State Medicaid Waiver Directory
Find your state's Katie Beckett waiver, TEFRA pathway, HCBS programs, and Medicaid eligibility rules for children and adults with disabilities. Each guide covers waitlists, application steps, income limits, and parent caregiver pay options.
For informational purposes only — not legal, medical, or financial advice. Medicaid rules, eligibility, and waitlists change frequently. Always verify with your state's official Medicaid agency before making decisions. Cross-check with Medicaid.gov's official waiver page.
Puerto Rico
Program Overview
Overview
Puerto Rico operates its own Medicaid program called Mi Salud (formerly known as the Government Health Plan / La Reforma). Puerto Rico has a capped federal Medicaid funding structure that differs from the 50 states, which affects the scope of available services. Disability services are administered through ASES (Administración de Seguros de Salud) and partner agencies.
Katie Beckett or similar pathway
Puerto Rico does not have a Katie Beckett or TEFRA pathway. Children with disabilities primarily access Medicaid-covered services through Mi Salud managed care enrollment. SSI eligibility is also a key route to Medicaid access.
Child-relevant waivers
Puerto Rico has historically had limited HCBS waiver infrastructure compared to the 50 states due to federal funding caps. Families seeking long-term community-based services should contact ASES and the Puerto Rico Department of Health (Departamento de Salud) to ask about currently available waiver programs.
Eligibility
Who qualifies
Children with disabilities must be enrolled in Mi Salud and meet Medicaid financial eligibility. SSI recipients are automatically eligible. HCBS waiver eligibility may require additional level-of-care criteria.
Financial and income rules
Puerto Rico's Medicaid financial eligibility rules apply. SSI recipients qualify automatically. Federal funding limitations have historically restricted the depth of Puerto Rico's Medicaid program compared to states.
Level of care
Level-of-care requirements vary by program. Institutional level of care or ICF/ID level of care may be required for HCBS waiver enrollment.
Age rules
Mi Salud serves children of all ages. Early intervention services are available for children from birth to age 3 through Puerto Rico's IDEA Part C program.
Getting Started
How to apply
Families can enroll in Mi Salud through ASES. For disability-specific waiver services, contact the Puerto Rico Department of Health or the Administration for Developmental Disabilities (ADFAN).
Documents needed
Medicaid enrollment documents, proof of residency, disability documentation, medical records, and financial eligibility information are typically required.
Waitlist information
Given Puerto Rico's federal funding constraints, waiver program availability can be limited. Families should contact ASES and ADFAN directly to ask about currently available programs and any waitlist status.
Practical next step
Contact ASES to confirm Mi Salud enrollment, and contact ADFAN (Administration for Developmental Disabilities) to ask about available disability services and waiver programs.
Services & Support
Services available
Mi Salud covers physician visits, hospital care, therapies, prescriptions, and other Medicaid-covered services. HCBS waiver services, where available, can include in-home supports, habilitation, respite, and community integration.
Parent caregiver pay
Self-directed care and parent caregiver pay options are more limited in Puerto Rico compared to many states due to federal funding structure. Families should ask ADFAN and ASES directly about any consumer-directed care options currently available.
Mental health and Medicaid coverage
Puerto Rico Medicaid (Mi Salud) covers behavioral health services through managed care organizations. Covered services include outpatient therapy, psychiatric evaluations, medication management, and crisis services. The Puerto Rico Mental Health and Anti-Addiction Services Administration (ASSMCA) oversees public behavioral health. Community mental health centers and outpatient facilities provide most direct services. Children can access mental health services through the EPSDT benefit. ASSMCA also operates prevention and early intervention programs for children and adolescents.
Additional notes
Puerto Rico's Medicaid program operates under a federal block-grant-style capped funding structure, which has historically limited the breadth of services compared to the 50 states. Families navigating disability services in Puerto Rico should contact ASES, ADFAN, and ASSMCA as the primary agencies. Advocacy organizations in Puerto Rico can also help families understand their current rights and available options.
Sources
Community Tips & Experience
Comments reflect the personal experiences and opinions of individual community members only. They do not represent the views, positions, or endorsements of National Disability Resource Project or any of its staff, volunteers, or affiliated members. Always verify information with official agencies and qualified professionals before making decisions.
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