39: Territories Avoid Medicaid Cliff

Carolyn McCoy, ASTHO’s Senior Director of Federal Government Affairs, explains how an extension of Medicaid funding for U.S. Territories gives them more time to work toward a permanent policy solution; Dr. Joseph Kanter, Louisiana’s State Health...

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

Carolyn McCoy, ASTHO’s Senior Director of Federal Government Affairs, explains how an extension of Medicaid funding for U.S. Territories gives them more time to work toward a permanent policy solution; Dr. Joseph Kanter, Louisiana’s State Health Officer and Medical Director, tells Congress public health needs federal help to rebuild its workforce; ASTHO updates the COVID-19 Vaccine Comparison Brief; and ASTHO welcomes new health officials to its ranks.

ASTHO Legislative Alert: October 1, 2021

ASTHO News Release: Top Louisiana health official outlines six requests for Congress to prevent crumbling of national public health infrastructure

ASTHO Document: COVID-19 Vaccine comparison brief

ASTHO Webpage: Member directory


ASTHO logo



This is Public Health Review Morning Edition for Monday, October 4th, 2021. I'm Robert Johnson.

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


An extension of federal funding approved by Congress late last week gives U.S. territories some breathing room. They were concerned they might lose Medicaid dollars needed to keep healthcare programs running.

Carolyn McCoy is ASTHO's senior director of federal government affairs. She's been tracking the issue and explains the latest in today's morning conversation.

Well, it's October 4th, and the big question this morning has to do with the Medicaid cliff. Did the territories go over the cliff last week?


Thank goodness, they did not. They were provided an extension of their federal medical assistance percentage—their FMAP—through December 3rd in the continuing resolution that was signed into law last week by President Biden.


Where does this leave the five territories, then, given that they depend so much on this money for their Medicaid services?


Yeah, so, there's still a lot that needs to be done. I think we just have a little bit of breathing room given that Congress and the president extended the FMAP for a little while until December; but that doesn't fix the ongoing problem of their funding levels, and it does not give them solid reassurance what their funding levels will be in the future and what they can plan for in the future.

So, ASTHO hasn't changed our stance in our work when it comes to what we're asking Congress to do, and that's provide an equitable solution for the territories in their Medicaid programs.


So, it's good news in the sense that services were not interrupted last week; but otherwise, the territories remain in limbo.


And there's a couple issues at play here.

So, it's a little confusing, it could be, for somebody who might pick up the paper and read that there's been also some adjustments made by the administration and the Centers for Medicare and Medicaid Services.

CMS reinterpreted the current statute as to how much funding would be provided to the territories; and so, again, this increases their allotments, but estimates are still not great as to how that will meet the needs in the territories. And there was a requirement in this re-interpretation to evaluate if this is legal, essentially. So, that is like you said, definitely in limbo.

So, ASTHO is still putting our foot on the gas and continuing our work to advocate for equitable treatment for the territories and their Medicaid programs.



Also on Capitol Hill, members of the select subcommittee on the coronavirus crisis are thinking about the state of the public health workforce.

At a hearing last Wednesday, Louisiana state health officer and medical director, Dr. Joseph Kanter, argued for federal support.


The pandemic has showed us how interdependent we all are. Outbreak waves of the virus have spread across the country, bleeding from one state into another.

As state health officer of Louisiana, it matters a great deal to me that Texas, Arkansas, and Mississippi have strong health departments. Threats to the health of their constituents will quickly become threats to the health of mine.

There is a clear national interest—indeed, a national security interest—in bolstering all public health workforces.



ASTHO's COVID-19 vaccine comparison brief has been updated again, the latest version now available online. It includes information about booster doses, effectiveness against variants, and side effects.

Download the updated document using the link in the show notes.


Finally this morning, several new state and territorial health officials have joined ASTHO's ranks. We reported on three Friday; others new to their positions include: Marcus Samo, secretary of health and social affairs for the Federated States of Micronesia; Dr. Joseph Ladapo, surgeon general and secretary appointee in Florida; Dr. Alexis Travis, state health officer in Michigan; and Dr. Leon Ravin, acting chief medical officer in Nevada.


Find a link to their bios, along with links to everything else mentioned today, 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

Carolyn McCoy MPH

Senior Director, Government Affairs, ASTHO