Opportunities and Deadlines: A Chance to Expand Services—If Funding Allows

Astra
Oct 7
2 min read

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. The expansion could strengthen long-term care options, improve patient outcomes, and create new roles for providers and community partners.

These Opportunities and Deadlines are especially important now: while the One Big Beautiful Bill Act (OBBBA), created a more flexible Section 1915(c) waiver pathway for territories, Puerto Rico must act quickly to seize the benefits. Building on existing work under the Money Follows the Person (MFP) Rebalancing Demonstration, leaders can transition more individuals from institutional care into community living.

Opportunities and Deadlines: Why Timing Matters

For patients – More dignity, independence, and personalized care options (HCBS Benefits – Medicaid.gov )
For providers – Expanded service lines and growth potential (Section 1915(c) Waivers)
For communities – Local job creation in home health, personal care, and support services (Bureau of Labor Statistics: Home Health Employment Outlook)

A Firm Deadline

To qualify for enhanced Federal Medical Assistance Percentage (FMAP) funding, Puerto Rico must launch HCBS expenditures by January 1, 2026. The additional federal match is temporary—missing this deadline means losing the financial boost, which could make expansion much harder under the territory’s capped Medicaid budget.

Challenges to Overcome

Funding within capped allotment – Learn more about Puerto Rico’s Medicaid block grant structure
Operational readiness – Requires workforce, infrastructure, and quality oversight systems
Sustainability – Must plan for long-term viability once temporary FMAP support ends

Next Steps for Healthcare Leaders

Assess readiness – Identify services that can be launched quickly
Build partnerships – Collaborate with community providers and stakeholders
Integrate strategically – Ensure HCBS expansion aligns with broader Medicaid and long-term care priorities
Plan backward from the deadline – Map milestones to ensure readiness by January 1, 2026

Strategic Insight

OBBBA’s HCBS expansion pathway is a rare opportunity in a challenging policy environment. Success will depend on swift action, coordinated planning, and disciplined resource allocation—but the payoff could be transformative for patients and providers alike.

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