Medicare

There have been at least four references in the papers over the last two days regarding “Medicare” in articles or other letters to the editor. It seems that there is some confusion about the third largest monetary expenditure of the Federal government (after the military and social security).

Supposedly, when a patient arrives at any public health care facility and asks for medical care, and is eligible for Medicare or Medicaid, he or she must receive care. Then the facility bills the cost of that care to the Federal Medicare or Medicaid disbursement office for payment.

Problem is, in the CNMI (and some other U.S. territories), it doesn’t work that way. Federal authorities DO NOT pay these monies directly to the facilities that bill them as they do in the U.S. Instead, there is a local office, under the Governor, that acts as a “clearing house” for all federal Medicare/Medicaid benefits. They, and they alone, receive all federal benefits as a “lump-sum appropriation” and pay them out to facilities. When the “appropriation” runs out, there just isn’t any more ‘til next year.

I don’t have last year’s figures, but the year before, this office received around $8 million in federal health payments—and it has been that way for many years. Now, that’s quite a good chunk of money and my question at the time was: “Why haven’t the Tinian or Rota medical facilities received even a single dollar of these payments after billing the office (for Medicaid patients) nearly $700,000 over the last five years or so?” This has placed tremendous burdens on the local Mayor’s offices on those two islands alone just to keep those “clinics” running and resulted in a “receivables” account that is sinking the economy of those islands.

Well, I found out, in speaking with the federal people at their office in San Francisco, that (in the CNMI) it is entirely up to the local office, under the Governor’s control, to send that federal money to whatever medical facility they wanted to—and with practically NO oversight.

Then I spoke with personnel at the local office to find out where the monies went. Well, it seems that the local Medicare/Medicaid billing from all facilities within the CNMI was actually larger than the federal disbursement, but that didn’t explain why it appeared that no one in the CNMI (including CHC) received ANY of that money.

The reason, it was disclosed, is that ALL of the money was used to pay outstanding bills from referral facilities off island because all those bills were even bigger than the local ones and bigger than the federal appropriation! This was apparently done under pressure from the off-island facilities to pay up or face refusal to accept referrals from the CNMI—and this included Hawaii, West Coast and the Philippine facilities.

Of course, the end result is the complete decline of the local health care system due in part to this payment fiasco and a lot of other factors as so eloquently pointed out by other authors. This is only a brief, simplified overview of what is occurring locally—but something must be done to rescue the collapsing health care system in the CNMI. The local government, it seems, simply cannot do the job as has been proven time after time, from health care to power.

Good luck.