Health Secretary Víctor Ramos and the Puerto Rico Health Insurance Administration (ASES) executive director, Carlos Santiago Rosario, told the Senate Government Committee on Monday that they are confident their lobbying before the federal government will secure adequate Medicaid funding, and that Vital plan beneficiaries will not be affected next year. Puerto Rico receives about $4.2 billion in federal funds this fiscal year under an extraordinary allocation in effect since 2023; without it, the permanent statute provides only about $500 million, and the federal matching rate would fall from 76% to 55% on October 1, 2027, the so-called Medicaid cliff.
Ramos told Senator María de Lourdes Santiago that the 'worst scenario' would be returning to the $500 million allocation, which committee chair Senator Ángel Toledo called 'truly grim', saying a system needing $4 billion cannot run on $500 million. The multisector committee created by La Fortaleza estimated up to one million people could lose the Vital plan, which had 1.36 million participants as of December, if Congress does not act.
The government, allied with industry leaders, is seeking a $4.815 billion allocation for federal fiscal year 2028. Ramos said services were added late in the prior four-year term without an actuarial study, and that cost-cutting measures include a drug rebate program projected to generate about $80 million extra this year. He said federal Health Secretary Robert F. Kennedy Jr. supports maintaining or increasing the federal contribution, though he knows of no written communication, and Toledo flagged that November’s midterm elections could force the committee to start over with new legislators.