Medicaid in Puerto Rico
Medicaid is the foundation of Puerto Rico's healthcare system, providing health coverage to approximately 1.3 million residents. MMAPA works to advance sustainable federal policies that strengthen the program, support healthcare providers, and protect access to care for the individuals and families who depend on it.
Sept 30, 2027
Current Medicaid Funding Expires
Congressional action is needed to ensure continued access to care.
Why Medicaid Matters
Medicaid is the primary source of health coverage for nearly half of Puerto Rico's population, including children, older adults, individuals with disabilities, and low-income families.
Beyond providing health insurance, Medicaid supports hospitals, physicians, community health centers, pharmacies, and other healthcare providers serving communities across the Island. As a result, the program plays a vital role not only in improving health outcomes but also in sustaining Puerto Rico's healthcare infrastructure and supporting its economic stability.
How Puerto Rico's Medicaid Program Differs from the States
Unlike the states, Puerto Rico operates under a unique Medicaid financing structure established by federal law. While recent federal investments have strengthened the program, Puerto Rico
continues to face funding limitations, more restrictive eligibility standards, and exclusions from
certain Medicaid benefits available elsewhere in the United States.
Federal Funding
Puerto Rico: Capped
States: Open-ended
Funding Stability
Puerto Rico: Relies on periodic congressional action to secure funding
States: Permanent financing structure
Eligibility
States: Up to 138% FPL
(in expansion states)
Puerto Rico: Up to 100% FPL
Federal Programs
States:
✔ Medicare Savings Programs (MSP)
✔ Supplemental Security Income (SSI)
✔Comprehensive Long-Term
✔Services and Supports (LTSS)
Puerto Rico:
❌ Medicare Savings Programs (MSP)
❌ Supplemental Security Income
❌ Comprehensive Long-Term
❌ Services and Supports (LTSS)
Improved Provider Payments
Recent federal funding has enabled Puerto Rico to increase provider reimbursement rates, helping strengthen and retain the healthcare workforce.
Expanded Eligibility
Medicaid eligibility has been expanded to cover individuals with incomes up to 100% of the Federal Poverty Level (FPL.)
Stronger Primary Care
Additional investments have strengthened primary care services and improved access to preventive care.
Progress Made Through Recent Federal Investment
Recent federal investments have helped strengthen Puerto Rico's Medicaid program demonstrating
that targeted funding can improve access to care and enhance healthcare system stability.
Program Integrity
Puerto Rico has strengthened oversight, accountability, and compliance with federal program integrity requirements.
Healthcare Access
Federal investments have helped preserve access to care for more than one million Medicaid beneficiaries.
Better Care Coordination
Managed care organizations continue to work with providers to improve care quality and patient outcomes.
Opportunities to Strengthen Medicaid
While recent federal investments have strengthened Puerto Rico’s Medicaid program, additional policy improvements would help ensure its long-term sustainability, strengthen healthcare
providers, and expand access to essential services for beneficiaries.
Healthcare needs do not diminish when funding is limited. A capped funding structure that requires periodic congressional action makes it difficult to plan beyond the next funding cycle, limiting Puerto Rico’s ability to make long-term decisions about services, provider capacity, and the healthcare system needed to serve its population.
Long-Term Services and Supports (LTSS)
These services help older adults and individuals with disabilities live as independently as possible by providing assistance with daily activities, home and community-based care, and other longterm supports. Unlike the states, Puerto Rico has limited access to the federal funding available for these services.
Funding Stability
Current federal Medicaid funding is scheduled to expire on September 30, 2027, creating uncertainty for beneficiaries, healthcare providers, and the broader healthcare system.
Medicare Savings Program
These programs help eligible low-income Medicare beneficiaries pay Medicare premiums and certain out-of-pocket healthcare costs. Unlike beneficiaries in the states, eligible residents of Puerto Rico do not have access to these federal programs.
Provider Sustainability
Continued investments are needed to strengthen Puerto Rico's healthcare workforce, support healthcare providers, and improve long-term system stability.
Responsible Stewardship
of Federal Healthcare Resources
Recent federal legislation required Puerto Rico to implement enhanced accountability, transparency, and oversight measures.
Puerto Rico has responded by strengthening procurement processes, provider payment oversight, financial controls, asset-verification systems, and other program integrity initiatives. Recent federal reviews have found Puerto Rico's Medicaid payment error rate to be below federal performance targets, reflecting the Island's ongoing commitment to responsible stewardship of federal healthcare resources and effective management of public funds.
Accountability
Oversight
Compliance
MMAPA Supports:
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A long-term Medicaid financing solution beyond September 30, 2027, that moves Puerto Rico away from a capped funding structure requiring periodic congressional action.
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Stable and predictable federal funding that reflects Puerto Rico’s healthcare needs and supports long-term planning.
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Continued investments that strengthen the healthcare workforce and preserve access to care.
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Policies that maintain strong accountability, program integrity, and responsible stewardship of federal healthcare resources.
Medicaid Timeline
1968
Puerto Rico Joins Medicaid
uerto Rico began participating in the federal Medicaid program, providing health coverage to eligible low-income residents under a financing structure that differs from those used in the states.
2009
MMAPA Is Established
MMAPA was founded to represent Puerto Rico's Medicaid and Medicare Advantage health plans and to advocate for policies that strengthen access to healthcare across the Island.
2010
Affordable Care Act
The Affordable Care Act provided additional Medicaid funding for Puerto Rico but did not change the Island's capped federal financing structure.
2017–2021
Temporary Federal Funding Extensions
Congress approved several temporary funding measures that helped stabilize Puerto Rico's Medicaid program while preserving health coverage for more than one million residents.
2022
Five-Year Federal Funding Framework
Congress approved approximately $19.4 billion in Medicaid funding through September 30, 2027, providing the longest period of funding stability in the program's history.
Sept 30, 2027
Current Funding Expires
The current federal funding framework is scheduled to expire, creating the need for a longterm financing solution that provides stability for beneficiaries,healthcare providers,
and Puerto Rico's healthcare system.
Policy Resources
Explore our latest publications and reference materials to learn more about Puerto Rico's Medicaid program, healthcare landscape, and MMAPA's policy priorities.