NEW YORK – The Puerto Rico Medicaid and Medicare Revenue Products Association (MMAPA) pointed out that final 2027 Medicare Revenue rule issued by CMS will prevent further cuts to the program on the island, but that it is necessary to continue collaborating with the Trump Administration to address the structural gap in payments.
In a statement sent to El Diario this Thursday, the entity confirmed that the New payment rates announced by the Centers for Medicare and Medicaid Services (CMS) reflect a “modest increase” for Puerto Rico in 2027, after three years of reductions.
The increase will be 4.01% compared to the national average of 2.4%.
“We recognize and appreciate that Congressional and Trump Administration officials have met on multiple occasions with Governor Jenniffer González Colón and community leaders to address the lack of adequate funding in Medicare Revenue for the island’s most vulnerable seniors. “This update represents an important step towards the short-term stability of a program that is important for access to health services in Puerto Rico,” he declared. Solange De Lahongrais, president of MMAPA.
De Lahongrais opted for a permanent solution to the financing of the program in the territory.
“However, A structural financing gap persists which, if not addressed, continues to reduce available resources.s for beneficiaries year after year. “We trust that in the coming months progress will be made towards a permanent solution for 2028 and future years,” he added.
Although residents of Puerto Rico pay the same Medicare taxes as those in other U.S. jurisdictions, they receive lower payments than those in the states and Virgin Islands because the federal reimbursement rates set by CMS are lower.
Regarding the figure of 4.01%, the president of MMAPA highlighted that it is below the cost trend in Medicare for 2027which is estimated at 6.1%, according to the most recent report from the Medicare trustees.
“The accumulated pressure of Cuts in recent years have caused historic financial losses for Medicare Revenue in Puerto Rico since 2023, which led to difficult decisions such as Humana’s exit from the market in 2026,” said the spokesperson for the non-profit organization made up of the main Medicaid and Medicare Revenue organizations on the island.
De Lahongrais explained that considering the demographic and economic particularities of Puerto Rico is key to thoroughly addressing the disparity.
“At the moment, 25% of the population is 65 years old or older, compared to 18% nationally, and about 40% live below the federal poverty level, compared to 13% in the US. At the same time, Medicare Revenue enrollment continues to grow steadily, with between 10,000 and 17,000 new beneficiaries each year (approximately 2.2% annually over the last five years), a trend that is expected to continue as the population ages,” he explained.
According to the MMAPA analysis, the fact of That CMS has decided not to implement additional changes to the risk model helps moderate the impact on plans and, in turn, on the beneficiaries.
“However, Puerto Rico’s biggest challenge remains unresolved: the growing financing gap,” De Lahongrais reiterated.
The entity’s calculations reveal that the Funding for Medicare Revenue in Puerto Rico for 2027 remains approximately 40% below the US average. and 20% below that of the Virgin Islands. The average payment in Puerto Rico is $778 dollars compared to $1,299 in the US and $967 in the Virgin Islands, which is another territory.
“As part of this solution, the organization continues to support the establishment of a minimum level of financing equivalent to 70% of the national average. Although Puerto Rico would continue to receive less than any state under this scenario, the staunch disparity would be considerably reduced and a more sustainable substandard would be established for the program,” insisted the MMAPA representative.
The organization also highlighted that MA compensates for the exclusion of Puerto Rico from other federal programs. such as Medicare Savings (MSP), Part D Low Income Subsidy (LIS) and Supplemental Security Income (SSI), among others.
MMAPA hopes that the efforts of stakeholders in Puerto Rico and Washington DC will lead to a permanent solution by 2028.
“Now is the time to take the next steps and allow the federal government and Congress to implement significant changes that are urgent and necessary,” De Lahongrais concluded.
The González Administration cataloged the announcement of the CMS of the Department of Health and Human Services (HHS) as a significant and necessary step for the system in Puerto Rico.
“After receiving the corresponding actuarial and technical inputs, we can conclude that the Medicare Revenue payment rates for 2027, announced by the Trump Administration earlier this month, represent a significant and necessary step towards stabilizing Puerto Rico’s health system and protecting access to quality medical care for more than 679,000 older adults on the island who are beneficiaries of this program,” La Fortaleza said in a statement.
The brief highlighted that González, since her years as resident commissioner, has been promoting this issue at the congressional level.
The first executive held meetings on the matter with HHS Secretary Robert F. Kennedy Jr.; CMS administrator Mehmet Oz; and with Chris Klomp, director of the Medicare program at CMS.
“Their willingness to listen and act reflects a clear understanding of the important role that Medicare Revenue plays on the island,” he mentioned.
“This joint work was important to achieve the new increase in Medicare Revenue payments, which will positively impact hundreds of thousands of our most vulnerable citizens,” González argued.
According to the Administration, the adjustment in payments will help “avoid immediate reductions in financing and provides short-term stability for the Medicare Revenue program on the island.”
“In addition, the federal government’s determination to pause changes to the Medicare risk adjustment formula preserved an estimated $561 million annually for Puerto Rico’s seniors, funds that previous changes to the formula had put under significant pressure, reducing Puerto Rico’s payments to almost three times below the national rate,” he added.
The governor agreed with MMAPA that there is still a long way to go to end the disparity in MA payments in the archipelago.
“We must continue working together to ensure a permanent and equitable solution in 2028 that ensures our seniors receive the same level of support as those in the states. This could be achieved through a structural correction to the payment methodology, administratively establishing a minimum level of financing for Medicare Revenue at the national level that includes Puerto Rico,” added the Governor.
He announced that he will continue meeting with the leadership of HHS and CMS during the coming months to continue advancing the discussion.
“In this sense, the action schedule is immediate, since CMS is already analyzing and drafting the potential Medicare Revenue payment rules for 2028 for their presentation to the Office of Management and Budget (OMB) next October,” the president said.
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