In Puerto Rico, power remains unstable, and remote areas continue to face major access challenges. Puerto Rico delayed Medicaid renewals for 12 months and USVI delayed renewals for six months to help individuals maintain stable coverage amid the recovery efforts. Directors from both FQHCs reported limited physical damage, enabling them to resume operations quickly after the storms. Many private providers remain closed or have left the territories, which has exacerbated pre-existing access challenges, particularly for specialty and mental health care. Currently, one of four MCOs, along with an additional plan serving a special population, serves each of eight geographic regions on the island.33 Beginning on October 1, 2018, the new model will require MCOs to compete in a single territory-wide region to provide services to the approximately 1.3 million enrollees across the island.34 Other changes will include increased preference for generic drugs, a capped per-member-per-month payment amount, and benefit redesign. In addition, the Office of the Assistant Secretary for Preparedness and Response (ASPR) and the Health Resources and Services Administration (HRSA) within HHS have been active in the recovery and working closely with FEMA, territory officials, and providers. According to FEMA, as of March 16, 2018, more than 3,500 Puerto Ricans were still living in hotels on the island and across 37 states with temporary housing vouchers.13 FEMA has extended this temporary sheltering program twice; the most recent extension ends on May 14, 2018.14. Coming Thursday: “Infidel” and “2 Hearts”, The Youth, Sports, Parks and Recreation Committee advanced legislation on Tuesday that would, if signed into law, allocate $375,000 toward the construction of Americans with Disabilities Act-compliant ramps or walkways on at least two beaches in each island district. Alternatively the territory had the option to add the $24.9 million to a pool of $275 million in extra Medicaid funding the territory would be eligible for over the next decade. ASPR leads the nation’s medical and public health preparedness, response to, and recovery from disasters and public health emergencies,11 while HRSA works to improve access to health care for vulnerable and underserved communities and individuals.12 ASPR representatives report continuing to work with territory officials to close the gap between their prioritized health care needs and resources to meet them. In addition, one clinic representative noted that, although they had been involved in emergency planning activities, the government did not coordinate with the clinic on response efforts. Respondents noted that, as people lose jobs, many are losing health insurance. July 12, 2013. Many residents still have major damage to their homes, with some still living in alternative living arrangements with other family. "While this initial expansion does not address the immediate need of all uninsured, it is our intent to phase in Medicaid expansion starting with the most vulnerable populations,” deJongh said in a letter to Senate President Shawn-Michael Malone about the decision. “Planned future expansions include further raising the income limits for families, senior citizens, childless adults and persons with disabilities,” he continued. Through volunteer, military, and other efforts, some individuals are continuing to go into these communities to deliver care, but as relief efforts phase out, these access difficulties may increase. These problems exacerbated existing difficulties, many of which stemmed from disparities in the federal government’s treatment of territories compared to states.1. They noted that private organizations and volunteers, often coming from the mainland, brought supplies and services into communities, including health care services. For one, the federal allocation of $24.9 million for premium and cost-share assistance for those seeking enrollment on the exchange and support from the government would not be sufficient for the territory. Providers, including community health centers that conduct routine screenings for mental health needs, also reported sharp increases in depression, anxiety, panic attacks, and post-traumatic stress disorder (PTSD) among the communities they serve. Providers and officials also described positive working relationships with their partners at the U.S. Department of Health and Human Services (HHS), including staff from the Centers for Medicare and Medicaid Services (CMS). The share of uninsured in USVI (30%) was much higher than in Puerto Rico (7%) and the rest of the United States (12%). Other actions they noted are improving the pre-staging of supplies, identifying patients with health needs to ensure that they have adequate medications and supplies, collecting and documenting information to assist with disaster response (e.g., location coordinates and generator fuel capacity), and planning for rapid support of staff. They also described profound effects on their mental and emotional health, with many feeling stressed and anxious and having trouble sleeping at night. Residents continue to face financial instability, reflecting more limited work options and ongoing costs associated with recovery. The budget bill increased the federal caps for Puerto Rico ($4.8 billion) and USVI (approximately $142.5 million) and provided Medicaid funds at 100% federal match from January 2018 through September 2019.31 Local officials and providers noted that these funds provide much needed immediate assistance and fiscal relief, but they expressed significant concerns about what will happen when the funding ends since no long-term changes were made to the federal match rate or cap on federal funds.

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