Medicaid agency: DPHSS
Guam's Medicaid program is run by the Department of Public Health and Social Services (DPHSS), the single state Medicaid agency, through its Bureau of Health Care Financing Administration (BHCFA), which also administers Guam's Medically Indigent Program (MIP). All care is paid fee-for-service: BHCFA enrolls providers, authorizes services and pays claims under its own annual Medicaid and MIP fee schedule, and there are no managed care plans, so CMS's managed care enrollment data has no Guam figures. Coverage runs through three benefit packages with different limits: the Medicaid State Plan, an Alternative Benefit Plan with cost sharing for enrollees above the standard income limit, and MIP, which also runs disease-specific plans for conditions including lytico-bodig, insulin-dependent diabetes, tuberculosis and end-stage renal disease. Federal flexibilities adopted after Super Typhoons Sinlaku and Bavi, including continuous coverage, self-attested eligibility and wider telehealth, ended October 9, 2026, and eligibility redeterminations have resumed. DPHSS gave notice in June 2026 of a State Plan amendment adding doula services from July 1, 2026, and is rewriting its provider manual chapter by chapter, starting with provider enrollment.
Guam has no Medicaid managed care. BHCFA pays enrolled providers directly under the Guam Medicaid and MIP Fee Schedule, which it reissues each year.
Guam has no home and community-based services waiver in operation. In June 2026 DPHSS put out for comment a Section 1915(c) waiver, Kumunidåt Diniseha: Community of Hope, which would be the first Medicaid-funded HCBS waiver in a U.S. territory, offering an assisted living setting, home-based supports, case management and services such as transition assistance and home modifications; comments closed July 31, 2026. The State Plan covers skilled nursing facility care for up to 180 days a fiscal year, home health with a home care referral and prior authorization, and hospice.
Mental health services are a State Plan benefit paid fee-for-service, without limit for members under 21 and up to 20 outpatient sessions for adults, covering individual, group and family therapy, medication management and care coordination. The Alternative Benefit Plan covers outpatient psychiatric care and acute inpatient admissions for mental health or chemical dependency.
Dental care is a fee-for-service benefit. The State Plan covers it, the Alternative Benefit Plan covers it for members under 21 only, and MIP covers members 17 and over with 20 percent coinsurance.
Prescribed drugs are limited to a formulary and a 30-day supply, with prior authorization for non-formulary and brand-name drugs and a $2.50 copay per prescription in the Alternative Benefit Plan and MIP. Guam's Medicaid pharmacy claims run under the U.S. Virgin Islands' pharmacy benefit management agreement, which Guam uses through agreements with the Virgin Islands Department of Human Services. Guam covers drugs under a Section 1115 Alternative Drug Coverage demonstration rather than the Medicaid Drug Rebate Program.
Emergency ambulance transportation is covered. Care not available on Guam is covered off-island with an approved referral and prior authorization, including round-trip economy airfare to the off-island hospital.
DPHSS is procuring a new integrated eligibility and enrollment system for Medicaid, SNAP, TANF and other assistance programs; the request for proposals issued in September 2026 has been under a stay of procurement since October 7, 2026.
9 agency updates tracked for Guam. Available with Pro.
See them with ProGuam's Medicaid program received a national award for its innovative collaboration to modernize its IT systems and operations. The recognition highlights the territory's approach to upgrading its Medicaid infrastructure. The award comes from the National Association of Medicaid Directors. This modernization effort affects how Guam administers its Medicaid program, including managed care oversight, eligibility systems, and operational processes that impact health plans operating in the territory.
1 active waivers tracked for Guam. Available with Pro.
See them with Pro1 active solicitations tracked for Guam. Available with Pro.
See them with ProGuam has no Medicaid managed care contracts: the program is fee-for-service, with providers paid directly by DPHSS's Bureau of Health Care Financing Administration. DPHSS posts no Medicaid vendor contracts.
Guam's legislation is not tracked yet: LegiScan does not cover the Guam Legislature, whose bills are published on its own site (guamlegislature.gov).
Get the daily briefing.