House Finance panel hears Health leaders’ FY25‑26 budget pitches; nursing pay parity, trauma center and generators top requests

Puerto Rico’s House Finance Committee heard detailed budget presentations from Secretary of Health Víctor Ramos Otero and agency heads on April 23 as officials described program needs, capital projects and personnel shortages tied to the Department of Health’s proposed FY25‑26 spending.

Secretary Víctor Ramos Otero told the panel the department’s funding proposal is financed roughly by three streams: approximately $492.1 million (about 37 percent) from the general fund, about $181.5 million (about 14 percent) in own revenues and roughly $642.1 million (about 49 percent) in federal funds. He highlighted a number of line‑item requests and program pressures, including a $4.1 million request to equalize nurse salaries between the pediatric and university hospitals and ASEM (Administración de Servicios Médicos). “Pedimos 4.1 millones nuevos para igualar el salario de las enfermeras del hospital pediátrico y del hospital universitario a la misma clasificación de las enfermeras de ASEM,” Secretary Ramos Otero said in his presentation.

Why it matters: Committee members said the hearing is part of the formal review of the governor’s budget submission and will inform follow‑up with the Office of Management and Budget and the Financial Oversight and Management Board. Lawmakers repeatedly pressed agency leaders about how federal funding changes would affect essential services such as Medicaid and federally aided recovery projects.

Key requests and program notes - Nurse pay parity and beds: Ramos Otero highlighted the $4.1 million request to equalize nursing pay so pediatric and university hospital nurses do not migrate to ASEM. He said opening closed hospital beds depends on having that pay parity and other staffing moves. - Utilities and capital: The secretary itemized operating and utilities requests (acueducto about $4.9 million; electricity about $14.7 million) and listed capital and equipment asks including a $26.6 million Medicaid IT modernization, a $12.3 million upgrade for Bayamón ORs and other investments for CDT clinics and regional hospitals. - Air ambulance and island services: The department budgets dedicated funding for the permanent air ambulance that serves Vieques and Culebra (noted figures of roughly $801,000 and $370,000 for island air service) and for Aeromed operations. - Legal exposure and program mandates: Ramos Otero listed several federally driven payments the department must cover, such as historical litigation or monitorship costs tied to intellectual disability services (figures cited in testimony).

Agency summaries presented to the committee - Amska / Psychiatric services: Dr. Katherine Oliver Franco (identified in testimony as administrator of Amska) said her agency’s total allocation under the Board proposal was about $147,000,433 and described line items for Pay‑As‑You‑Go, payroll, special allocations and funds for psychiatric facilities and a forensic psychiatric center contract with the Department of Corrections (she referenced an amount around $16,300,000 for that contract). She also identified needs for electronic medical records (a federal mandate) and crisis‑call capacity expansion. - ASES (Health Insurance Administration): Limary Colón Rodríguez, acting executive director of ASES, described ASES’ requested FY25‑26 budget (total program request she cited about $5,780,460,000), noting the split she presented among general fund, special revenues and federal funds and saying the agency aims to maintain plan operations and regulatory oversight of insurers. - ASEM and Centro Médico: Regino Colón (executive director, Administración de Servicios Médicos) gave operational and service detail for Centro Médico and related hospitals, describing emergency and trauma capacity, number of operating rooms and specialized services, and listing more than a dozen FEMA and CDBG projects in construction or planning. He said generators and full electrical redundancy work is underway and that 19 projects tied to FEMA remain active. He also said some hospitals are operating with closed beds (he estimated about 70 closed beds) and that opening them would relieve emergency‑room crowding. - Centro Cardiovascular: Javier Marrero Marrero (director executive) summarized a proposed $91.6 million budget for FY25‑26 funded by own revenues, described a $6 million CAPEX ask, and said the center has received federal recovery and mitigation funds (including FEMA and a $53 million competitive CDBG‑MIT award) that are being invested in generators, chiller systems and structural repairs. Marrero said the center’s accounts receivable totaled about $12.6 million and that roughly $8 million of that is currently recognized as exigible debt from insurers. - Centro de Diabetes: Miguel Buzztelo (director executive) outlined a request of roughly $2,000,290 (transcript numbers shown as 2,000,290) from the general fund to reopen and relocate the center, hire additional specialists and resume education and prevention activities. He described the island’s diabetes burden and argued modest recurrent funding for prevention creates long‑term savings.

Federal funding and contingency planning Committee members repeatedly asked whether agencies had received any formal federal notice about cuts or restructuring of federal grants. Ramos Otero and other agency leaders said most programs have not received an immediate cut notice beyond previously signaled expirations (for example COVID‑related funds that had been expected to phase out). Ramos Otero said the department has asked human resources to model a “core‑operations” staffing scenario in case federal funds were reduced, and that work was in progress.

Insurer payment, collections and provider relations Officials from ASEM and the Centro Cardiovascular told the committee they continue collection efforts against insurers and have filed administrative complaints where appropriate. Marrero said the center’s billed‑to‑collected ratio has been roughly 89 percent this fiscal year (down from higher levels in prior reporting) and said the center is pursuing administrative remedies and legal avenues where insurers do not meet contractual obligations. Secretary Ramos Otero told the committee he has met with major insurers and supports strict enforcement of contractual terms where insurers are late or underpay. "Mi posición sobre ustedes no ha cambiado… podemos trabajar de la mano todos juntos, pero si tengo que caerle un marrón, le va a caer un marrón," he told insurers during questioning.

Operational pressures and workforce retention Members pressed agencies about staff retention, particularly of nurses and specialists. Ramos Otero and ASEM leaders described competition between hospitals and explained some staff move to facilities that pay more; the nurse pay‑parity request is intended to reduce that churn. Agencies also emphasized recruitment needs for psychiatrists, psychologists and social workers in behavioral health programs and for specialty physicians at Centro Cardiovascular.

What’s next Committee technicians will use the testimony to compare the governor’s submission and the oversight board’s review. Lawmakers said they may call agency leaders back if the Financial Oversight and Management Board changes the budget the governor transmitted.

Ending note The health panel’s presentations combined immediate operational asks (pay parity, utility funding, minor equipment) with multi‑year capital and recovery projects that depend on federal disaster funding, making the committee’s upcoming technical review and interagency coordination with the Office of Management and Budget and the oversight board critical to any final legislative recommendations.