Yes, Puerto Rico has Medicaid. The program operates differently than in the 50 states, but it covers a large share of the island’s population through a managed care system called Plan Vital. Residents who meet income requirements can enroll and receive coverage for hospital care, primary care, prescriptions, dental, behavioral health, and more.
How Puerto Rico’s Medicaid Works
Puerto Rico has run its Medicaid program through managed care since 1994. The program has gone through several name changes over the years: Reforma, then Mi Salud in 2010, the Government Health Program in 2015, and finally Plan Vital starting November 1, 2018. The program is managed by ASES, Puerto Rico’s health insurance administration, which contracts with private managed care organizations to deliver services.
When you enroll, you’re assigned to a managed care plan that coordinates your care. Covered services include inpatient hospital stays, primary care and outpatient visits, pharmacy benefits, outpatient behavioral health, dental care, and medical transportation.
Income Limits for Eligibility
Puerto Rico sets its own income thresholds for Medicaid. For the period starting April 2026, the monthly income limits are:
- 1 person: $1,835
- 2 people: $2,489
- 3 people: $3,142
- 4 people: $3,795
These limits are notably more generous than they were a decade ago, reflecting recent federal legislation that expanded funding to the territories. Puerto Rico is also required to implement an asset verification program by January 1, 2026, which will add a step to the eligibility process for certain applicants.
The Funding Gap With the States
This is where Puerto Rico’s Medicaid diverges sharply from what the 50 states receive. Two structural differences define the program’s limitations.
First, federal Medicaid funding for Puerto Rico is capped. The island receives an annual ceiling on federal dollars, known as the Section 1108 allotment. States, by contrast, get open-ended federal matching: however much they spend on Medicaid, the federal government covers a fixed percentage with no upper limit. Puerto Rico can and does hit its ceiling, which forces the territorial government to either cover the gap with its own revenue or cut benefits and eligibility.
Second, the federal matching rate is lower. For states, the federal government covers anywhere from 50% to about 77% of Medicaid costs, based on each state’s per capita income. Puerto Rico’s base rate is set by statute at just 55%. Congress has temporarily raised this to 76% through legislation that runs through September 2027, but that increase is not permanent. If it expires without renewal, Puerto Rico’s matching rate drops back to 55%, which would create a massive budget shortfall for the program.
Policy experts at MACPAC, the federal commission that advises Congress on Medicaid, have repeatedly flagged this disparity. They’ve outlined proposals that would treat territories more like states by providing open-ended financing with matching rates calculated the same way. None of those proposals have become law yet.
Coverage for Seniors on Medicare
Low-income seniors and people with disabilities in Puerto Rico who qualify for both Medicare and Medicaid have an additional option. Since 2006, a program called Medicare Platino has offered voluntary enrollment in a Medicare Advantage plan that bundles standard Medicare benefits with Medicaid wraparound services. This means participants get their hospital, primary care, pharmacy, behavioral health, dental, and transportation benefits coordinated through a single plan rather than navigating two separate systems.
Enrollment in Medicare Platino is voluntary. Dual-eligible residents who prefer to keep their Medicare and Medicaid benefits separate can do so.
How to Apply
Applications for Plan Vital are handled through ASES, Puerto Rico’s health insurance administration. You can apply at local ASES offices across the island. You’ll generally need proof of identity, residency in Puerto Rico, and documentation of household income. The process is similar in structure to Medicaid applications on the mainland, though Puerto Rico does not use the HealthCare.gov marketplace. If you’re already receiving other public assistance, your information may be used to streamline eligibility determination.