Territorial leaders describe ‘border’ patient backlog, Medicaid uncertainty and nursing‑home shortfall

St. Croix, U.S. Virgin Islands — Testimony before the Legislature’s Committee on Health, Hospitals and Human Services on Feb. 25 laid out a series of interlocking problems that officials say are constraining care across the territory: hundreds of millions in unpaid bills and underfunding for hospitals, a shrinking Medicaid caseload following the end of pandemic protections, and a shortage of nursing‑home and assisted‑living capacity that leaves dozens of patients “boarded” in hospitals.

“The broader border crisis, which has placed unprecedented pressure on our hospitals, long term care facilities, and social services,” said Avril Lee George, commissioner of the Virgin Islands Department of Human Services, as she described how discharged patients who have no safe placement remain in hospital beds. “On average, between 7 and 10 individuals are classified as borders at any given time,” she told the committee, and later testified that DHS maintains waiting lists for nursing‑home placements.

Why it matters: Hospital leaders said boarded patients reduce bed availability for urgent cases, drive up uncompensated care costs and slow emergency‑department throughput. Hospital executives and DHS urged the Legislature to prioritize short‑term placements, while pursuing longer‑term investments in certified nursing facilities and community‑based services.

What officials told lawmakers

Medicaid and enrollment: Gary Smith, director of Medicaid at DHS, and Commissioner George both described steep enrollment changes connected to the end of the public‑health emergency and recertification processes. “As of 12/29/2024, Medicaid enrollment in The Virgin Islands stands at 21,071 members,” George said. Smith highlighted that the territory now has an 83% federal medical assistance percentage (FMAP) but that the program’s long‑term sustainability is uncertain as Congress debates territory funding; Smith…