Projeto de lei busca acabar com o teto do Medicaid territorial a partir de 2026

In the United States Congress, a bill is circulating that, if it becomes law, would fundamentally change how Medicaid is funded in Puerto Rico and in the other territories. It is H.R. 6494, the Territories Health Equity Act of 2025, introduced on December 5, 2025, by delegate Stacey Plaskett together with Jennifer González-Colón (then resident representative, here signing as Hernandez in the official GPO text), Amata Radewagen, James Moylan, and Kimberlyn King-Hinds. The date of this note is September 10, 2026; the legislative byline is that of the text introduced (IH) on Congress.gov, not a release from the same day.

Section 101 tackles the most controversial federal ceiling: the 'cap' of section 1108 of the Social Security Act. Today, Medicaid in the territories is not open-ended like in the 50 states and DC. There is an annual federal funding limit. When it runs out, the local government either covers 100% or cuts services. The bill adds a new subsection (j) so that subsections (f) and (g) no longer apply to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa starting in fiscal year 2026. In plain language: it would eliminate the overall Medicaid funding limitation for the territories starting in FY2026.

Section 102 goes to Puerto Rico's FMAP. The territorial matching rate is not calculated with the per capita income formula used for states; it is set by statute. Puerto Rico operates with a temporary FMAP of 76% which, under current law according to the CRS, must revert to 55% after September 30, 2027. H.R. 6494 proposes to remove that specific FMAP limitation for Puerto Rico, adjusting the text of section 1905 so that the special rule does not carry beyond FY2025 in the points the bill amends. This is not an automatic check disbursement; it is an architectural change. Without a cap and without a downward 'frozen' FMAP, the federal share would behave more like that of a state — provided the territory contributes its local share and meets program requirements.

Section 103 opens the door to Medicaid DSH (Disproportionate Share Hospital) allotments for the territories. For FY2026, the joint allotment would start from a base of $300 million distributed according to the proportion of low-income or uninsured people in each territory, according to estimates by the Secretary. In subsequent years, each territory would be subject to the increase provided in paragraph (3) of section 1923(f). Today, states receive DSH for hospitals that serve a high proportion of uninsured or Medicaid patients; the territories have been left out or in a different limbo. The bill includes them “beginning with fiscal year 2026”.

Title II gets involved with Medicare in Puerto Rico: calculation of DSH payments under IPPS for hospitals on the Island, rebasing of the hospital target amount in territories, Medicare Advantage adjustments for counties with low base payments, elimination of certain late enrollment penalties of Part B for residents of Puerto Rico, and automatic eligibility of certain low-income territorial residents for premium and cost-sharing subsidies in Part D, with sunset of the enhanced allotment program. Title III requests transparency of Medicaid and CHIP in territories, a report on the exclusion of territories from the exchanges, and access to coverage in areas without available plans.

For the San Juan table, the point is not equity rhetoric: it's whether the government will be able to plan ASES and the health budget without the FY2028 cliff of the statutory cap. To obligate (in the federal budgetary sense of appropriations) is not the same as awarding a grant, nor as disbursing to a hospital, let alone theft. Here there is not even an award: there is an introduced bill. Until it passes the House, Senate, and is signed, the cap remains. The text on Congress.gov makes the proposed effective date clear—beginning with fiscal year 2026—but the legislative status at the time of this piece is still that of a bill referred to Energy and Commerce and Ways and Means.

In Borinquen, any serious reading has to separate three clocks: (1) the federal fiscal calendar that marks the cap cliff; (2) the program integrity and physician payment floor requirements that release add-ons of hundreds of millions under current law; and (3) ASES's local policy on networks, prior authorization, and provider payments. H.R. 6494 attacks (1) and part of Medicare asymmetry; it does not replace the discipline of (2) and (3). Whoever confuses 'a bill was introduced' with 'the funds have already arrived' is lying about the calendar.

Source: Congress.gov (H.R. 6494 IH) — https://www.congress.gov/119/bills/hr6494/BILLS-119hr6494ih.htm