The Commonwealth Medicaid Agency reported significant gains in healthcare coverage, federal funding and operational modernization during fiscal year 2026, highlighting its role as one of the CNMI's largest healthcare safety-net programs.
According to the CMA’s report, the agency served 23,690 active Medicaid beneficiaries during the reporting period, representing about 50% of the CNMI's population based on the 2020 U.S. Census and nearly 54% of the territory's estimated 2026 population.
The report said enrollment included individuals who maintained coverage through continuity-of-coverage provisions tied to public health emergency declarations following Super Typhoons Sinlaku and Bavi. The agency described Medicaid as a critical healthcare safety net that supports more than half of the Commonwealth's residents.
Among the year's major accomplishments was the approval of four disaster-relief state plan amendments by the Centers for Medicare and Medicaid Services. The amendments support disaster-related healthcare coverage, behavioral health services and provider reimbursement. The agency also reported that federal legislation authorized an additional $21.4 million for FY 2026 Medicaid expenditures.
The report highlighted several modernization efforts, including CMS approval of the agency's FY 2026 Advance Planning Document and continued development of Medicaid information technology systems. CMA also established electronic provider enrollment portals, digitized workflow processes and upgraded office internet infrastructure from DSL to fiber service. Agency officials reported no network outages following relocation to a new facility.
Provider participation also expanded during the fiscal year. The agency approved 57 provider enrollment applications from the CNMI, Guam and the U.S. mainland, while continuing the use of letters of agreement to facilitate off-island specialty care unavailable locally. CMA processed 203 of 213 requests involving such agreements.
In its financial report, the agency reported a FY 2026 approved budget of nearly $67 million for Medical Assistance Payments and total reimbursement costs of approximately $89.7 million. On-island reimbursement expenditures totaled about $72.3 million, while off-island reimbursements amounted to roughly $17.4 million.
The agency also emphasized workforce development, reporting 18 new hires, three workforce program conversions to permanent agency positions and continued employee training initiatives. Total staffing increased from 40 to 41 employees.
Looking ahead, CMA said its priorities include implementing a new eligibility and enrollment system, expanding healthcare access through a proposed state plan amendment addressing coverage for foreign healthcare providers, pursuing a potential Section 1115 Medicaid demonstration waiver and strengthening provider compliance oversight. The agency also plans to continue exploring additional federal funding opportunities and improvements to behavioral health services.
Agency Director George J. Cruz said the agency remained focused on accountability, transparency and operational improvements while ensuring continued access to healthcare services for eligible residents throughout the Commonwealth.
