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The Medicaid program in the Commonwealth of the Northern Mariana Islands (CNMI) differs from Medicaid programs operating in each of the 50 states and the District of Columbia. Some of the key differences are:
- CNMI became a territory in 1978 and its Medicaid program was established in 1979. It is a 100% fee-for-service delivery system with one hospital servicing the territory. There are no deductibles or co-payments under the CNMI Medicaid program. Unlike states, CNMI residents are not eligible for Medicaid Part D low-income subsidies; instead the Medicaid program receives an additional grant through the Enhanced Allotment Plan (EAP) which must be utilized solely for the distribution of Part D medications to dual-eligible or low-income Medicare eligible individuals.
- CNMI operates its Medicaid program under a broad waiver granted under the authority of Section 1902(j) of the Social Security Act. This provision allows the Secretary to waive or modify any requirement of Title XIX, in regards to CNMI’s Medicaid program, with the exception of three: the territory must adhere to the funding cap set under Section 1108 of the Act; the territory must adhere to the statutory Federal Medical Assistance Percentage (FMAP); Federal medical assistance payments may only be made for amounts expended for care and services described in a numbered paragraph of section 1905(a).
- Effective October 1, 2017 CNMI elected to allow individuals whose income is in excess of the established income criteria to spend-down to become Medicaid-eligible. Additionally, effective January 1, 2021 CNMI elected to cover otherwise eligible individuals who lawfully reside in CNMI in accordance with the Compacts of Free Association (COFA) between the US and Micronesia, the Marshall Islands and Palau.
- Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. Over the past decade Congress has temporarily increased federal funding for the territories’ Medicaid Programs via a number of specific statutory provisions. For federal fiscal year 2021 CNMI’s ceiling is $62.3 million.
- Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage (FMAP) rate for that state, in CNMI the FMAP is applied until the Medicaid ceiling funds and any other specified federal funds are exhausted. The statutory FMAP rate increased to 55%, effective July 1, 2011. Starting in January 2014 Congress has temporarily increased the FMAP along with federal funding, bringing CNMI’s FMAP to 83% for federal fiscal year 2021.
CNMI was awarded $9.1 million for its Medicaid program in lieu of establishing a health marketplace. CNMI exhausted these funds as of March 2019.
Medicaid and CHIP Standard Monthly Income Eligibility Levels
Medicaid operates differently in CNMI than in the states. The territory is the only U.S. jurisdiction to participate in the Supplemental Security Income (SSI) program and Medicaid eligibility is based on SSI requirements. All individuals receiving SSI cash payments are eligible for Medicaid simply by filing an application. CNMI Medicaid also covers anyone else who meets or can spend-down to meet 150% of the income and resource standards for SSI, with the standard exemptions and deductions. CNMI does pay Medicare premiums (i.e., buy-in) for dually eligible individuals. CNMI does not have a TANF program.
Monthly Medicaid and CHIP Enrollment Data
As of June 2021, 16,868 people are enrolled in the Medicaid and CHIP program in CNMI.
Medicaid and CHIP Applications
- Currently, CNMI has no online Medicaid/CHIP application
Medicaid and CHIP 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 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 and CHIP SPAs.
Demonstrations and Waivers
Demonstration and waivers are vehicles states can use to test new or existing ways to deliver and pay for health care 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.
- Currently, CNMI has no demonstration projects or waivers.
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. At this time, CNMI is 100% fee-for-services (FFS) and does not offer managed care services to its beneficiaries.
CHIP Program Information
The Children’s Health Insurance Program was established in 1997 to provide new coverage opportunities for children 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 (PDF 216.11 KB) as an expansion of Medicaid, as a stand-alone program or through a combined approach.
CNMI has elected to operate a title XXI funded Medicaid Expansion program.
- Letter to Medicaid Agency of CNMI (PDF, 148.52 KB)