# Understanding the Territorial Equity Act of 2021

This bill aims to give Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa more equal access to federal health and social safety net programs. Right now, these U.S. territories receive significantly less federal funding for healthcare and assistance programs than the 50 states, even though their residents are U.S. citizens. This bill tries to close that gap.

The biggest changes involve Medicaid, the federal health insurance program for low-income people. Currently, territories face strict caps on how much federal Medicaid money they can receive each year, which limits how many people they can cover. This bill removes those caps starting in 2022, allowing territories to expand coverage like states can. For Puerto Rico and the Virgin Islands specifically, the bill temporarily increases federal funding to 100 percent for two years (2022-2023), meaning the federal government would cover all Medicaid costs instead of requiring the territories to contribute. The bill also expands which territories can apply for special Medicaid waivers that allow them to customize their programs to fit local needs, and it allocates $300 million for hospitals in territories that serve many uninsured and low-income patients.

The bill also addresses Medicare (the federal health insurance for seniors and some disabled people) by adjusting how much hospitals in territories get paid and ensuring Puerto Rico hospitals can receive additional payments for serving low-income patients. Additionally, the bill extends the Supplemental Nutrition Assistance Program (food stamps) to all territories, expands the Supplemental Security Income program (which helps elderly and disabled people with very low incomes) to territories that currently don't have it, and makes residents of Puerto Rico and the Virgin Islands eligible for the Earned Income Tax Credit and Child Tax Credit. For Puerto Rico specifically, the bill also addresses labor issues by adjusting minimum wage rules for young workers and overtime protections.

Territorial Equity Act of 2021

Velázquez, Nydia M.

Territorial Equity Act of 2021 This bill alters provisions relating to the treatment of U.S. territories under Medicaid, Medicare, Medicare Advantage, the Supplemental Security Income (SSI) program, and other federal assistance programs. The bill modifies provisions under several health care programs with respect to U.S. territories. Among other changes, the bill <ul> <li>eliminates Medicaid funding limitations for U.S. territories beginning in FY2022, </li> <li>repeals provisions that exclude residents of Puerto Rico from a certain automatic enrollment process for Medicare medical services, </li> <li>establishes minimum criteria for certain elements used in Medicare Advantage payment calculations for areas within U.S. territories, and </li> <li>allows residents of U.S. territories who are unable to obtain health insurance through their employer or a health insurance exchange to instead obtain coverage that is at least as broad as the coverage available to Members of Congress and their staff through the District of Columbia exchange. </li></ul> The bill also modifies provisions under other federal assistance programs. Among other changes, the bill <ul> <li>allows Puerto Rico, American Samoa, and the Northern Mariana Islands to participate in the Supplemental Nutrition Assistance Program (SNAP, formerly known as the food stamp program);</li> <li>makes residents of Puerto Rico eligible for the federal earned income tax credit; and</li> <li>extends the SSI program to Puerto Rico, Guam, the Virgin Islands, and American Samoa.</li> </ul>