Medicaid & CHIP in 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 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 Size | Medicaid | ||||
|---|---|---|---|---|---|
| Household Size | 1 | Medicaid | $1,156.00 | ||
| Household Size | 2 | Medicaid | $1,562.00 | ||
| Household Size | 3 | Medicaid | $1,967.00 | ||
| Household Size | 4 | Medicaid | $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.
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 (PDF 216.11 KB) 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.