ACA, Virgin Islands Style

As the Affordable Care Act (ACA) rolls out across the US, the Virgin Islands will also be making significant changes to its health care delivery system as a result of the legislation.

Ending months of public speculation, Governor John P. DeJongh announced in July that the VI would expand the VI Medicaid Program instead of participating in a health care insurance exchange. The decision came as a direct result of almost 2 years of in-depth study by his Health Care Task Force.  The study concluded that the VI could not currently sustain a health care exchange on its own.  The ACA law excludes territories from participating in the national health care exchange, so when the VI was unable to find a state that would either partner with or include the VI in their state exchange, the decision to expand Medicaid became the only viable option.

The decision to expand the VI Medicaid program will allow the VI to receive a total of $273,819,503 in federal money between July 2011 and September 2019. The change to the federal match formula (55 percent federal and 45 percent local funding) will enable this money to go much farther than the money for the exchange would have permitted. In addition to going farther, the change to the federal/local percentages will give the VI greater ability to access the federal dollars required in the matching formula.

In support of the Governor’s decision, Human Services Commissioner Christopher Finch spoke on July 20th at a VI Town Hall hosted by Delegate to Congress Donna M. Christensen and the Congressional Black Caucus Health Brain Trust. In order to ensure a successful roll out of the program, Commissioner Finch revealed plans to begin the new Medicaid expansion process in phases due to the territory’s limited staff and technology.

Under the first phase of the VI Medicaid expansion, which begins August 1, the program’s eligibility criteria will be raised by one thousand dollars to $6,500. Enrollees during this phase will be limited to pregnant mothers and children. Finch predicted that an additional 200 pregnant mothers and 3,700 children will be able to be added to the program as a result of this change. He also indicated that the Department of Human Services staff had reviewed its Supplemental Nutrition Assistance Program (SNAP) rolls and had pre-determined who the 3,700 children will be as a result of that program’s rigorous low-income eligibility standards. Letters will be mailed out to individuals deemed pre-qualified.

Phase two is expected to take place early in 2014. It is scheduled to increase the eligibility requirements by an additional thousand dollars to $7,500 plus it will allow an additional $1,000 for each family member. During this phase ALL family members will be included, not just pregnant mothers and children. This will allow seniors and persons with disabilities to participate.

Even though the VI has opted to expand its Medicaid program, it will still benefit from portions of the language contained in the ACA, such as:

• Allowing young adults up to age 26 remaining on parents’ health insurance policies
• Children who are being insured can no longer be rejected for coverage as a result of pre-existing diseases, like diabetes, sickle cell or asthma
• NO lifetime limits to care
• Free preventative programs under Medicare with no required co-pays
• Rebates for Medicare patients who fall into the Medicare Part D “donut hole”
• Increased funding for Community Health Centers such as the East End or Frederiksted Health Centers
• Approximately 22,500 residents could be served annually

AARP VI State Director, Denyce Singleton, appears confident that the expansion of Medicaid will provide immediate help to some territorial residents: especially those, low-income residents who are among the most vulnerable.

However, she cautions, “We cannot look at the Medicaid expansion as the ‘perfect fix’ for all our health care challenges. It will not solve the challenges for people who are 50-64 years of age who will not qualify for Medicaid, or the nearly 30 percent of our workforce that is not offered insurance by their employers.  As a partner in this endeavor, AARP VI continues to work with other stakeholders on resolving these issues.

Director Singleton continues that we must change how we look at health care.  “Prevention is critical.  We need to instill the idea that it is much easier, less expensive and less invasive to prevent serious health issues, like diabetes, high cholesterol or high blood pressure with proper diet, exercise and ongoing preventative care, rather than to treat diseases after they have become full blown, chronic health problems. This change in thinking will not only bring down the skyrocketing cost of health care, but it will allow us to live longer, happier and healthier lives.”