Medicaid Unwinding in Puerto Rico: What You Need to Know If You Lose Coverage

The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times between January 2020 and February 2023.

People who were eligible for Medicaid coverage at the start of the PHE were able to keep their insurance during the pandemic — even if they were no longer eligible. This is because all 50 states, Washington, D.C., and five territories, including Puerto Rico, were mandated to provide continuous coverage during the PHE.

But now the PHE is ending in May 2023, and automatic renewals for Medicaid enrollees stopped nationwide on March 31, 2023. This process is already underway and could cause 5 to 14 million enrollees nationwide to lose coverage.

Promotional Disclosureinfo_outlined

SPECIAL OFFER

Prescription Savings Are Just the Beginning

See what other benefits you qualify for—from cashback cards to cheaper insurance.

Unlock Savings

Puerto Rico has resumed eligibility reviews for Medicaid, which is known as redetermination or recertification. (In Puerto Rico, Medicaid includes coverage for children up to age 19, in lieu of a standalone Children’s Health Insurance Program (CHIP) that operates in many states.). Anyone who no longer qualifies could be disenrolled as early as June 1, 2023.

Here’s what you need to know about Medicaid changes in Puerto Rico, and what to do if you lose your insurance coverage.

Why is Medicaid changing nationwide?

After the PHE ends, COVID-19 will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.

The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories, including Puerto Rico.

What’s happening with Medicaid renewal in Puerto Rico?

The Department of Health (Departamento de Salud) is responsible for overseeing the Puerto Rico Medicaid Program (Programa Medicaid) — also known as the Government Health Plan or Vital. The department has a redetermination plan that outlines how eligibility reviews will be conducted for current enrollees. As of March 2023, before the end of continuous coverage, there were nearly 1.6 million people in Puerto Rico enrolled in Medicaid.

The Puerto Rico Medicaid website is in Spanish. You will have to use your browser to translate if you need to read the site in English or another language.

Read more like this

Explore these related articles, suggested for readers like you.

Medicaid Unwinding in Nevada: What You Need to Know If You Lose Coverage

Medicaid Unwinding in North Dakota: What You Need to Know If You Lose Coverage

Medicaid Unwinding in Oklahoma: What You Need to Know If You Lose Coverage

Medicaid Unwinding in D.C.: What You Need to Know If You Lose Coverage

View more

The Medicaid Program began its recertification process on April 1, 2023. Medicaid enrollees should watch their mail and email for information about the date for their renewal appointment.

It is important that Puerto Rico’s Medicaid program has current contact information for enrollees. When you visit the Department of Health site, a pop-up notes that a large number of mailings have been returned to the department because of incorrect addresses. It says that if you have not received a notice from Medicaid in the past year, you should contact the department to update your:

• Phone number

• Mailing address

• Email address

You can confirm or update your information by:

• Logging in to your account on the citizen portal

• Calling the department’s call center at 787-641-4224 from 8AM to 6PM, Monday through Friday

• For people with hearing impairment, using TTY/TDD at 787-625-6955 from 8AM to 6PM, Monday through Friday

You can complete and submit your recertification application:

• Through the citizen portal

• By mail

• By taking it to a local Medicaid office

• By making an appointment through the call center at 787-641-4224 for an in-person interview

You will need these documents to renew your Medicaid:

• Photo identification

• Proof of address

• Proof of U.S. citizenship or legal permanent residency

• Social Security number for each person in your household

• Proof of age

• Proof of income for the current month and the previous two months

• Proof of other resources, such as savings

• Proof of insurance or medical plan other than Medicaid for any household member

You may also be required to submit additional information or documentation.

If you need to reach the Puerto Rico Medicaid Program by phone, call 787-641-4224.

Tribal health and Medicaid unwinding 

State liaisons are reaching out to people who are enrolled in Medicaid and who are also members of or affiliated with Native American tribes. The National Indian Health Board estimates that as many as 236,000 American Indians and Alaska Natives (AI/AN) nationwide could lose coverage during the unwinding process.

What should I do if I lose my Medicaid coverage in Puerto Rico?

In order to receive Medicaid in Puerto Rico, you must meet all of the following criteria:

• You must be a Puerto Rico resident.

• You must be a U.S. citizen, permanent resident, or legal resident.

• You must need assistance with access to healthcare or insurance coverage.

• Your annual household income before taxes must be below the limit for your household size.

In Puerto Rico, you may also qualify for reasons other than income, including if you are:

• Pregnant

• A child or teenager

• Responsible for the care of a child who is 18 years old or younger

• Blind

• 65 years old or older (and meet certain criteria)

• A person with a disability, or you have a person in your household who has a qualifying disability

If you no longer qualify or the Medicaid Program can’t reach you, you won’t be able to use your benefits, which could leave you temporarily uninsured.

If you lose your coverage but believe you still qualify, you can reapply for Medicaid. You may be uninsured for a while until you’re approved for coverage again.

If you live in Puerto Rico, you are not eligible to use the Affordable Care Act (ACA) marketplace to find healthcare coverage. That’s because the island government received $925 million for its Medicaid program instead of establishing an ACA marketplace.

You may be able to use GoodRx coupons to save on your prescription medications. In addition, you may be able to enroll in an alternative health insurance plan such as:

• Employer plan: You could qualify for employer-sponsored healthcare if you have a job that offers health insurance benefits.

• Medicare: If you have a qualifying disability or condition — such as end-stage renal disease or ALS (amyotrophic lateral sclerosis), commonly referred to as Lou Gehrig’s disease — you can enroll in Medicare at any age.

• Partner’s plan: If you have a spouse or domestic partner who has insurance, you may be able to join their plan during an open enrollment or special enrollment period.

• Special plans: Short-term insurance can be a great choice if you anticipate a better option, like job-based health insurance, to be available soon. You may also consider alternative and limited-benefit plans, such as fixed indemnity, accident, cost-sharing, and catastrophic insurance plans.

• Student health plan: If you’re enrolled in a college or university, you may be eligible for a campus health plan.

• U.S. Department of Veterans Affairs (VA): If you are an active-duty service member or a veteran, you may qualify for TRICARE coverage or VA benefits and services.

If you choose not to reapply for Medicaid coverage, or if you’re no longer eligible, you may qualify for other low-cost or free healthcare alternatives. The Department of Health offers these options:

• Federally qualified health centers (FQHCs), which provide primary healthcare

• Mammography and pap smear screening for women through the National Breast and Cervical Cancer Early Detection Program

• HIV/AIDS services through the Department of Health’s Ryan White program

Puerto Rico Medicaid resources

Here are some resources to help you learn more about Medicaid in Puerto Rico and upcoming changes related to the end of the public health emergency:

• Puerto Rico Medicaid office: The Department of Health oversees and administers the Puerto Rico Medicaid Program (Programa Medicaid) — also known as the Government Health Plan or Vital.

• Puerto Rico Medicaid self-service portal: You can visit the citizen portal to access your account online 24/7 and to confirm or update your contact information.

• Puerto Rico Medicaid office phone assistance: You can reach the Medicaid Program’s call center at 787-641-4224.

Why trust our experts?

Written by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

Our editorial standards

Meet our experts