Legislation covers $5.6M Medicaid shortfall

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Sen. Therese Terlaje introduced legislation to cover DPHSS' $5.6 million Medicaid shortfall.(PNC photo)

Guam – The Department of Public Health and Social Services (DPHSS) is facing a $5.6 million shortfall from unpaid Medicaid claims made through the end of fiscal year 2019. A piece of legislation recently introduced by Sen. Therese Terlaje offers a solution to the issue.

According to Terlaje, public health only has enough funding through the first week of this month to cover the regular Affordable Care Act Medicaid and Medicaid Childless Adults claims from private medical providers.

The shortfall was first brought to the attention of the senator in February at the informational briefing with DPHSS.

“Clearly this situation was a priority months ago and today it is a potential crisis. DPHSS has exhausted its FY19 local Medicaid appropriation with five months left unfunded and $61 million in federal funds waiting to be tapped,” Terlaje said.

She added, “The government cannot afford to cover these patients without the federal match, and our community cannot afford the risks of even a temporary shutdown in health services to these patients. The government must immediately allocate additional funds to DPHSS through this bill or the bill introduced two months ago, through the Governor’s transfer authority, or by redirecting compact impact funds.”

Terlaje’s latest legislation, Bill 78-35, proposes to allocate $5.6 Million as a local funding match to allow public health to access to an additional $6.8 million in federal Affordable Care Act (ACA) grants.

In the past, Terlaje introduced companion Bills 35-35 and 36-35. “At that time, DPHSS reported a potential $13.3 million shortfall for local matching funds for Medicaid. Since then, an executive order was signed by the Governor to redirect $7.7 million of the FY2019 GMHA pharmaceutical funds back to DPHSS to pay GMH Medicaid claims, leaving a shortfall of approximately $5.6 million for non-GMH Medicaid claims.”

This isn’t the first time GovGuam has had the inability to match the federal funds as Terlaje said, $61 million is left untapped as a result of the expiration of federal ACA funds in September.

She said, “This year Guam has already used $13.1 million of local funds to access $15.6 million of the ACA funds for Medicaid claims. A $10.5 million decrease in federal funds is indicated in the Governor’s 2020 budget request, and $3 million in compact impact funds are allocated towards Medicaid.”

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Jolene Toves
Jolene joined the PNC team in 2017, as a producer, co-anchor and investigative reporter covering law enforcement, courts and crimes. Notable coverage includes the Ehlert case, the Mark Torre Jr. trial, the Allan Agababa trial, exclusive pieces on the Life of a Drug Dealer/Addict, and Life behind bars...the story of Honofre Chargualaf and Kevin Cruz. In 2019, she was promoted to Assistant News Director and Lead Anchor. From 2015 to 2017 she served as Public Relations and Promotions Manager, for the Hotel Nikko Guam handling local radio and advertorial promotions, as well as produced and directed tv commercials for the hotel. Prior to this she worked with KUAM for three years as a reporter and segment host. She began her journalism career in 2012, working with Glimpses of Guam contributing to the Guam Business Magazine, R&R magazine, MDM magazine and the Marianas Business Journal.