$27.1M secured for Medicaid for FY25

The CNMI’s Medicaid program will be kicking off the new fiscal year debt-free thanks to funding secured by Delegate Gregorio Kilili C. Sablan (D-MP).

Sablan succeeded in attaching a one-time payment of $27.1 million for the Marianas Medicaid program to appropriations passed by the U.S. House of Representatives and Senate yesterday.

The funds will allow the Marianas Medicaid program to pay its bills to the Commonwealth hospital and private healthcare providers that have been piling up over the last two years. As a result, the Medicaid program will begin fiscal year 2025 on Oct. 1 debt-free.

“Our Medicaid program has been under severe financial pressure because so many people became eligible for this form of federal health insurance during the pandemic and during the on-going economic downturn in our islands. Medicaid’s inability to pay its bills has put our hospital at risk and forced health providers to turn away patient. Today’s action, appropriating an additional $27.1 million will put Medicaid finances back on track, so those in need of health services are cared for,” Sablan said.

The continuing resolution passed yesterday keeps the U.S. government funded through Dec. 20, while Congress works to complete appropriations to cover all of fiscal 2025.

The 49-page resolution is generally free of new spending requests, but Sablan was able to make the case for a one-time funding boost just for the Marianas; and he won support from both Republican and Democratic leaders to include the money he asked for.

“I am most grateful to House Speaker Mike Johnson and Minority Leader Hakeem Jeffries, as well as Appropriations Chairman Tom Cole and Ranking Member Rosa DeLauro for their understanding of how dire the situation is for the Marianas Medicaid program. I also want to thank Energy and Commerce Committee Chair Cathy McMorris Rodgers and her Democratic counterpart Frank Pallone—and their staff—whom we have been updating on the financial predicament of Marianas Medicaid throughout this year. They understood what an emergency we face,” he said.

Some 16,000 Marianas residents currently depend on the Medicaid program for their health care, down from 40,000 during the pandemic. The program helps those who are otherwise uninsured and who have low incomes and few personal assets.

Yesterday’s funding continues a long history of legislative success for Sablan. When he was first sworn in to the U.S. Congress in 2009, the Marianas was receiving less than $5 million each year for the Medicaid program and the Commonwealth government had to match that money 50-50. Sablan steadily increased the annual funding—the Commonwealth will get about $65 million for 2025—and lowered the matching rate to 83-17, less than any U.S. state.

In related news, the CNMI will save $1,720,000 of its required match of federal Medicaid or Children’s Health Insurance Program grants in the current fiscal year. The federal government had been waiving just $200,000 of the required match since 1983. The new, higher waiver amount for fiscal 2024 will continue in following years, adjusted for any inflation in the cost of health care.

“This is good news for our cash-strapped Commonwealth government and, particularly for the Commonwealth Health Care Corporation, which covers the lion’s share of the match each year,” said Sablan

Sablan has been working intensely with the Biden White House on the waiver issue since the President’s Office of Management and Budget issued a “Controller Alert” last year, advising federal agencies they had wide discretion to waive any local match requirement for the Marianas and other small insular areas.

The “Controller Alert” was highlighted in the annual Interagency Group on Insular Areas meeting in 2023 at which Interior Secretary Deb Haaland announced she would now waive any matching requirement for grants from her department.

Immediately after, Sablan led his insular area colleagues to ask President Biden to follow up on the IGIA announcement by sharing any information about agency reviews of the law that would prevent the waivers.

“A waiver of local match requirements would not only reduce the financial burden on territorial governments for grants currently received, but would also encourage applications for grants previously passed over because a match was prohibitively expensive,” he said.

Previously, Sablan and other insular area representatives have introduced legislation to amend the 1983 law and increase the $200,000 waiver. Those efforts have been unsuccessful.

“Yesterday’s announcement that the Medicaid match is being lowered by $1.7 million is significant, of course. There is much more work to be done, however, to get rid of these matching requirements for all federal grants to the Marianas and other insular areas,” Sablan stated.

Meanwhile, the Commonwealth Healthcare Corp. has issued a statement extending its appreciation for the passage of the Continuing Appropriations and Extensions Act, 2025. T

“This significant legislation includes Section 211, which allocates $27.1 million in Medicaid funding to the Northern Mariana Islands, addressing the healthcare funding shortfall for Fiscal Years 2023 and 2024,” said CHCC.

Through this financial support, CHCC explains that Medicaid will be able to settle the $8,698,852 owed to the Commonwealth Healthcare Corporation for services rendered between June 2023 and September 2023.

“While this funding offers temporary relief, it highlights the broader issue at hand—the need to eliminate the Medicaid cap for U.S. Territories to ensure sustainable, long-term healthcare funding,” said CHCC.

Furthermore, the funding will mitigate prior shortfalls in the CNMI’s Medicaid program, which faced unprecedented challenges due to increased enrollment during the peak of the COVID-19 pandemic and the economic strain caused by natural disasters.

“CHCC acknowledges the tireless efforts of Congressman Sablan, whose leadership was instrumental in securing this vital funding. His unwavering commitment to addressing the Medicaid shortfall, coupled with his continuous engagement with federal stakeholders, has been essential in ensuring that the healthcare needs of the Commonwealth remain a priority at the national level. Gov. Arnold I. Palacios and Lt. Gov. David M. Apatang have also provided steadfast support throughout this process, advocating for fair treatment of the Northern Mariana Islands under federal programs and emphasizing the importance of healthcare funding for the CNMI’s residents. Their leadership has been pivotal in securing this victory for the Commonwealth’s healthcare system,” said CHCC.

CHCC further recognizes the collaborative efforts of the CNMI Medicaid Agency and the corporation in advocating for Medicaid funding.

“Both agencies have worked diligently to ensure that federal representatives fully understand the unique healthcare challenges faced by the Northern Marianas. In addition to the support of Congressman Sablan and CNMI leadership, CHCC extends its sincere thanks to the White House Office of Intergovernmental Affairs, the Association of State and Territorial Health Officials (ASTHO), National Association of Medicaid Directors (NAMD), the U.S. Congress, the Dept. of Health & Human Services, and the Centers for Medicare & Medicaid Services (CMS) Region IX. These organizations have been key partners in elevating the healthcare needs of the Northern Marianas and advocating for sustainable Medicaid funding solutions and a permanent removal of the Medicaid cap,” said CHCC.

Gregorio Kilili C. Sablan