CHIP in Puerto Rico

Puerto Rico at a glance

Puerto Rico is home to about 88,645 foreign-born residents (2.7% of the state’s 3,254,885 people) and 3,215,824 residents of Hispanic or Latino origin (98.8%), per the U.S. Census Bureau’s American Community Survey (2023 5-year estimates). The procedures below apply to everyone in Puerto Rico regardless of immigration status unless noted.

CHIP covers health insurance for uninsured children from families earning too much for Medicaid but unable to afford private insurance.

How to apply for CHIP in Puerto Rico

Healthcare.gov is not the route here — healthcare.gov says so itself. Its Puerto Rico page reads: “If you live in Puerto Rico, you’re not eligible to use the Marketplace to enroll in health coverage. Check with your territory’s government offices to learn about Medicaid, CHIP, and other health care options” (healthcare.gov/puerto-rico, checked September 9, 2026). The same page says the identical thing about the SHOP Marketplace for employees.

  1. Apply through the Puerto Rico Medicaid Program. CMS names the Puerto Rico Department of Health as the single state agency, working with the Puerto Rico Health Insurance Administration (PRHIA), also known as the Administración de Seguros de Salud (ASES), which runs the government health plan through which Medicaid and CHIP coverage is delivered — ases.pr.gov
  2. One application covers both Medicaid and CHIP — Puerto Rico determines which one your child qualifies for
  3. Puerto Rico’s program sets its own income standards, so do not use a mainland state’s dollar figures

Typical coverage

State CHIP plans cover doctor visits, vaccines, hospitalization, prescriptions and mental health care. Dental is required by federal law — coverage of dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions” (42 U.S.C. 1397cc(c)(6)(A)). Vision and hearing are not required. The statute puts prescription drugs, vision services and hearing services in a separate list of “categories of additional services” (42 U.S.C. 1397cc(c)(2)). Whether your state’s CHIP covers eye exams and glasses is a state benefit choice, not a federal guarantee.

Income limits

Generally 200-300% federal poverty level is the pattern across the states. We do not convert that into a dollar figure for Puerto Rico: the HHS poverty guidelines are published only for the 48 contiguous states and DC, Alaska and Hawaii, so a mainland figure would not apply here. Ask the Puerto Rico Medicaid Program for the current limit.

Costs

CHIP has low co-pays (sometimes $0) and, in states that charge them, low monthly premiums; federal rules cap a family’s total CHIP cost-sharing at 5% of its income over the child’s eligibility period (42 CFR 457.560).

Last verified: 2026-09-24.