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Testimony: Medicaid and CHIP in the U.S. Territories

MACPAC executive director Anne L. Schwartz testified before the Health Subcommittee of the House Energy and Commerce Committee on the role of Medicaid and CHIP in the territories. The testimony described how Medicaid operates in the five U.S. territories, how it is financed, and Medicaid spending in the territories. MACPAC’s testimony noted that two features of Medicaid financing – a capped federal allotment and the statutorily set federal matching rate of 55 percent – have led to chronic underfunding for Medicaid in U.S. territories. In addition, MACPAC estimates that all five territories will face a funding shortfall in fiscal year 2022.

Although an additional infusion of federal funds would ensure the continued delivery of critical health care services to eligible individuals in the short term, it would not address underlying challenges with the financing structure that make it difficult for territorial officials to plan, manage, and sustain long-term, reliable access to care for Medicaid beneficiaries.