Medicaid in Puerto Rico

Medicaid expansion

Puerto Rico CANNOT adopt the ACA Medicaid expansion — the expansion is a state-plan option, and Puerto Rico, as a territory, runs a separate Medicaid program under a capped federal allotment, outside the expansion framework (per KFF tracking, verified July 27, 2026). Income eligibility in Puerto Rico follows the territory’s own standards, not the 138%-of-FPL expansion rule used in the states.

Coverage for undocumented individuals

Emergency Medicaid is available in Puerto Rico regardless of immigration status and includes labor and delivery. Community health centers (FQHCs) serve you regardless of status or ability to pay.

Federal rules applying in Puerto Rico

Regardless of expansion, federal eligibility rules by immigration status apply in Puerto Rico:

  • Citizens: YES qualify
  • Permanent residents (green card) 5+ years: YES qualify
  • Permanent residents < 5 years: NO (5-year bar), EXCEPT children and pregnant women in CHIPRA Option states
  • Refugees, asylees: YES qualify (no 5-year bar)
  • DACA: NO qualify (excluded by current rule)
  • Undocumented individuals: NO qualify federally

Emergency services

Under EMTALA, all hospitals in Puerto Rico must treat medical emergencies regardless of immigration status. Emergency Medicaid may cover the cost of treating an emergency medical condition for people who meet the other Medicaid requirements that apply in Puerto Rico — income, household and state residency — but not the immigration-status requirement (42 U.S.C. 1396b(v)(2); 42 CFR 440.255(c)).

How to apply for Medicaid in Puerto Rico

  1. Visit Puerto Rico’s Medicaid portal (search “Puerto Rico Medicaid” or specific program name)
  2. Fill application online (also available by paper or in person)
  3. Provide: identification, proof of income, proof of residency, immigration documents (if applicable)
  4. Wait for the decision — federal rules set a deadline, not a typical time: the agency must determine eligibility within 45 days, or within 90 days if you applied on the basis of disability (42 CFR 435.912(c)(3)). Those limits may be exceeded only in unusual circumstances, such as a delay by the applicant or an examining physician (42 CFR 435.912(e))
  5. If approved, receive Medicaid card + provider information

Last verified: 2026-07-27.