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Disparate Treatment of Puerto Rico Residents with Disabilities in Federal Programs and Benefits Wednesday, May 25, 2022
 
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    Emergency Management
  
    

    
    Financial Assistance & Incentives
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 **SCOPE AND PURPOSE**: For a variety of historical and policy reasons, Congress has not extended certain federal benefits programs to residents in the U.S. territories like Puerto Rico. In this report, NCD examines the social, legal, and ethical implications to the residents of Puerto Rico with disabilities when Congress “legislates differently with respect to the Territories than it does with respect to the States.”[[1]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn1) It particularly highlights the experiences of people with disabilities and is intended to provide Congress with information in support of extending safety net benefits to residents in the U.S. territories. It examines federal programs that provide a safety net for people with disabilities including Medicaid, Medicare, Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Supplemental Nutrition Assistance Program (SNAP). In addition, this report examines how these disparities limit the availability of durable medical equipment (DME) and create barriers to obtaining employment, as well as to transportation and accessible housing. Finally, this report examines how continued disparities result in delays to federal response during natural disasters in Puerto Rico. This report was written prior to but is released after the recent Supreme Court decision in *United States v. Vaello-Madero*,[[2]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn2) in which the Court held that, while Congress is not *required* to extend Supplemental Security Income benefits to residents of Puerto Rico under the equal-protection component of the Fifth Amendment’s Due Process Clause, it *may* exercise discretion to do so.[[3]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn3) The majority further noted the ripeness for Congress to reconsider extending federal benefits programs to the residents in the territories, noting that the Solicitor General informed the Court that the President supports such legislation as a matter of policy.[[4]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn4) **KEY RECOMMENDATIONS** Congress should re-evaluate the provisions of the Jones Act, specifically those provisions that restrict coastwise trade on U.S. flagged vessels regarding durable medical equipment covered under Medicare Part B such as manual wheelchairs, power wheelchairs and components and replacement parts, scooter and component parts and replacement parts, patient lift and transfer equipment, patient ventilators, portable oxygen, foam, gel, innerspring and air mattresses, continuous positive airway pressure (CPAP) devices, shower chairs and commode chairs, and suction pumps.
  Congress should amend the Social Security Act to replace the Medicaid block grant program in Puerto Rico and other U.S. territories with a federal matching system comparable to the Medicaid program provided to U.S. residents.
  Congress should amend Title XVI of the Social Security Act to extend eligibility for Supplemental Security Income (SSI) benefits to eligible residents in Puerto Rico.
  Congress should extend SNAP benefits available under the Food Stamp Act to eligible residents in Puerto Rico, the Northern Mariana Islands, and American Samoa, as Congress has historically extended to the residents in Guam and the U.S. Virgin Islands.  [[1]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref1) *United States v. Vaello-Madero*, 142 S. Ct. 1539, 212 L.Ed.2d 496, 499 (2022)*.* [[2]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref2) *Id*. at  499-500. [[3]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref3) *Ibid.* [[4]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref4) *Id.* at 502.  **RELATED PUBLICATIONS**: *NCD letter regarding REAADI for Disasters Act* (2021) *Preserving Our Freedom: Ending Institutionalization of People with Disabilities During and After Disasters* (2019)  **ALCANCE Y PROPÓSITO:** Por una variedad de razones históricas y políticas, el Congreso no ha extendido ciertos programas de beneficios federales a los residentes en los territorios de los Estados Unidos como Puerto Rico. En este informe, NCD examina las implicaciones sociales, legales y éticas para los residentes de Puerto Rico con discapacidades cuando el Congreso “legisla de manera diferente al respecto a los territorios entonce lo hace con respecto a los Estados.”[[1]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn1) En particular, destaca las experiencias de las personas con discapacidades y tiene como objetivo que proporcionar información al Congreso para apoyar la extensión de los beneficios de la red de seguridad a los residentes en los territorios de los EE. UU. El reporte examina los programas federales que brindan una red de seguridad para las personas con discapacidades, incluyendo Medicaid, Medicare, el Seguro de Discapacidad del Seguro Social (SSDI), la Seguridad de Ingreso Suplementario (SSI) y el Programa de Asistencia Nutricional Suplementaria (SNAP).  Adicionalmente, este informe examina cómo estas disparidades limitan la disponibilidad de equipo médico duradero (DME) y crean barreras para obtener empleo, así como para el transporte y la vivienda accesible. Finalmente, este informe examina cómo las continuas disparidades resultan en demoras en la respuesta federal durante los desastres naturales en Puerto Rico. Este informe fue escrito antes pero se publica después de la reciente decisión de la Corte Suprema *en los Estados Unidos v. Vaello-Madero*,[[2]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn2) en el que el tribunal sostuvo que, mientras el Congreso no está obligado a extender los beneficios de la Seguridad de Ingreso Suplementario a los residentes de Puerto Rico bajo el componente de igualdad de protección de la Cláusula del Debido Proceso de la Quinta Enmienda, puede ejercer discreción para hacerlo.[[3]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn3) La mayoría señaló la madurez para que el Congreso reconsidere la extensión de los programas de beneficios federales a los residentes en los territorios, y señaló que el Procurador General informó a la corte que el Presidente apoya dicha legislación como una cuestión de política.[[4]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftn4) **RECOMENDACIONES CLAVE** El Congreso debe reevaluar las disposiciones de la ley Jones, específicamente aquellas disposiciones que restringen el comercio costero en embarcaciones con bandera de los EE. UU. con respecto a equipos médicos duraderos cubiertos por la Parte B de Medicare, como sillas de ruedas manuales, sillas de ruedas eléctricas y componentes y repuestos, escúters y componentes y piezas de repuesto, equipos de traslado y elevación de pacientes, ventiladores de pacientes, oxígeno portátil, espuma, gelatinas, colchones de muelles internos y de aire, dispositivos de presión positiva continua en las vías respiratorias (CPAP), sillas de ducha y sillas con inodoro, y pompas de succión.
  El Congreso debe enmendar la ley del Seguro Social para reemplazar el programa de subvenciones en bloque de Medicaid en Puerto Rico y otros territorios de los EE. UU. con un sistema federal equivalente comparable al programa de Medicaid proporcionado a los residentes de los EE. UU.
  El Congreso debe enmendar el Título XVI de la ley del Seguro Social para extender la elegibilidad para los beneficios de Seguridad de Ingreso Suplementario (SSI) a los residentes elegibles en Puerto Rico.
  El Congreso debe extender los beneficios de SNAP disponibles bajo la ley de cupones para alimentos a los residentes elegibles en Puerto Rico, las Islas Marianas del Norte y Samoa Americana, como históricamente el Congreso ha extendido a los residentes en Guam y las Islas Vírgenes de los EE. UU.  [[1]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref1) Estados Unidos *v. Vaello-Madero*, 142 S. Ct. 1539, 212 L.Ed.2d 496, 499 (2022)*.* [[2]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref2) *Id*. at  499-500. [[3]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref3) *Ibid.* [[4]](https://ncd.gov/publications/2022/disparate-treatment-puerto-rico-residents-disabilities-federal-programs#_ftnref4) *Id.* at 502.


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