‘Medicaid under-funded, off-island care difficult’

The Medical Assistance for the Needy Program, commonly known as the Medicaid program, is so under-funded that it makes it extremely difficult to obtain competent on and off island care for very sick people of the CNMI.

Medicaid director Helen C. Sablan said the most affected are children.

She said providers do not want to accept the CNMI’s Medicaid patients because of the delay and difficulty in securing payment from CNMI Medicaid. It is also because of this that no new providers want to be the Commonwealth’s off-island Medicaid providers.

“Rates are not what they could be if we could offer timely and sure payment and if there were some competition for the CNMI Medicaid business,” she said.

For the entire United States, there are eight kinds of mandatory Medicaid services and five kinds of optional services, with federal financial participation ranging from 50 percent in the wealthiest states, to 77 percent in the poorest states. The CNMI receives only 18 percent of federal financial participation in the Medicaid program.

Sablan said the federal Medicaid program separates the CNMI Americans from other kinds of Americans and provides less Medicaid assistance to them by:

capping Federal fiscal participation to a set amount;

limiting the federal and the Commonwealth match to a significantly lower percentage; and,

limiting the type of services that are subject for reimbursement.

Consequently, CNMI Americans receive federal assistance for only the following services due to the disparate federal financial participation: pharmacy, limited off-island acute medical care; and dental, optometry and ophthalmology services.

The services can be compared to the 13 categories of assistance Americans living in the states can receive, both for local care and out of state care when it is required, Sablan said.

“As distinguished from any state, all of the cost of the CNMI on island hospital and clinic care such as preventive care, prenatal care, immunizations, psychiatric care and counseling, long-term care, support services that allow individuals with disabilities to remain at home or work in the community, is borne solely by the CNMI local government without federal contribution,” Sablan said.

When patients in the CNMI are sent elsewhere for healthcare, they must be sent not to another city but off-island, usually Guam, Hawaii or California. She said the cost of medical care in both Hawaii and California are among the highest in the U.S. and likely in the world.

“Transportation and logistical costs for off-island care in Hawaii and California are likewise extremely high,” she said.

Because of federal funding requirements, Medicaid patients cannot be sent to cheaper and closer destinations like the Philippines, Australia, New Zealand, Japan or Thailand.

Sablan presented her report during the recently concluded Healthcare Conference held last month.