‘CHCC has limited access to fed funds’

Funding has always been an issue with the Commonwealth Healthcare Corp. before and after it became a corporation in 2012—and it’s not as if it is awash in federal funds.

To say that CHCC has had a drought in terms of help coming from the CNMI government is an understatement because the hospital continues to struggle even if federal funds are at its disposal.

Speaking in front of the Current Issues class of the Northern Marianas College last week, CHCC CEO Esther Muña said that 50 percent of the CNMI population is on Medicaid.

Medicaid is a healthcare program that assists low-income families or individuals in paying for long-term medical and healthcare costs. It is a joint program of the federal government and the state or U.S. territory like the CNMI.

“The way Medicaid works is that 50 percent is funded by the federal [government] and 50 percent by the CNMI government. If the government gives $2 million to CHCC, then [the] federal [government] will match that and give $2 million,” she said

“The problem is, if the federal [government] has $100 million in the bank, we have to match it. We have to have $100 million to get $100 million. If Medicaid is going to pay the hospital, it has to come up with $100 million in order to pay the other $100 million,” she added.

Since 2011 and up to now, from one legislative appropriation to another, CHCC has always been underfunded.

“What we came up with is to do the switch where we changed the Medicaid state plan to have a certified public expenditure payment. What that does is, in order for us to take or draw out $100 million from the federal government, we would base it on CHCC expenditures,” she said.

“So in order for us to get money from our cost of providing services to the 50 percent of the Medicaid population, we have to use the certified public expenditure, which basically takes our cost of providing services as a match to the federal share,” she added.

No matter how CHCC is good in doing the math and turning the wheels to have a portion of the federal money, there is no denying, however, that CHCC has been losing money since 2011, Muña said.

“To understand the setup is, for example, I spend a dollar, I only get $50 cents back. The other $50 cents is lost and we cannot do anything about it because the only way for me to tap the federal share is through CPE [certified public expenditure]. This has been our payment methodology [from] 2011 to 2017,” she said.

“Since we are not getting sufficient funding from the government, this is only revenue that we can count on and the revenue that we needed to survive. Otherwise, we won’t be able to survive if nobody pays,” Muña added.

Muña said the $100 million came from the Affordable Care Act (Obamacare) and this expires in 2019 and after that it goes back to the U.S. federal fund because that’s how territories are set.