Guam

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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 one hospital currently servicing the territory. There are no deductibles or co-payments under the Guam Medicaid program. Guam’s Medicaid program does not administer a Medicare Part D Plan; 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-eligibles.
  • 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 $268,343,113 in Medicaid funding to Guam.
  • 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 the Affordable Care Act available 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 Guam’s FMAP to 57.2%.

Medicaid-Marketplace Overview

Guam was awarded $24,436,001 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 Size Medicaid
1 $775.00
2 $1,049.00
3 $1,323.00
4 $1,596.00
  $274.00 per additional household member

Monthly Medicaid and CHIP Enrollment Data

As of January 2015, 38,482 people are enrolled in the Medicaid and CHIP program in Guam.

Medicaid and CHIP Applications

  • Currently, Guam 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, Guam has no demonstrations 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, Guam is 100% fee-for-service (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 as an expansion of Medicaid, as a stand-alone program or through a combined approach. 

Guam has elected to operate a title XXI funded Medicaid Expansion program.