Territory Operations Survey

The National Association of Medicaid Directors (NAMD) serves Medicaid Directors from all 50 states, the District of Columbia, and the five U.S. territories: American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands. Each year, NAMD administers its Operations Survey to Medicaid Directors in the 50 states and District of Columbia, and presents the information collected in an annual Operations Survey Report.

For the first time, NAMD administered a new, territory-specific survey to the five U.S. territories for FY 2018. This survey is NAMD’s first attempt to help elevate awareness and appreciation of the unique nature of the territories’ programs as well as the unique financial challenges they face. Just as the U.S. territories’ Medicaid programs differ from that of the states, they also differ drastically from each other, especially in population size, and therefore also in the number of beneficiaries.

Additionally, the territories have distinct standards and processes for determining eligibility. Guam, Puerto Rico and the US Virgin Islands are permitted to use the local poverty level to establish income-based eligibility for Medicaid, and are exempt from statutory requirements to provide poverty related eligibility to children and pregnant women, as well as qualified Medicare beneficiaries. CNMI uses the income and resource requirements for the federal Supplemental Security Income (SSI) program to automatically qualify people for Medicaid. In American Samoa, Medicaid pays for care provided at a specified medical center in proportion to the number of residents with incomes below Medicaid income eligibility standards. For that reason, eligibility is not individually determined. There are also differences in what benefits are provided, the structure of delivery systems, and much more.

Download the full report above.