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Government of the Virgin Islands of the United States DEPARTMENT OF HUMAN SERVICES Press Contact: Ryan Nugent Director of Communications Phone: (340) 725-4924 ryan.nugent@dhs.vi.gov For Immediate Release: June 10, 2024 Administration Seeks Additional $3 Million Appropriation to Meet Medicaid Match DHS Announces Temporary Adjustments to Medicaid Program U.S. VIRGIN ISLANDS - The Department of Human Services (DHS) is announcing temporary service adjustments to the Medicaid program. This difficult decision aims to preserve the long-term viability and integrity of essential healthcare services provided to our community. Effective July 1, 2024, certain services will be paused or limited, including Adult Dental, Medical Escort Travel Services, Personal Care Attendant (PCA) Program, and Durable Medical Equipment (DME). Through Congressional action, the USVI received a permanent CMS FMAP match increase to 83% federal share and 17% local share, up from the historic 55% federal share and 45% local share. This change allowed for the expansion of additional services and increased the Medicaid beneficiary enrollee population. During the COVID-19 pandemic, CMS authorized numerous waivers and utilized increased FMAPs to address the unprecedented public health emergency. These measures were necessary to provide critical support to our community during a time of crisis, resulting in peak Medicaid membership. However, now that the public health crisis has ended, we are transitioning back to pre-pandemic requirements and eligibility standards. This transition is essential to ensure the long-term sustainability of our Medicaid program within the current fiscal climate. In response to these necessary adjustments, the Bryan/Roach Administration is formally requesting an additional $3 million appropriation to meet the federal Medicaid matching requirements. This funding request is critical to restoring and maintaining the essential healthcare services that our community relies upon. The $3 million Medicaid appropriation measure was forwarded to the 35th Legislature of the Virgin Islands on Friday, June 7, 2024. DHS understands the concerns these changes may cause and assures the public that the decision was not made lightly. VIDHS is actively working on reassessing these programs to help ensure their continuation in a financially sustainable manner. Our goal is to minimize the impact on our community and make these programs available to members again as soon as possible. P R E S S R E L E A S E For Immediate Release: June 10, 2024 Effective July 1, 2024, the following services will be paused: • Adult Dental • Medical Escort Travel Services * Some prescription services may be impacted. Effective July 1, 2024, the following services will be limited: • Personal Care Attendant (PCA) Program** • Durable Medical Equipment (DME)*** * Critical and therapeutic medications will remain available and may require a prior authorization. **Notably, services for children will remain unaffected by these adjustments. The continued services for aged, blind and disabled members will be temporarily authorized for a limited time while DHS reassesses service limitations. ***Exclusive of life-sustaining equipment and services. The DHS team understands the impact these changes may have on our community, particularly on those who heavily rely on these services and appreciate your understanding and patience during this challenging time. Our goal is to come back stronger with services that meet the needs of our community more effectively. We are committed to keeping you informed and plan to provide regular updates on our progress. FAQs Why are the PCA Program, Durable Medical Equipment, Adult Dental and Prescription Services, and Medical Escort Travel Programs Being Paused or Limited? We experienced an influx of clients after the storms of Irma and Maria, followed by the COVID-19 pandemic, and the numbers have never gone down. In the wake of these disasters, many individuals faced new health challenges and increased care needs, driving a surge in demand for these services to support daily living activities and overall well-being. This unprecedented increase in requests has led to unsustainable costs. Will the PCA Program Continue to be Available for Children? Yes. The PCA Program will continue to be available for children. Will the PCA Program Continue to be Available for Members who are Aged, Blind, or Disabled? Yes. The PCA Program will continue to be available for the aged, blind, and disabled on a temporary basis. During the time in which the service is limited, certain measures will be reimplemented to help ensure the proper utilization of resources. Prior authorizations for specific procedures will be reinstated to maintain the efficiency and effectiveness of our services. For Immediate Release: June 10, 2024 What If I Have a Need for The Services During This Time When They Are Paused or Limited? During the time services are paused you can still submit a request in writing to have your case reviewed by DHS and the medical review team who will review your request and make a determination on a case-by-case basis. For written service requests, please submit to: dhs.map@vi.giv What If I Have a Need for Prescription Drugs During This Time When They Are Paused or Limited? Critical and therapeutic medications will remain available and may require a prior authorization. Generic alternatives are also being reviewed and may be considered as a substitute to an existing prescription. Additionally, individuals should ask their pharmacist about prescription discount programs that may be available for prescriptions not being covered. When Can We Expect These Programs to Resume? We recognize the importance of these services and are working diligently to bring them back online. Efforts are underway to seek additional funding and resources to restore these services as soon as possible. What Can We Expect When These Programs Resume? Certain measures will be reimplemented to help ensure the proper utilization of resources. Prior authorizations for specific procedures will be reinstated to maintain the efficiency and effectiveness of our services. How Will DHS Continue to Make These Programs Sustainable? DHS is actively working on reassessing these programs to help ensure their continuation in a financially sustainable manner. We are committed to exploring avenues to minimize the impact of these changes. DHS is also exploring the potential implementation of copays for certain services in the future. This measure will help manage costs while maintaining access to care for those who need it most. These adjustments, though challenging, present opportunities for improving our services. By reassessing and restructuring, we can develop programs that are more efficient and less prone to misuse. Prioritizing essential services and implementing measures like prior authorizations will help ensure that resources are used effectively. We also value community input and welcome feedback on how we can best enhance our services The Department of Human Services (VIDHS) exists to provide social services to members in our commu.nity with diverse needs. In times of national uncertainty and hardship we act as a safety-net and exist to inspire hope and empower change through non-judgmental, quality delivery of needed services and resources. Please visit the Department of Human Services website, www.dhs.gov.vi or on Facebook (https://www.facebook.com/usvidhs). The Bryan-Roach Administration is investing in the Territory’s people, infrastructure, and future through transparency, stabilizing the economy, restoring trust in the government, and ensuring that recovery projects are completed as quickly as possible. Visit transparency.vi.gov