Puerto Rico’s Medicaid program has a new opportunity to expand Home and Community-Based Services (HCBS)—services that allow individuals to receive care in their homes or community settings rather than in institutional facilities.

For healthcare providers, insurers, and administrators in Puerto Rico, the One Big Beautiful Bill Act (OBBBA) is reshaping the Medicaid operating environment. While the territory avoids some of the most burdensome mandates imposed on states, the requirements that do apply bring significant compliance costs—without any increase in federal funding.

The One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, introduces significant compliance requirements for Puerto Rico’s Medicaid program. While the territory is exempt from some of the stricter mandates placed on U.S. states, it now faces a new wave of federal obligations that will impact providers, plans, and health systems alike.

Puerto Rico’s access to emergency federal support may be entering a more uncertain period. Rising national debt—projected to increase by as much as $4.1 trillion over the next decade—will likely tighten discretionary budgets and make supplemental aid harder to secure.

For many in Puerto Rico, Nutrition Assistance Program (NAP) benefits are the primary safeguard against food insecurity. Yet when compared to the Supplemental Nutrition Assistance Program (SNAP) available in the states, the disparity is striking—both in benefit amounts and program flexibility.

Puerto Rico’s Nutrition Assistance Program (NAP) serves as a lifeline for hundreds of thousands of households. It’s similar in purpose to the Supplemental Nutrition Assistance Program (SNAP) in the states—but the funding model is very different. Unlike SNAP, which expands based on need, NAP operates under a capped federal block grant.

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