Hagåtña, Guam – Guam is that much closer to seeing some relief in its Federal Medical Assistance Percentage (FMAP) program. The U.S. Senate today passed a Disaster Relief Package that includes language that increases the Affordable Care Act (ACA) subsidy to Guam to 100%.

In 2011, $268.3 million in ACA funds were made available to Guam with an expiration date of September 30, 2019. However, in order to avail of the additional ACA funds, Guam must first expend its capped Medicaid funding allotted within a fiscal year (FY) which is subject to a 45% local match. And while ACA funds alleviate any traditional Medicaid funding shortfalls, it is also subject to local match requirements under the FMAP.

Every year, we struggle to find the local match. In February, I testified before Congress and implored them to treat Guam and the other U.S. Territories equitably by lifting the cap on Medicaid funding like the Federal Government does for the states, and by increasing our FMAP. I followed this up with a letter to the Senate a few weeks later, urging them to include language in the Emergency Disaster Relief legislation that would also provide much-needed relief to the Territories whose Medicaid programs face serious shortages,” said Governor Lou Leon Guerrero. “Although the Senate version of the bill does not extend or remove the expiration date on ACA funds for Guam, and while it does not remove the cap on regular Medicaid funds, I appreciate that the Senate removed the requirement of a local match on ACA funds. This will still allow us to continue to provide our people with healthcare coverage through the Medicaid program and maximize the availability of Federal funds. We will continue to monitor the progress of this bill.”

The Senate version of the Disaster Aid Bill allows Guam to draw down from the available ACA funds without having to put up a local match, but only within a limited timeframe of January 1, 2019 to September 30, 2019.

The bill is now headed back to the House, which is expected to vote on the measure before the Memorial Day weekend.


The passage of the Disaster Relief Bill by the Senate also follows a House Natural Resources Full Committee Hearing that focused on the Insular Areas Medicaid Cliff. Maria Theresa Arcangel, Chief Human Service Program Administrator for the Division of Public Welfare of the Department of Public Health and Social Services, testified about the disparity in Medicaid funding made available to Guam and the U.S. Territories and how it adversely affects the healthcare of its people, as well as the economy.

In FY 2019, Guam’s regular Medicaid funding was capped at $17.97 million, but Arcangel emphatically pointed out that, “Guam’s Medicaid expenditure increased by 323% over the past decade (from $26,185,419 in FY 2009 to $110,876,286 in FY 2018) due to an increase in utilization, cost of medical treatment, new medical technology or mode of treatment, and the increasing cost of drugs. If ACA funding is not extended or replaced, the Guam Medicaid Program could be forced to decrease its income guideline and terminate more than 50% of its current eligible individuals.”

Arcangel added: “Guam proposes to remove the expiration date of funding appropriation under Section 2005 and Section 1323 of the ACA until the funding is fully expended; remove the Medicaid cap; and increase the FMAP of Guam and the other U.S. Territories. The low-income U.S. citizens in Guam and the other U.S. Territories are no different from the U.S. citizens in the mainland and so their healthcare benefits and needs should neither be viewed nor treated any differently.

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