Puerto Rico and the U.S. Virgin Islands (USVI) suffered significant damage to their infrastructure and health care systems from Hurricanes Irma and Maria in September 2017. Drawing on interviews with residents and key stakeholders as well as public reports, this brief provides an overview of the status of the recovery efforts six months after the storms, with a focus on the health care systems. It finds: (1) Recovery has progressed, but major challenges remain. Power is back in many areas but remains unstable in Puerto Rico, and remote areas of the island are still without power. There are some signs of economic recovery, but revenues are still down, particularly in USVI, where major hotels remain closed. Many homes are still damaged, and individuals face ongoing financial challenges. Schools in USVI continue to operate on part-day schedules, and many school-aged children have left both territories. Others, particularly young professionals and health care providers, continue to migrate away from the islands, leaving an older population with less family support. (2) Physical and mental health needs have increased. Gaps in care and medication have led to worsened chronic conditions, such as diabetes and hypertension. The unstable power in Puerto Rico makes it challenging to manage chronic conditions due to difficulties refrigerating insulin and accessing oxygen, dialysis, and other machines. Many individuals are struggling emotionally amid sharp increases in depression, anxiety, panic attacks, and post-traumatic stress disorder. (3) Health care systems have resumed operations, but there are limitations on access and gaps in services. Hospitals in Puerto Rico are operational, while hospitals and other facilities in USVI are still operating at limited capacity due to major structural damage. Clinics in both territories have resumed operations, but a number of Puerto Rico's clinics lack stable power. Loss of providers has exacerbated pre-existing access challenges for specialty care and mental health services. (4) Federal relief funding for Medicaid provides essential support but does not address underlying fiscal problems. The budget bill increased the federal caps on Medicaid funding and provided Medicaid funds at 100% federal match from January 2018 through September 2019.However, it does not address underlying fiscal problems or the disparity in federal Medicaid match rates and the cap on federal Medicaid funds faced by the territories. (4) Individuals, hospitals, clinics, and territory officials are taking steps to prepare for future natural disasters but have limited time and resources to prepare before the next hurricane season. Amid recovery and preparation efforts, the territories are also engaged in major delivery system reform efforts.
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