To amend titles XVIII and XIX of the Social Security Act to make improvements to the treatment of the United States territories under the Medicare and Medicaid programs, and for other purposes.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Territories Health Equity Act of 2023 removes the historical funding caps on Medicaid for U.S. territories and adjusts Medicare payment formulas to provide fairer reimbursement to territorial hospitals. It also extends health insurance marketplace access to territory residents who currently lack exchange options.
Who Benefits and How
Residents of Puerto Rico, Virgin Islands, Guam, Northern Mariana Islands, and American Samoa gain access to uncapped Medicaid funding similar to U.S. states. Hospitals in territories receive increased Medicare disproportionate share hospital (DSH) payments for serving low-income patients. Low-income territorial residents become automatically eligible for Medicare Part D premium subsidies.
Who Bears the Burden and How
The federal government faces substantially increased healthcare spending for territories, estimated in the hundreds of millions to billions annually. CMS must publish new transparency data and reports on territorial healthcare programs. The enhanced allotment program for territories sunsets as regular Medicaid funding replaces it.
Key Provisions
- Eliminates Medicaid funding cap for all five territories beginning FY2024
- Removes 55% FMAP limitation for Puerto Rico, allowing regular formula calculation
- Creates $300 million DSH allotment pool for territorial hospitals
- Automatic Part D subsidies for territory residents enrolled in territorial Medicaid
- Provides exchange-equivalent coverage access for territory residents without marketplace options
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Eliminates long-standing funding caps and disparities in Medicare and Medicaid treatment for U.S. territories (Puerto Rico, Virgin Islands, Guam, Northern Mariana Islands, American Samoa), providing parity with state-level healthcare funding
Key Policy Areas
Healthcare, Medicaid, Medicare, Territorial Policy
Primary Purpose
Eliminates long-standing funding caps and disparities in Medicare and Medicaid treatment for U.S. territories (Puerto Rico, Virgin Islands, Guam, Northern Mariana Islands, American Samoa), providing parity with state-level healthcare funding
Policy Domains
Title I - Medicaid Improvements
Identified Gains
- Territory Medicaid programs
- Low-income territorial residents
- Healthcare providers in territories
Identified Costs
- Federal government (increased spending)
- CMS administrative staff
Title II - Medicare Improvements
Identified Gains
- Hospitals in U.S. territories
- Medicare beneficiaries in territories
- Low-income territorial residents
Identified Costs
- Medicare Trust Fund
Title III - Transparency and Exchange Access
Identified Gains
- Uninsured territory residents
- Policy researchers and advocates
Identified Costs
- HHS and CMS (reporting requirements)
- Federal government (premium subsidies)
Sponsors
Legislative Progress
IntroducedMs. Plaskett (for herself, Mrs. González-Colón, Mr. Moylan, Mrs. Radewagen, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Centers for Medicare & Medicaid Services, Department of Health and Human Services, Federal Medicaid program
Positive-direction: Territorial Medicaid agencies, US territories (Puerto Rico, USVI, Guam, CNMI, American Samoa)
Negative-direction: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Federal Medicaid program, HHS, Treasury, and OPM, Medicare program
Low-income Medicare beneficiaries in US territories, Low-income patients in Puerto Rico, Medicaid beneficiaries in US territories
Healthcare providers in US territories, Hospitals in Puerto Rico serving low-income patients, Hospitals in US territories
Health insurers in DC Exchange, Health insurers offering plans through DC Exchange, Medicare Part D plans serving territories
Policy researchers and healthcare advocates
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "the_secretary"
- → Secretary of Health and Human Services
- "opm_director"
- → Director of the Office of Personnel Management
- "the_secretary"
- → Secretary of Health and Human Services
- "secretary_of_treasury"
- → Secretary of the Treasury
Key Definitions
Terms defined in this bill
Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa
The Medicaid program under title XIX of the Social Security Act
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology