Presumptive Eligibility for Medicaid in NMI is 24K individuals

If no local match if found, CNMI Medicaid Agency may be left with 2 options: End presumptive eligibility program or run into deficit

The estimated Presumptive Eligibility for Medicaid for the entire CNMI is 24,000 individuals but the CNMI Medicaid Agency may have no option but to end the program if there is no local match.

Speaking at a House of Representatives Health and Welfare Committee’s meeting in the House chamber Thursday, acting director for the CNMI Medicaid Agency Vicenta Borja disclosed that if the CNMI does not get the local match and is unable to reimburse providers for these services, she will have to make the hard decision of ending the Presumptive Eligibility program.

She said there is no other option: It’s either end the program or run into a deficit.

Presumptive Eligibility is an expedited process of enrolling eligible residents in the CNMI Medicaid program. It allows patients to have their care covered while waiting for their application to be fully processed.

The Presumptive Eligibility Medicaid program was established pursuant to the National Public Health Emergency put in place due to COVID-19. It has been extended another three months, or until this October.

It was Health and Welfare Committee chair Rep. Christina E. Sablan (D-Saipan) who asked Borja to elaborate on the possibility that Medicaid may have to cut Presumptive Eligibility even before the public health emergency is over. Sablan also requested some updates on Presumptive Eligibility enrollment.

Borja said that prior to Presumptive Eligibility, the rough estimate for regular Medicaid was 14,000.

Borja agreed with Sablan that they are looking at potentially 10,000 people being removed from the roll if they’re found to be ineligible.

Sablan said that would just compound the burden on the Commonwealth Health Center because it would be uncompensated care for those 10,000 people who may lose services.

Sablan said this is a very sobering information and echoed Rep. Sheila Babauta’s (D-Saipan) statement that this is very alarming. She underscored the need to continue the discussion on how to find the $5 millio local match that Medicaid needs before the end of this fiscal year and also how to ensure that Medicaid is adequately funded for the next fiscal year.

Borja stated that if there is no available $5 million local match for Medicaid’s federal allotments for fiscal year 2023, the CNMI must return $28 million in available funds.

Ferdie De La Torre | Reporter
Ferdie Ponce de la Torre is a senior reporter of Saipan Tribune. He has a bachelor’s degree in journalism and has covered all news beats in the CNMI. He is a recipient of the CNMI Supreme Court Justice Award. Contact him at

Related Posts

Disclaimer: Comments are moderated. They will not appear immediately or even on the same day. Comments should be related to the topic. Off-topic comments would be deleted. Profanities are not allowed. Comments that are potentially libelous, inflammatory, or slanderous would be deleted.