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Puerto Rico Medicaid Contracting and Procurement Oversight

Announced on  | Last Modified on  | Project Number: A-02-24-01002
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The Puerto Rico Medicaid program is a 100-percent managed-care program that provides health services to more than 1 million enrollees. In December 2022, Congress provided the Commonwealth of Puerto Rico additional funding for the program under the Consolidated Appropriations Act, 2023, until FY 2027. The law requires OIG to submit to Congress a report on whether Puerto Rico complied with the law's Medicaid contracting and procurement oversight requirements. We will determine whether Puerto Rico: (1) complied with applicable provisions of the Consolidated Appropriations Act, 2023; and (2) designed, implemented, and effectively operated an internal controls system for Medicaid contracts covered by this law in compliance with Federal procurement standards.

TIMELINE

REPORT PUBLISHED

Puerto Rico Did Not Designate a Medicaid Contracts Oversight Lead in a Timely Manner and Certified Contracts That Were Noncompliant (A-02-24-01002)

25-A-02-017.01 to CMS - Open Unimplemented
Update expected on 05/13/2026
We recommend that the Puerto Rico Health Department (the Health Department) update its policies and procedures to conform to Federal procurement standards—including policies and procedures related to contracts for leases, goods, and nonprofessional services—and to address the role of the Oversight Lead and the certification process.

25-A-02-017.02 to CMS - Open Unimplemented
Update expected on 04/10/2026
We recommend that the Puerto Rico Department of Health (the Health Department) provide training to staff on policies and procedures.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Contracts Financial Stewardship
Target Groups
-
Financial Groups
Medicaid