New York – The Secretary of the Puerto Rico Department of Health, Carlos Mellado, confirmed to El Diario that Medicaid granted an additional extension of time so that beneficiaries on the island who have already started the process of recertification to the program can complete it.
The 60-day extension until June applies to beneficiaries whose process is already running and could not complete it by March 31, explained the secretary.
“A (new) extension was given for an additional 60 days to all those people who began the recertification process or whose appointment was during that period and were unable to access the Medicaid plan in PR called Vital. We have made many efforts during the past year so that Puerto Ricans would not be left without coverage, especially when we had managed to increase the poverty level to 100%, which we had never had in PR,” the official declared when asked by El Diario.
“It should be noted that it is not that the person cannot do (the recertification) again; If the person never did it or decides to do it again, he would have to start a new process,” Mellado clarified.
Until June, beneficiaries under five categories will also be able to complete the process: those under 18 years of age, homeless, Platinum beneficiaries, bedridden patients and those with special conditions or who use health insurance a lot.
The Department of Health’s Medicaid program made the decision for the new extension on Monday, March 18.
According to an article in El Nuevo Día, until that date, 60% of the Medicaid population had been recertified, which means that 32%, equivalent to 104,608 beneficiaries, had not met the requirement.
At a general level, Medicaid insured people under the Vital Plan or Medicare Platino, about 1.4 million, had until March 31 to recertify.
Dinorah Collazo, director of the program in PR, previously stated that usually beneficiaries between 20 and 45 years old are the ones who take the longest to complete the procedure.
Medicaid is a program funded by the federal government to pay medical expenses for low-income people that applies to states and territories.
The program began in Puerto Rico on January 1, 1966, under the Social Security Law.
By federal regulation, Medicaid beneficiaries must recertify to the program. The process began in April of last year and the process has been extended several times.
During the pandemic, since March 2020, registration was changed to automatic. However, the above became void on April 30, 2023, so the beneficiaries had to complete the renewal process as was done regularly.
The Centers for Medicare and Medicaid Services (CMS) has also joined the efforts of the Department of Health and the Puerto Rico Health Insurance Administration (ASES) so that Puerto Ricans on the island complete the recertification process to ensure medical coverage, regardless of whether they have been certified before or not.
The process to notify of the need for recertification is based on several phases. First, the authorities send a letter by mail. If no response is obtained, try contacting the person by email. If this option does not work either, the beneficiary is called by phone twice. If the previous procedures are completed without result, the process to disenroll the person from the program begins.
More than 200,000 Puerto Ricans at risk of losing health insurance
In Puerto Rico, some 202,083 individuals were absent from their appointments, so they lost or are at risk of wasting their benefit, according to figures from the aforementioned media released on April 1.
The inconveniences with the recertification process not only affect patients, but also laboratories, hospitals, pharmacies and doctors who offer services under the Medicaid program.
In the case of providers, part of the problem is that the PR government received, only in 2023, the necessary funds to develop the platform for this group to register. This despite the fact that, since 2018, by mandate of the authorities in the US, it has been a requirement that this group register.
The panorama in Puerto Rico is complicated by the lack of personnel to care for the large number of people.
Department of Health assures that it has worked to streamline processes
Despite the previous situations, Mellado assured that they are taking all measures at their disposal to streamline processes, such as hiring more staff.
“We expanded the offices to 74 from the 62 we had throughout the island. We did massive activities in all the important districts in Puerto Rico and on weekends. We opened centers in different shopping centers, and we notified patients who used a PDM or medical office, and we gave them the specific turn of when it was time to do the recertification. We have two call centers, and if the phone was busy, they would call you back. We have two mobile applications to deliver all the documents that were required,” listed the interviewee.
In that sense, Mellado clarified that, unlike the processes in the states, in PR five years passed without it being carried out.
“The situation we had was that at the level of the US and the states, they had two years; We had five years without doing that process, therefore it was very challenging, because there are 1.6 million people that we have been entering the database and it has been a titanic effort,” he described.
To complete the recertification process, the Department of Health’s Medicaid program for the Vital Health Plan in PR must evaluate the applicants’ documentation.
Beneficiaries of the program must complete the process in one of the following ways:
1. By calling the call center (787) 641-4224, TTY (787) 625-6955 Monday through Friday, 8:00 am to 6:00 pm, and request an in-person interview at local offices
2. Completing the Recertification Application on paper and sending it by postal mail accompanied by the required documents
3. Completing the Recertification Application through the Citizen Portal and providing the required documents
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