GOVERMENT OF PUERTO RICO Department of Health - PR 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the date at the top of the form. This is essential for record-keeping.
  3. In the 'Nombre de la Compañía' section, input the name of the company employing the individual seeking Medicaid benefits.
  4. Fill out the employee's work status by selecting either 'Tiempo Completo' or 'Tiempo Parcial'.
  5. Provide details about total weekly hours worked and the employee's position within the company.
  6. Indicate how long the employee has been with your company, as this information is crucial for eligibility assessment.
  7. Complete the income section by detailing current and past monthly earnings, including gross salary, tips, bonuses, and commissions.
  8. Finally, ensure that all fields are filled accurately before signing and dating at the bottom of the form.

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In Puerto Rico, the allotments are set in statute through FY 2027, and the FMAP was increased to 76% and set to expire after FY 2027 and return to 55% without legislative action.
Puerto Rico is 100% managed care. Beneficiaries do not have a choice of managed care plans. The beneficiaries have the option to enroll into any of the four managed care plans contracted to provide medical services island wide.
The Puerto Rican Medicaid program is a unique health care program that provides services for approximately half of Puerto Ricos 3.2 million population. The Commonwealth of Puerto Rico is the chief provider of health services for the indigent population, principally through the Medicaid program.
MENTAL HEALTH, ALCOHOL AND DRUG ABUSE SERVICES Plan Vital offers mental health, alcohol and substances abuse services. You do not have to see your PCP first to see a doctor or other provider for mental health, alcohol, or substances abuse services. You can ask for these services whenever you feel like you need them.
Healthcare and Facilities The public institutions of the health sector in Puerto Rico are part of the umbrella Department of Health.

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Jenniffer Gonz-Coln Puerto Rico / Governor
It was once called La Reforma, later it was called Mi Salud and now called Vital (The Vital Plan) but they are all Medicaid, a government-run program which provides medical and healthcare services to indigent and impoverished citizens of Puerto Rico.
The governor of Puerto Rico (Spanish: gobernador de Puerto Rico) is the head of government of the Commonwealth of Puerto Rico, and commander-in-chief of the Puerto Rico National Guard. Currently, Jenniffer Gonz-Coln is serving as the 190th governor of the archipelago and island.

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