The U.S. Congress approved an appropriations bill — a budget — last week. Among many other things, this bill provided improved funding for Medicaid in Puerto Rico.

Medicaid is a program that funds healthcare for needy people. In every state, the federal government pays a percentage of the cost of the program, calculated on the ratio of the state’s average income and the average income of the whole United States. If New Mexico spends $100, the federal government covers $79.91 of the cost. If Mississippi spends $100, the federal government covers $84.51.

If Puerto Rico spends $100, the federal government covers $56.00.

But wait — that’s not all. Puerto Rico also has a spending cap. If a state needs to spend more on healthcare, perhaps because of a natural disaster or a pandemic, the federal government just keeps paying their percentage of the total. In Puerto Rico, if the medical costs go higher than the designated amount, Puerto Rico must pay 100% of the overage.

The new bill authorizes $200,000,000 for Puerto Rico Medicaid expenses in 2022. It also extends federal reimbursement of Puerto Rico’s Medicaid expenses at 76%. Puerto Rico’s poverty rate is twice that of Mississippi, so as a state, Puerto Rico would receive the maximum match just as Mississippi does.

The bill requires Puerto Rico to produce a report by December 1st detailing the procurement processes and standards used for selecting contracts under Puerto Rico’s Medicaid program, something that is not required of any state. It also requires physician reimbursement to meet at least 70% of the standard rate.


The San Juan Daily Star quoted Gov. Pedro Pierluisi as saying of the funding, “We receive the news with great enthusiasm because of the positive impact it will have on the lives of millions of Puerto Ricans who depend on this help for their well being.”

Puerto Rico Federal Affairs Administration Executive Director Carmen M. Feliciano said in a statement, “However, there is still improvement to be made for the U.S. citizens in Puerto Rico. There is still a long way to go in terms of achieving state-like treatment and funding parity for Puerto Rico; we continue to advocate for the inclusion of Puerto Rico as a priority so that these funding increases can shorten the parity gap.”

The improvement is temporary, and it does not bring Medicaid funding for Puerto Rico up to the level that the territory would receive if it were a state.

This is the reality for Puerto Rico as a territory. Congress may provide improved funding in a particular case, but Congress can just as easily take away that funding. As a state, Puerto Rico would be entitled to the same treatment as the current 50 states. 

We need statehood

The idea that Puerto Rico can negotiate special terms with the United States is a fantasy. Right now, with U.S. citizenship and a non-voting representative in Congress, Puerto Rico must work hard to achieve something similar to the treatment states get every day.

As a state, Puerto Rico will have equality with the states. Congress must take action to admit Puerto Rico as a state. It is only by bringing this issue to the attention of congressional leaders that we will see permanent change.



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