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Medicaid & CHIP in Guam

Medicaid Overview

The Medicaid program in Guam differs from Medicaid programs operating in each of the 50 states and the District of Columbia. Some of the key differences are:

  • Guam became a territory in 1950 and its Medicaid program was established in 1975. It is a 100% fee-for-service delivery system with two hospitals currently servicing the territory. Guam elected to expand Medicaid to the Adult Group effective January 1, 2014.  Effective January 1, 2021 Guam elected to cover otherwise eligible individuals who lawfully reside in Guam in accordance with the Compacts of Free Association (COFA) between the US and Micronesia, the Marshall Islands and Palau.
  • Expansion adults are served through an Alternative Benefit Plan, with co-payments for individuals at higher income levels.  There are no deductibles or co-payments for any other populations under the Guam Medicaid program. Unlike states, Guam residents are not eligible for Medicare 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.
  • 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 Guam’s ceiling is $129.7 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 Guam, 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 Guam’s FMAP to 83% for federal fiscal year 2021.

Medicaid-Marketplace Overview

Guam was awarded $24.4 million for its Medicaid program in lieu of establishing a health marketplace. Guam must exhaust its Affordable Care Act (Section 2005) allotment prior to using these funds

Medicaid Standard Monthly Income Eligibility Levels

Household SizeMedicaid
Household Size 1Medicaid $1,156.00
Household Size 2Medicaid $1,562.00
Household Size 3Medicaid $1,967.00
Household Size 4Medicaid $2,373.00
Household Size  Medicaid $406.00 per additional household member

Monthly Medicaid and CHIP Enrollment Data

As of June 2021, 33,537 people were enrolled in the Medicaid and CHIP program in Guam.

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, Guam, 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