Interviewees noted that clinics played a key role in response efforts, particularly in the immediate aftermath of the storms, but received little government support. Overall, tourism remains down, particularly in USVI, where the major hotels are still closed. Through volunteer, military, and other efforts, some individuals are continuing to go into these communities to deliver care, but as relief efforts phase out, these access difficulties may increase. The significant unifying role that the BVIHSA, the Peebles Hospital, and its dedicated staff played during that time cannot be understated, and still continues to this day. Many private providers remain closed or have left the territories, which has exacerbated pre-existing access challenges, particularly for specialty and mental health care. These partners must work collaboratively to develop and sustain the HIE. “We were given an “A” rating on the PAHO Hospital safety index – one of only two hospitals in the entire region. Prior to the storms, Puerto Rico also was anticipating facing a large funding gap as additional funds provided under the Affordable Care Act (ACA) were running out.

In contrast, annual federal Medicaid funding for the territories is subject to a statutory cap, with a fixed federal match rate of 55%. Natasha Lettsome, BVIHSA Marketing & Communications Manager, experienced the hurricane first-hand and recalls, “Afterward, people were just so grateful to be alive. A real-time interoperable HIE is critical to eliminating redundant tests and procedures, increasing patient engagement by allowing patients to view their health information in real time, and to increasing the quality of care since longitudinal information may exist. In May 2020, Governor Bryan resubmitted to the 33rd Legislature an amended version of the proposed Virgin Islands Cannabis Use Act, which incorporates the product of collaboration and input from those multiple senators who came forward and comments received from the public in town hall meetings. Participation in Association Health Plans expands access to quality, affordable health coverage for U.S. Virgin Islands residents employed by small businesses. Others felt that the local response has been strong and played a helpful role in recovery within the community. The legislation, which was also submitted in October 2019, gives the VI Department of Health regulatory authority over all out-of-hospital emergency medical service providers in the Territory. Some said that increased financial pressures have forced them to change or postpone plans for the future, such as delaying education and career plans. As of mid-April 2018, the hospital was waiting on a final determination from FEMA as to whether it will repair and rebuild the existing facility or construct a new facility. They noted that their top priorities include facilitating access to power and communications by expanding generator capacity, exploring solar power options, identifying ways to ensure refrigeration for medications amid power outages, and obtaining satellite phones. In addition, interviewees noted that children who have stayed on the islands are experiencing problems performing in school, with some still displaced from their homes and/or without power, and some dealing with ongoing fear and emotional stress from the storms. In October 2019, the VI Department of Health initiated this effort with a stakeholders meeting that included representatives from the Territory’s hospitals and health centers, and the University of the Virgin Islands. Phase 1 – Complete a housing and services assessment by the end of 2020.

