Puerto Rico State Plan for Independent Living (SPIL) for 2017-2019
“Persons with disabilities in Puerto Rico achieve greater independence, are empowered and take control of their lives in order to increase their integration, inclusion, equality and access to the services and resources in the community according to the following Goals.
Goal 1: Persons with disabilities have the necessary independent living services and other complementary services.
Goal 2: Persons with disabilities exercise control in decision-making and intercede for system changes.
Goal 3: The community at large knows about the independent living philosophy and services”
Puerto Rico Department of Vocational Rehabilitation (Administración de Rehabilitación Vocacional (ARV) in Spanish)
Vocational Rehabilitation Administration, or Administración de Rehabilitación Vocacional (ARV) in Spanish “provides services to people with eligible impairments, so that they can prepare, obtain, retain, or maintain a job.”
Puerto Rico VA Services Offered by the San Juan Regional Office
“VA’s San Juan Regional Office (RO) administers a variety of services, including Compensation, Education, Insurance, Loan Guaranty, Pension, and Vocational Rehabilitation and Employment for Veterans, Servicemembers, their families and survivors in Puerto Rico and the U.S. Virgin Islands. We offer the following additional services:
Counseling about eligibility for VA benefits and how to apply
Information about VA health care and memorial benefits
Outreach to Veterans, including those who are homeless or at risk for homelessness and older, minority, and women Veterans
“The Medicaid program in Puerto Rico differs from Medicaid programs operating in each of the 50 states and the District of Columbia in three important ways.
The Puerto Rico Medicaid delivery system is a subset of the larger public government healthcare delivery system for most of the island’s population. The Puerto Rico Department of Health is the single state agency, and they have a cooperative agreement with the Puerto Rico Health Insurance Administration (PRHIA) also known as Administracion de Seguros Salud de Puerto Rico (ASES) which implements and administers island-wide health insurance system. Approximately half of Puerto Rico’s 3.5 million residents have low incomes and depend upon the public health system for their medical care.
Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. For the period of July 1, 2011 through September 30, 2019, Section 2005 of the Affordable Care Act provided an additional $5.4 billion in Medicaid funding to Puerto Rico.
Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage (FMAP) rate for that state, in Puerto Rico, the FMAP is applied until the Medicaid ceiling funds and the Affordable Care Act available funds are exhausted. The statutory FMAP local matching rate increased from 50%/ 50% to 55% federal /45% local, effective July 1, 2011. From January 1, 2014 to December 31, 2015 there is a temporary 2.2% FMAP increase for all Medicaid enrollees, bringing Puerto Rico’s FMAP to 57.2%.”
Puerto Rico Veterans Affairs (VA) Caribbean health care
“At VA Caribbean Healthcare System, our health care teams are deeply experienced and guided by the needs of Veterans, their families, and caregivers. Find a health facility near you, and manage your health online. Sign up for community events and updates.”
U.S. Territories: 2019 Transforming Lives through Supported Employment grants
“The purpose of the program is to support state and community efforts to refine, implement, and sustain evidence-based supported employment programs and mutually compatible and supportive evidence-based practices (e.g., supported education) for transition-aged youth/young adults (ages 16-25) with serious emotional disturbance (SED), and adults with serious mental illness (SMI) or co-occurring mental and substance use disorders (COD). SAMHSA expects that this program will increase state and community capacity to implement and sustain Supported Employment Program (SEP) models and integrated supports to improve competitive employment outcomes for individuals with SED, SMI, or COD…
Eligible applicants are domestic public and private nonprofit entities. For example: State governments; the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are also eligible to apply.”
U.S. Territories: Projects for Assistance in Transition from Homelessness (PATH)
“PATH grants are distributed annually to all 50 states, the District of Columbia, Puerto Rico, the Northern Mariana Islands, Guam, American Samoa, and the U.S. Virgin Islands. Each state or territory solicits proposals and awards funds to local public or nonprofit organizations, known as PATH providers. Supported Activities for PATH….
Across the United States, approximately 500 local organizations offer an array of essential services and supports that may not be supported by mainstream mental health programs. In total, PATH staff outreached to 139,515 individuals in 2017 and enrolled 73,246 PATH-eligible clients with the following services:
Outreach
Screening and diagnostic treatment
Habilitation and rehabilitation
Community mental health
Substance use disorders treatment
Referrals for primary health care, job training, educational services, and housing
Housing services as specified in Section 522(b)(10) of the Public Health Service Act”
“Medicaid and the State Children’s Health Insurance Program (CHIP) operate in the five U.S. territories- American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI). This fact sheet summarizes federal requirements and design features of these programs in the territories, including eligibility and enrollment, benefits, financing and spending, data and reporting, and quality and program integrity…
Delivery System
Puerto Rico is currently the only territory to use Medicaid managed care, in which the entire Medicaid population is enrolled. Managed care organizations (MCOs) provide commonwealth-wide acute, primary, specialty, and behavioral health services. They are paid risk-based capitated payments. MCOs contract with primary medical groups, which in turn create preferred provider networks (PPNs). Enrollees are auto assigned to a health plan but may switch once per year, and do not need referrals for specialists in their PPN (MACPAC 2019b).”
