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Federal Gov’t Approves New Healthcare Model for Puerto Rico

Federal Gov’t Approves New Healthcare Model for Puerto Rico

San Juan, Puerto Rico – Puerto Rico Governor Ricardo Rosselló announced that the Center for Medicare and Medicaid (CMS) approved Puerto Rico’s newly established publicly-funded health insurance model, known as Vital, which currently provides essential medical coverage to over a million citizens in this United States territory.

"We are grateful to the federal government for approving Puerto Rico’s health insurance model. Our patients now have the right to decide which insurer and which health providers respond best to their needs," said Governor Rosselló.

Puerto Rico’s Vital plan provides medical coverage to those that cannot afford traditional medical plans while allowing patients to choose their preferred insurance company and healthcare providers.

The new model allows patients to choose between five insurers and their health providers such as doctors, laboratories, therapists and hospitals, among others. In addition, each insurer must have a network of services throughout Puerto Rico to allow greater mobility and freedom of choice for patients.

Rosselló added that "patients have until January 31 of this year to request any change of insurer and thus be able to use another provider network. At present, over 450,000 patients have opted to change their insurer.”

The president of the Board of Directors of Puerto Rico’s Health Insurance Administration (ASES) and secretary of the Department of Health, Rafael Rodríguez Mercado, said that "this approval demonstrates the professional and correct work we have done for the benefit of our patients that today have over 5,000 providers in Vital."

Meanwhile, the executive director of ASES, Angela Avila, said that "we are extremely pleased with the decision of CMS regarding the Vital plan. It allows us immediate access to the federal funds allocated by Congress retroactively to November 1, 2018. "

Ávila added that "this decision should end any uncertainty that some sectors tried to raise. Vital is here to stay and will give our patients more rights."

The approval by CMS is given pending a process that includes demonstrating compliance with existing regulations.

Avila thanked the CMS officers for their support and the commitment shown to Puerto Rico during the Vital approval process and the changes it brings for the benefit of patients.

Recently, CMS also certified Puerto Rico’s compliance with the provisions of the federal Bipartisan Budget Act of 2018 (BBA) related to the successful implementation of the statistics system of Medicaid (Transformed

Medicaid Statistical Information System or T-MSIS) as part of the MMIS system and the Medicaid

Fraud Control Unit (MFCU) through a report to the U.S. Congress.

Signed into law in February by the president of the United States, Donald J. Trump, the BBA allows access to $1,200 million additional to the $3,600 million in emergency Medicaid funds allocated to the Island to mitigate the impact of Hurricane Maria.