Those revenues, estimated at between $14 million and $17 million annually, would be used to help stabilize the GERS which is underfunded to the tune of $2.82 billion by some estimates, and by $4.74 billion by other estimates. They are also awaiting proposals for the architectural and engineering design of the permanent replacement to the Juan F. Luis Hospital. The group is currently developing a framework for completion and implementation of the Community Health Improvement Plan. Territory officials and some providers reported positive experiences with FEMA, noting that they were working closely with the agency to finalize damage assessments and rebuild facilities. Roy L. Schneider Hospital Temporary Facility, Myrah Keating Smith Community Health Clinic. “Far and away the best prize that life offers is the chance to work hard at work worth doing.” – Theodore Roosevelt. The brief builds on earlier work that examined how residents in Puerto Rico were faring two months after the storm and key issues for recovery in Puerto Rico and USVI identified during a Fall 2017 roundtable with key stakeholders. Due to the storms, the first review for accreditation was delayed. It addresses the coordination of services by public and private agencies that support individuals throughout the USVI who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, or drug dependency. The purpose of the VI Telehealth Workgroup is to develop a telehealth strategy, to coordinate telehealth activities, to address issues and challenges around telecommunications and interoperability, and to enhance the use of telehealth in the USVI. Puerto Rico delayed Medicaid renewals for 12 months and USVI delayed renewals for six months to help individuals maintain stable coverage amid the recovery efforts. Pending Obligation of additional items required to complete the THS buildout. Medicaid and the Children’s Health Insurance Program played important roles covering residents in both territories before the storms, covering nearly half of the population in Puerto Rico (49%) and over one in five individuals (22%) in USVI (Figure 1). The first step to achieving the department’s goal is the completion of a Community Health Assessment to identify key health needs and issues through comprehensive data collection and analysis. The budget bill increased the federal caps for Puerto Rico ($4.8 billion) and USVI (approximately $142.5 million) and provided Medicaid funds at 100% federal match from January 2018 through September 2019.31 Local officials and providers noted that these funds provide much needed immediate assistance and fiscal relief, but they expressed significant concerns about what will happen when the funding ends since no long-term changes were made to the federal match rate or cap on federal funds. This includes the size of facilities needed and the type of services they need to be prepared to provide, not just now, but for the foreseeable future. Prior to the storms, Puerto Rico and USVI had fiscal challenges, including high rates of debt, poverty, and unemployment, and they faced a range of health disparities. Take the Teleheath Provider Survey by clicking HERE. All of the interviewed residents who experienced damage to their homes were still in the process of repairing their homes. Schneider Regional Medical Center on St. Thomas suffered major structural damage, leaving it with limited capacity to provide inpatient care, emergency services, and dialysis care six months after the storms. Moreover, mental health services in both territories were limited. Medical tourism is still on the agenda, and is predicated on obtaining accreditation and having an efficient organization. We were all just so thankful of having survived. This match rate is lower than the rate the territories would receive if the rate was based on per capita income like the states. They are also working with the Medicaid Program to implement a health information exchange platform used in declared disasters to provide care to displaced patients. Incorporated in 1997, VI Equicare membership includes the majority of primary care and specialty physicians as well as ancillary facilities and allied healthcare practitioners practicing in the islands of St. Croix, St. Thomas, and St. John. Some interviewees said that these living arrangements had led to increased stress and strains on family relationships. “That really drove home for us the importance of disaster mitigation and emergency planning,” Dr. Georges stated. After the storm, it housed government services and ministries and the National Emergency Operations Center. Many residents still have major damage to their homes, with some still living in alternative living arrangements with other family. The Policy subgroup is tasked with focusing on policy and regulation, has drafted proposed legislation called the Virgin Islands Telehealth Act. Many residents felt that the federal response through FEMA has been slow and inadequate. It recognizes the adult use of cannabis for cultural and sacramental uses and enables business ownership and financial opportunities for local Virgin Islanders.

Government of the United States Virgin Islands. The Community Health Improvement Plan will define the vision for the health of the VI community through a collaborative process and will address the gamut of strengths, weaknesses, challenges, and opportunities that exist to improve the Territory’s health status. Children’s daily lives and education remain disrupted. The VI Telehealth Workgroup comprises members of the public and private sectors, including the VI Department of Health; VI Department of Human Services; LAN Communications; Broadband VI; Viya; The Plessen Group; TADAH; Continuum Care; VI Territorial Emergency Management Agency; Witt O’Brien; the VI Public Services Commission, VI Next Generation Network; Inner Circle Logistics; Island Analytics; and the Federal Emergency Management Agency. While some may qualify for Medicaid coverage, a number are becoming uninsured. Many interviewees felt that private organizations, volunteers, and local communities have played an instrumental role in recovery. The department also engaged ASTHO, the Association of State and Territorial Health Officials, a nonprofit organization dedicated to assisting states and territories with developing sound public health policy. One of healthcare’s fastest-growing initiatives, telehealth is the use of mobile technology to extend the reach of physicians and healthcare providers beyond traditional clinical settings. The proposed amendment creates a regulated system under the Office of Cannabis Regulation (OCR), enables sales to tourists, and increases tax revenues to the Government of the Virgin Islands. The purpose of the compact is to increase consumer access to physical therapy services by increasing mobility of eligible physical therapy providers to work in multiple states. “Think of the organization as an organism,” he avers. Local officials and providers also noted that they are engaging in outreach and education efforts to help reach and enroll individuals who may be newly eligible for Medicaid as they are losing jobs and income. The doors were opened, people were fed. Hospitals and clinics are facing increased financial strain as the territories’ uninsured populations grow due to increases in unemployment.

In USVI, both hospitals as well as some urgent care centers and health department facilities suffered damage from the storms that limited their operations. Officials noted that modular units and dialysis trailers are being brought to USVI to expand service capacity, which will hopefully reduce off-island transfers and allow more evacuees to return home. Partners included but were not limited to: Westcare, the VI Law Enforcement Planning Commission, the Judicial Branch, hospitals and health centers, the VI Department of Health, Viequicare, the VI Bureau of Corrections, VI Developmental Disabilities Council, Lutheran Social Services, Catholic Charities, the VI Department of Human Services, the VI Police Department, the VI Department of Labor, Community Foundation of the Virgin Islands and the St. Croix Foundation. In a Fall 2017 roundtable discussion, key stakeholders pointed to short- and long-term options to address health care needs in Puerto Rico and USVI, and emphasized the need to address pre-existing fiscal debt problems as well as economic damages from the storms.



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