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Medicaid & CHIP in US 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 and CHIP Standard Monthly Income Eligibility Levels as of April 2017.

Eligibility in the USVI differs from eligibility in the states. The U.S. Virgin Islands uses a local poverty level (LPL), rather than the federal poverty level (FPL), to determine eligibility.  Medicaid eligibility and CHIP eligibility is based on Modified adjusted gross income (MAGI). The following table provides a more detailed view of the U.S. Virgin Islands’ MAGI -based eligibility levels, expressed as a percentage of the U.S. Virgin Islands LPL for Medicaid and CHIP eligibility groups:

Household SizeMedicaid
Household Size 1Medicaid $1,305.00
Household Size 2Medicaid $1,757.00
Household Size 3Medicaid $2,209.00
Household Size 4Medicaid $2,661.00

Monthly Medicaid Enrollment Data

As of September 23, 2021, the U.S. Virgin Islands has enrolled 34,158 individuals in in the Medicaid and CHIP program.

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