United States Virgin Islands

Medicaid Overview

The Medicaid program in the United States Virgin Islands differs from Medicaid programs operating in each of the 50 states and the District of Columbia in three important ways.

  • The United States Virgin Islands Medicaid delivery system is a subset of the larger public government healthcare delivery system for most of the island’s population. The United States Virgin Islands Department of Human Services is the single state agency.
  • Through section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. For the period of July 1, 2011 through September 30, 2019, section 2005 of the Affordable Care Act provided an additional $273.8 million in Medicaid funding to the United States Virgin Islands.
  • For the 50 states and the District of Columbia, the federal government will match all Medicaid expenditures at the federal matching assistance percentage (FMAP) rate based on the state’s per capita income. For the United States Virgin Islands, all Medicaid expenditures are matched until the Medicaid base funds and the Affordable Care Act funds are exhausted. The statutory FMAP local matching rate increased from 50%/ 50% to 55% federal /45% local, effective July 1, 2011. From January 1, 2014 to December 31, 2015 there is a temporary 2.2% FMAP increase for all Medicaid enrollees, bringing The United States Virgin Islands’ FMAP to 57.2%.

Medicaid-Marketplace Overview

  • The United States Virgin Islands was awarded $24.9 million for its Medicaid program in lieu of establishing a health marketplace. The United States Virgin Islands must exhaust its Affordable Care Act (section 2005) allotment prior to using these funds.

Medicaid Standard Monthly Income Eligibility Level

Household Size Medicaid
1 $548.40
2 $739.19
3 $929.98
4 $1,120.77
  $191 per additional household member

Monthly Medicaid Enrollment Data

As of July 2015, 18,036 people are enrolled in the Medicaid program in the United States Virgin Islands.

Medicaid Application

Medicaid State Plan Amendments

The state Medicaid and CHIP plans spell out how each state has chosen to design its program within the broad requirements for federal funding. As always, states amend their Medicaid and CHIP state plans in order to inform CMS of programmatic and financing changes and to secure legal authority for those changes. The Affordable Care Act included many new opportunities for states to augment and improve their Medicaid and CHIP programs.  As a result there has been a great deal of state plan amendment (SPA) activity over the past several years in the areas of eligibility, benefits design and financing, as well as new approaches to providing health homes, long-term services and supports, and enrollment strategies like hospital presumptive eligibility. See below for a state-specific list of approved Medicaid SPAs.

Demonstrations and Waivers

Demonstration and waivers are vehicles states can use to test new or existing ways to deliver and pay for healthcare services in Medicaid and CHIP. The primary types of waivers and demonstration projects include section 1115 demonstrations, section 1915(a) and 1915(b) managed care waivers, and section 1915(c) home and community-based services waivers. More information about waivers is available on the Waivers page.

  • There are no waivers operational in The United States Virgin Islands

Medicaid Delivery System

States have choices in their approach to delivery system design under the Medicaid and CHIP programs. States are increasingly moving to the use of managed care and other integrated care models in serving their Medicaid beneficiaries. The United States Virgin Islands Medicaid is 100% fee for service.

CHIP Program Information

The Children’s Health Insurance Program (CHIP) was established in 1997 to provide new coverage opportunities for children up to age 19 in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage. Like Medicaid, CHIP is administered by the states, but is jointly funded by the federal government and states. States had the opportunity to design their CHIP programs as an expansion of Medicaid, as a stand-alone program or through a combined approach.

The United States Virgin Islands uses it’s CHIP funding for Medicaid children after it exhaust the territory’s annual Medicaid funding.