerto Rico’s Healthcare Crisis 

Roughly one in two Puerto Ricans are enrolled in the island’s Medicaid program. What’s more Puerto Rico’s health care system faces a number of challenges. As young people migrate to the U.S. mainland, seniors now make up a larger share of the population. Health indicators are worse than for the rest of the United States, and the island’s Medicaid program that covers half of the population faces financing difficulties in addition to Puerto Rico’s overall fiscal challenges. 

Adding to the hardship, Puerto Rico’s health system has endured a lack of resources due to systemically unequal reimbursement rates. As a result, many health professionals are leaving the island every year to earn more in the mainland U.S. 

In the wake of Hurricane Maria, which placed additional pressure on Puerto Rico’s already strained healthcare system, the most commonly cited challenges currently facing health centers are growing health needs, broader health system changes, and infrastructure issues. Insurance revenue that is inadequate to cover the cost of care was also reported as a key challenge.

Healthcare administrators in the territories warn that the uninsured population could double if funding collapses. What’s more, if the Medicaid programs reduce provider reimbursement it will exacerbate the situation.

Higher spending caps or an elimination of spending caps would help to meet the healthcare needs of the Medicaid populations in Puerto Rico and the territories. 

Technology Solutions for Under- and Uninsured Puerto Ricans 

Proven technology is being used to leverage decades of health industry knowledge and speed access to care among Hispanic communities – including Puerto Rico. These solutions and digital access align with Hispanic use of new technology tools: 84 percent of all Hispanics are online and Hispanic internet smartphone usage is 10.5 hours per week – 25 percent more than the national average.

Now, a growing number of Hispanic consumers can access several cash-based primary care and pharmacy solutions, such as:

  • A medication voucher program that gives consumers the ability to pre-purchase generic medications at affordable price points. They can be purchased for personal use or gifted to a friend or family member either domestically in the U.S. and Puerto Rico, or internationally.
  • A free prescription savings card model allows cash-pay consumers to save a significant percent on brand name and generic medications across a wide network of pharmacies. 
  • An end-to-end clinical solution for patients with diabetes, hypertension, asthma, and obesity that includes vouchers for medications, peripherals, testing supplies, tablet, apps, and access to lifestyle coach consults.
  • A bilingual telemedicine platform, which helps underserved populations access the healthcare they need with more ease.

Solutions such as these are drastically simplifying access and delivery of quality health and wellness products, and enabling individuals to access care, learn about their health, determine their wellness needs, access low cost medications, manage their chronic conditions and engage in behavior modification solutions to help them lead healthier and more productive lives.

This level of innovation holds great promise for closing gaps in care for under- and uninsured Puerto Ricans by providing greater access to quality care and medications that they can afford. 

Mario Anglada is CEO of Hoy Health.

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