Skip to content


Currently, Puerto Rico Hospitals Are Paid A Medicare Base Rate That is 14 Percent Lower Than Hospitals in the States; Just-Released Omnibus Changes That By Providing Puerto Rico Hospitals With Same Base Payment Rate as Hospitals in the States; New Law Means That Puerto Rico Hospitals Could Be Provided With An Additional $600M Between 2016-2025

Omnibus Bill Also Provides Puerto Rico Hospitals With Bonus Payments If They Use Electronic Health Records; Bonus Payments Under Medicare Are Already Provided to Hospitals in the States; New Law Could Increase Payments to Puerto Rico Hospitals By $266M Over 10 Years 

Schumer Will Continue to Push for More Equitable Federal Funding for Puerto Rico’s Health Care Programs & Work to Give Puerto Rico Authority Access to Chapter 9 Bankruptcy Protections

U.S. Senator Charles E. Schumer today announced that, following his push, the just-unveiled omnibus bill includes 2 provisions that will help rectify unfair Medicare payments in Puerto Rico, home of 3.5 million United States citizens. The omnibus bill will treat Puerto Rico, a U.S. territory, more like states by eliminating two key disparities that negatively affect Puerto Rico hospitals.

“Residents of Puerto Rico are American citizens and deserve access to quality health-care that is reimbursed in the same way as other places – and that’s why I have been pushing to eliminate some of the disparities in the Medicare program. It is good news that this bill will rightfully offer Puerto Rico some of the same treatment under our federal health programs as the states and I will continue to work hard in Congress to eliminate other disparities that plague Puerto Rico hospitals,” said Senator Schumer

First, the legislation will eliminate a disparity involving Medicare hospital payments. Right now, the federal government pays hospitals who serve Medicare patients a base rate, which can then be adjusted upwards based on a variety of factors.  Hospitals in the states are paid the same base rate, but Puerto Rico hospitals are paid a base rate that is about 14 percent lower. Following Schumer’s push, the just-unveiled omnibus bill includes language that will provide Puerto Rico with the same base payment rate as hospitals in the states. The Congressional Budget Office estimates that this will provide hospitals in Puerto Rico with an additional $618 million between 2016 and 2025. Second, the legislation will eliminate the exclusion of Puerto Rico hospitals from the Medicare component of the HITECH Act, which authorizes bonus payments for hospitals that become meaningful users of electronic health records. Right now, physicians and hospitals are provided with bonus payments under Medicare that become meaningful users of electronic health records. The just-unveiled omnibus bill extends this opportunity for bonus payments to hospitals and physicians in Puerto Rico. It is estimated that this new law will increase payments to Puerto Rico hospitals by $266 million over the next years. Both provisions are part of Schumer’s larger bill he introduced, the Improving the Treatment of the US Territories under Federal Health Programs Act, which addresses inequities in our territories, include Puerto Rico’s Medicare and Medicaid programs. In addition, Schumer has long fought ensure that the 75% of Medicare beneficiaries in Puerto Rico that are enrolled in Medicare Advantage are adequately reflected in the payment rates from the Centers for Medicare and Medicaid Services (CMS). Included in the legislation is a directive for CMS to examine the unique costs associated with delivering care in the territories in order to accurately calculate Medicare Advantage payments to Puerto Rico.

Schumer has long supported Puerto Rico, and also introduced legislation to grant Puerto Rico the ability to declare bankruptcy for its municipalities and public utilities in order to avoid a growing fiscal crisis. A large part of Puerto Rico’s financial obligations are health care-related and this bill allows for more equitable treatment for Puerto Rico’s health care programs, which will infuse much-needed funding for the care of Puerto Rico’s citizens. Schumer today said that he will continue to push for bipartisan solutions in Congress to help Puerto Rico address its dire fiscal crisis.

Schumer continued, “I will continue to make Puerto Rico’s dire fiscal crisis a priority in Congress and work towards a bipartisan solution that gives Puerto Rico the tools it needs to avert financial disaster. I will not rest until Congress provides a means for Puerto Rico to use bankruptcy authority to restructure its enormous debt – something that congress can do tomorrow and it won’t cost taxpayers a nickel.”

In 2010, Congress enacted the Patient Protection and Affordable Care Act (ACA), which provided $7.3 billion in additional Medicaid funding that expires at the end of FY2019; Puerto Rico receives $6.4 billion of that amount and right now, has only $3.5 billion leftover. Puerto Rico’s funding is expected to deplete by 2017 or 2018, and if this funding is not replenished, the territories will go back to receiving Medicaid funds under the old formula—which for Puerto Rico means less than $400 million a year.  Schumer said that would negatively impact residents of Puerto Rico who rely on governmental health care, like Medicaid. Medicaid, the governmental health program for low-income individuals, is funded in part by the federal government and, in part, by the state or territory government.  Currently, for states, there is no limit on the amount of federal funding provided for Medicaid as long as the state provides its share of matching funds. However, for U.S. territories like Puerto Rico, the amount of federal funding for the Medicaid program is capped. Schumer today said that he will continue to work hard in Congress to eliminate these disparities as well.