US Territories

Medicaid in the U.S. Territories: Free Companion Guide

This guide provides a clear, accessible overview of how Medicaid works in the five U.S. territories — American Samoa, Guam, Puerto Rico, the U.S. Virgin Islands, and the Commonwealth of the Northern Mariana Islands (CNMI).

It explains key concepts like the Federal Medical Assistance Percentage (FMAP), the federal funding cap (Section 1108), and major changes under the Consolidated Appropriations Act of 2023 (CAA 2023). Each territory’s Medicaid program is profiled, highlighting unique challenges, delivery systems (fee-for-service vs. managed care), and future outlooks.

Special sections include:

• FMAP & funding caps explained in plain language
• Territory-by-territory management models (government-run vs. Puerto Rico’s managed care)
• A comparative table of all territories
• A flow chart for visual learners

This guide complements the State Medicaid Bundles by ensuring that the territories are not forgotten, offering a complete picture of Medicaid across all U.S. jurisdictions.