February 26, 2025 – La Fortaleza, Puerto Rico – Governor Jenniffer González-Colón formally submitted a letter to U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. in response to the Advance Notice of Methodological Changes for CY 2027 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies issued by the Centers for Medicare & Medicaid Services (CMS).

In her letter, the Governor calls for specific administrative action to address longstanding structural inequities in the methodology used to calculate Medicare Advantage rates in Puerto Rico—an issue that has placed the Island at a persistent disadvantage compared to the states.

Governor González Colón underscored that Medicare Advantage is the backbone of the Medicare system in Puerto Rico, serving more than 676,000 beneficiaries, including over 305,000 individuals who are dually eligible for Medicare and Medicaid. She warned that nationwide methodological adjustments that fail to account for Puerto Rico’s unique healthcare landscape could have disproportionate consequences on a system that already operates under the lowest reimbursement levels in the nation.

The Governor explained that Puerto Rico continues to be negatively impacted by a rate-setting methodology rooted in the traditional “fee-for-service” model, which does not accurately reflect the Island’s market composition. This structural mismatch creates distortions that contribute to financial instability, provider strain, and limitations on infrastructure investment and healthcare workforce retention.

Among her proposals, Governor González Colón requested that CMS establish a national benchmark floor of at least 0.70 as an initial corrective measure to address the historical disparity. She also urged the adoption of transitional administrative safeguards to ensure stability and predictability while broader structural reforms are implemented.

The Governor noted that the need to correct this inequity has been acknowledged for years in multiple federal forums, including public statements during the administration of Joe Biden, where disparities in Medicare Advantage funding were identified as requiring attention. However, those acknowledgments did not translate into concrete administrative changes to the rate-setting methodology affecting Puerto Rico.

“For years, the problem was discussed. Today, we are demanding specific solutions. Puerto Rico cannot continue to wait,” the Governor stated. Prior to the formal comment period, she had already submitted written comments on the Advance Notice, continuing efforts she began during her tenure as Resident Commissioner.

This initiative forms part of a coordinated federal advocacy agenda led directly by the Governor alongside PRFAA Executive Director Gabriella Boffelli. On February 20, the Governor held meetings at the White House to discuss increased Medicaid funding and the status of Medicare Advantage. She subsequently welcomed to Puerto Rico the Director of the Center for Medicare at CMS and Senior Advisor to the HHS Secretary, Chris Klomp, to continue advancing concrete solutions.

Governor González Colón emphasized that while consensus exists regarding the disparity facing Puerto Rico under Medicare Advantage, the time has come to translate that consensus into decisive administrative action.

“Puerto Rico cannot continue operating under a formula that fails to reflect our reality. We are working directly with federal agencies and through PRFAA to secure targeted adjustments that protect our seniors and vulnerable populations. This is a priority for our administration—and I am personally leading this effort,” the Governor concluded.

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