Medicaid agency: DHS
The U.S. Virgin Islands' Medicaid program, the Medical Assistance Program, is run by the Department of Human Services (DHS) through its Office of Medicaid and pays all care fee-for-service; there are no managed care plans, so CMS's managed care enrollment data has no Virgin Islands figures. The federal government pays 83 percent of program costs and the territory 17 percent, a permanent match set by Congress that let DHS add services and enroll more members. Coverage includes the State Plan and an Alternative Benefit Plan, disability-based eligibility follows a DHS definition of permanent and total disability issued in January 2026, and DHS ties many physician payments to the Virgin Islands Medicare fee schedule. DHS is writing down its program policy in 2026, issuing provider manuals for general information, provider enrollment, physician services, applied behavior analysis and dental for 30-day public comment, and has given notice of State Plan and Alternative Benefit Plan amendments adding a rural health clinic benefit and capping adult dental services.
The Virgin Islands has no Medicaid managed care. DHS pays enrolled providers directly, with Gainwell Technologies processing claims and handling provider enrollment. Since December 1, 2025, on-island physicians have been paid for interventional cardiology at the Virgin Islands Medicare fee schedule's global non-facility rate, and DHS has proposed a rural health clinic benefit, estimated at about $11.1 million a year, to take effect once CMS approves it.
The Virgin Islands operates no Section 1915(c) home and community-based services waiver. Personal care attendant services and hospice are State Plan benefits.
Applied behavior analysis is covered for members under 21 with an autism spectrum disorder diagnosis made before age 8, referred through an EPSDT screening and subject to prior authorization, under a provider manual first issued for comment in January 2026. A General Information manual covering prior authorization, appeals, program integrity and telehealth applies to all services, behavioral health included.
Dental care is a fee-for-service benefit governed by a dental provider manual issued for comment in September 2026. DHS has given notice of a State Plan amendment setting an annual limit of $3,500 per member for adults 21 and older from January 1, 2027, with preventive and emergency dental services and dentures exempt.
The Virgin Islands covers drugs under a Section 1115 Alternative Drug Coverage demonstration that keeps its fee-for-service drug program in place of the Medicaid Drug Rebate Program, and a pharmacy benefit manager processes claims under a DHS agreement that Guam also uses. Since October 1, 2026, contraceptives are dispensed only through designated Family Planning Clinics on St. Croix and St. Thomas, with prior authorization required to dispense those drugs elsewhere for other indications.
Gainwell Technologies operates the Virgin Islands Medicaid Management Information System (VIMMIS) and its provider portal, and since March 2, 2026 also runs provider enrollment, screening and revalidation through the portal's online Provider Enrollment Application.
13 agency updates tracked for U.S. Virgin Islands. Available with Pro.
See them with ProNo national stories tagged to U.S. Virgin Islands yet.
1 active waivers tracked for U.S. Virgin Islands. Available with Pro.
See them with ProDHS has no Medicaid procurement page. Territory-wide solicitations are listed by the Division of Property and Procurement (dpp.vi.gov), which showed no open Medicaid solicitation when checked on October 9, 2026; it is not tracked here.
21 Medicaid vendor and interagency contracts tracked for U.S. Virgin Islands. Available with Pro.
See them with ProThe Virgin Islands' legislation is not tracked yet: LegiScan does not cover the Legislature of the Virgin Islands, whose bills are published on its bill tracker (billtracking.legvi.org).
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