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Medicaid & CHIP in Northern Mariana Islands

Medicaid Overview

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.

Medicaid-Marketplace Overview

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.

Core Set Data

CMS developed the Medicaid and Children’s Health Insurance Program (CHIP) Core Set Data Dashboard to improve accessibility of data about the quality of care provided to Medicaid and CHIP beneficiaries. CMS encourages users to explore Core Set Data to examine performance across states and to inspire and inform efforts to improve the quality of care provided to Medicaid and CHIP beneficiaries.

Starting with the 2024 Core Set, reporting of the Child Core Set and the behavioral health measures on the Adult Core Set is mandatory for states. The term “states” in this context refers to the 50 states, the District of Columbia, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. More information on mandatory Core Set reporting requirements is available in 42 CFR Parts 433, 437, and 457, and the Initial Core Set Mandatory Reporting Guidance State Health Official Letter.

The Child and Adult Core Sets assist CMS, states, and the public in understanding and monitoring access and quality of health care provided to individuals enrolled in Medicaid and CHIP. The Core Sets include measures of health care quality across the lifespan and domains of care.

CMS reports state performance on the Child and Adult Core Set measures annually. The Core Set Data Dashboard shows detailed information, including state-specific performance and national medians, on each measure that was reported by at least 25 states and met CMS’s standards for data quality for the reporting year. Data include measures reported by states and on behalf of states.

Territory Allotment