35: Medicaid Cliff Nears

Karl Ensign, ASTHO’s Vice President for Territorial Support, discusses the potential for Congressional action to approve enhanced financial support for Medicaid services in the U.S. Territories, as a Thursday deadline nears; Dr. Joseph Kanter,...

Spotify podcast player badge
Apple Podcasts podcast player badge
Amazon Music podcast player badge
Google Podcasts podcast player badge

Karl Ensign, ASTHO’s Vice President for Territorial Support, discusses the potential for Congressional action to approve enhanced financial support for Medicaid services in the U.S. Territories, as a Thursday deadline nears; Dr. Joseph Kanter, Louisiana State Health Officer and Medical Director, makes plans to offer pandemic-related testimony before Congress on Wednesday; ASTHO previews a new episode of the Public Health Review podcast exploring the importance of crisis communications during the pandemic; and we share details of an ASTHO blog article about legislative approaches to PFAS substances.

Hybrid hearing on “Upgrading public health infrastructure: The need to protect, rebuild, and strengthen state and local public health departments.”

ASTHO Blog Article: Regulating and remediating PFAS in states

ASTHO logo



This is Public Health Review Morning Edition for Tuesday, September 28th, 2021. I'm Robert Johnson.

Here's today's news from the Association of State and Territorial Health Officials.


Healthcare funding for people in five U.S. territories down to the wire as a deadline for extending enhanced financial support for their Medicaid services is now less than 48 hours away.

Congress has until Thursday to address federal funding allocations and the question of the amount of territories need to contribute to access those dollars.

Karl Ensign, ASTHO's vice president for territorial support, tells us what to expect this week. It's today's morning conversation.

What happens on September 30th?


So, September 30th, a number of things begin to happen, and that's where we do have a glimmer of good news.

So, again, it's a little complicated and I'll try not to get too wonky on this, but what you got to pay attention to is both the allocation and the FMAP.

Now CMS—the Centers for Medicare and Medicaid Services—just this last week provided some administrative relief there and that they adjusted the cap. So, in essence, now territories can receive more money from the feds, and that is that their base allocation is based on last year's allocation, which was adjusted up to provide some relief and it's adjusted for inflation.

So, CMS and the administration is saying that these are higher than expected allotments, which is true, and it's good, and we're thankful for that.

The problem with this, though, is that the FMAP continues to be in jeopardy and could adjust this coming year. If it does that, jurisdictions will be eligible for more funding, but they will have to provide more funding from their side in order to access those funds, if that makes sense.


It sounds like there's a lot of uncertainty here in the last 48 hours.

That's not really where we had hoped we'd be by this time.



I mean, early on, we had some very promising conversations and a lot of attention paid to this and realization that the territories were very important for strategic reasons; that they suffered, unfortunately, from pretty bad health outcomes, and that we needed to pay attention to that.

And, again, that squeezing money here wasn't the thing to do because these folks are U.S. citizens. They will simply travel to states to access the care they need; it places a burden on them, places a burden on the jurisdiction—but if you need cancer treatment, you're probably going to go get it, and then the states will have to bear it.

So, those messages were really resonating, and we had a lot of hope.

Unfortunately, you know, a lot of other agenda items have come to the floor in these months and have really crowded out that message.

Now, again, we do have movement on the administration side where they're able to pump some more funding in and raise the allocations. But, you know, our jurisdictions are going to have to pay for that money, you know, in a way that states would not.


Should we expect something catastrophic to occur in two days?


No, I don't think so. I think, you know, what we're doing is we're talking with our jurisdictions, we're kind of reading the tea leaves here.

So, nothing's going to happen in the immediate future—this gives us some breathing room—but we're really keeping the pressure on and that this gives us some more time since we didn't make all the traction we needed to make. We're pushing forward with full equity.

I do want to say that even this administrative fix treats Puerto Rico differently. So, we continue to not only have inequities between the states and the territories, but also among the territories. And while all the territories, their basis this last year—which was pretty good adjusted for inflation—for Puerto Rico, for some reason, we go back a year and that's used as the base.

So, it seems like at every turn we're kind of facing this inequity within territories as well, which is concerning.



On Capitol Hill, Wednesday, Louisiana state health officer and medical director, Dr. Joseph Kanter, will offer testimony about public health infrastructure before the select subcommittee on the coronavirus crisis. The hearing is billed as a discussion about possible solutions to pandemic challenges, including workforce concerns.

Watch the hearing live using the link in the show notes and listen for highlights from the hearing on this newscast later in the week.


Also today, ASTHO considers the importance of crisis communications in a new episode of the Public Health Review podcast, posting tomorrow everywhere you stream audio.

Washington State health secretary, Dr. Umair Shah, and Dr. Khalilah LeGrand, director of communications at the Nebraska Department of Health and Human Services, are the guests.

They'll talk about how communications helps audiences connect with public health policies during the pandemic, and the challenges caused by social media disinformation, fast changing policies, and endless media cycles.


I think one of the biggest challenges is certainly public perception.

The amount of misinformation that was being thrust at the states trying to put out information, thrust via different vehicles and platforms—certainly social media has its benefits, but it also has provided us with a great deal of challenges because people can put something out and it's not always vetted.



Finally this morning, synthetic chemicals are used in nonstick cookware, water repellent clothing, and fire-fighting products are getting more attention from states and territories worried about the environmental impacts of PFAS substances.

ASTHO has a blog article summarizing a variety of legislative efforts to address these materials.


Find a link to the article along with links to everything else mentioned in the show notes.


Also remember to follow us on Apple Podcasts or Spotify, or listen on Alexa or Google assistant.

And, if you have a minute, please take time to leave us a rating and a review.


Join us tomorrow morning for more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition.



Joseph Kanter MD MPH

State Health Officer, Louisiana Department of Health

Karl Ensign

Vice President for Territorial Support, ASTHO