In an unprecedented partnership for Puerto Rico, New York will assist in submitting a request to the Centers for Medicare and Medicaid Services for a waiver that would allow the island territory to implement changes that could alleviate its dire financial situation.

Officials expect to submit the waiver before the year’s end, an ambitious goal considering it took New York two years to make a similar request as part of its Medicare reform.

“We’re going to put together a winning proposal that we can take to Washington to let them see that Puerto Rico should be entitled to get a Medicare waiver, which is how New York was able to get away from the burden it was under,” New York Lt. Gov. Kathy Hochul said. “We can do this, but it’s going to take a creative approach and expertise to get it done and that’s why we’re here.”

The development came as Hochul led a dream team of New York health officials to Puerto Rico this week, and the announcement of a joint effort in seeking a Medicaid waiver marked the first time any state or agency has been so involved with Puerto Rican health authorities to address the issue of Medicare and health in general.

During the visit, the New York delegation met with government and legislative officials and toured various medical and health facilities to see firsthand the critical challenges facing the island’s public health care system.

“We engaged on a three-day fact finding mission to understand more about the barriers and challenges affecting the system and the community,” Hochul said. “This team helped New York when it faced a similar crisis and that’s why we come with a sense of optimism, because although the crisis in Puerto Rico is worse than we imagined, we were on that same scenario in our own state not so long ago.”

Although Puerto Ricans are U.S. citizens and pay the same amount in Medicare and Social Security taxes, residents of the island territory receive half the benefits of citizens in the mainland.

“This alliance with New York is very important for us, in order to achieve parity for Puerto Rico, which is paying the same Medicare tax and Social Security as the rest of the nation but is receiving much lower benefits,” said Ricardo A. Rivera, executive director of the Puerto Rico Health Insurance Administration. “We need to make Congress see that this disparity has to stop.”

The New York delegation, which included state Health Commissioner Howard Zucker, state Medicaid Director Jason Helgerson and Assembly Health Committee chairman Richard Gottfried, visited four institutions that are representative of the Puerto Rican health system. They started with a tour of a Medicare office in the town of Río Piedras and then headed to the Puerto Rican Medical Center, the largest government-owned medical center on the island. They also visited Med Caribe, a primary care medical group, and APS, a mental health clinic, and met with local legislators.

The delegation did not travel outside the metro area, but strengthening facilities in other regions to alleviate the heavy burden on the personnel at the Puerto Rican Medical Center was discussed during the visit.

Zucker said he met with medical staff and resident students to learn about the challenges they’re facing at the Puerto Rico Medical Center, including the exodus of medical staff to the U.S. in search of better work conditions and pay.

“We have to find creative ways to keep the doctors here on the island because it’s critically important if we want to move forward on health care for the people of Puerto Rico,” Zucker said. He added that the system needs to move towards a model of preventive medicine and not only responding when a patient is already ill.

The challenges Puerto Rico is facing with Medicaid are greater than those in any other U.S. jurisdiction, said Helgerson, who heads New York’s Medicaid program.

“That’s not meant as an overstatement, it’s based on my experience as Medicaid director for two different states for more than a decade,” he said. “We need to make smarter investments in the facilities and infrastructure which will produce savings in the long run in terms of energy costs, better work environments and better patient outcomes.”