Velázquez Leads Letter Calling on HHS to Improve Health Care for Seniors in Puerto Rico

Washington, D.C.— Today, Congresswoman Nydia M. Velázquez (D-NY) led 12 members in writing to the U.S. Department of Health and Human Services (HHS), calling on the agency to improve health care services for seniors in Puerto Rico by thoroughly reviewing and refining the formula used to determine payments for Medicare Advantage (MA) plans on the island. Specifically, the lawmakers ask HHS to evaluate modifying the methodology to calculate the Average Geographic Adjustment (AGA) that is part of the current formula, in its application to Puerto Rico.
 
Unlike the rest of the mainland, the vast majority of senior adults in Puerto Rico are beneficiaries of the MA Program, compared to the original Fee-for-Service (FFS) Medicare. Health care experts have raised concerns about the current formula’s ability to ensure adequate MA payments for Puerto Rico, given that it depends primarily on the per-capita spending of beneficiaries in original FFS Medicare. Puerto Rico’s MA benchmark, or the maximum monthly payment per beneficiary paid to a MA plan, is 39% below the national average.
 
“It is abundantly clear that additional administrative action is needed to prevent Puerto Rico’s anomalous MA benchmark from falling further behind the 50 states and the U.S. Virgin Islands,” wrote the lawmakers. “As HHS and the Centers for Medicare and Medicare Services propose and implement new programmatic changes to MA for FY 2025, we request a review of the adequacy, and potential refining, of the formula to set Puerto Rico’s MA benchmarks.”
 
In the letter, the lawmakers highlight the current health care crisis unfolding in Puerto Rico. Puerto Rico lost 46 percent of its doctors over the last 13 years, with many leaving due to low pay. This shortage of medical professionals has worsened the affordability and accessibility of health care on the island. In 2022, there was an unusually high number of, primarily senior adult deaths, which experts have attributed to the deteriorating health care system.
 
The lawmakers urge the HHS to increase the adequacy of Puerto Rico’s MA benchmark in its upcoming FY 2025 Medicare Advantage and Part D Advanced Notice and ensure improved medical services for senior adults on the island.
 
“HHS leadership is particularly relevant in the current political context, where the health and well-being of racial and ethnic minorities, including Puerto Ricans, is at risk,” wrote the lawmakers. “American citizens living in Puerto Rico, particularly the elderly and most vulnerable population, deserve access to the same standards of quality health care enjoyed by U.S. citizens in the States.”
 
In addition to Velázquez, the letter was signed by Representatives Chrissy Houlahan (D-PA), Ritchie Torres (D-NY), Nanette Diaz Barragán (D-CA), Raul Ruiz, M.D. (D-CA), Adriano Espaillat (D-NY), Sheila Cherfilus-McCormick (D-FL), Susan Wild (D-PA), Raúl M. Grijalva (D-AZ), Delia C. Ramirez (D-IL), David J. Trone (D-MD), Darren Soto (D-FL), and Juan Vargas (D-CA).
 
A PDF of the letter is online, here.

 
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