Commonwealth Medicaid Agency

The CNMI Medicaid Program is a Federal-State partnership, administered by the State and funded through both Federal and State revenues. Established in 1979, the program was created under Title XIX of the Social Security Act in 1965. The Federal government oversees funding, eligibility standards, quality control, and the scope of medical services. In 1989, the CNMI received a waiver that made eligibility based solely on income and resources, leading to the creation of the Medical Assistance for the Needy (MAN) Program.

In 2020, Public Law (PL) 21-28 established the Commonwealth Medicaid Agency (CMA) as an independent agency under the Office of the Governor. This law mandates the CMA to implement Medicaid Enterprise Systems (MES) modules, including a Medicaid Management Information System (MMIS), a medical claims and clinical data warehouse, and a community health record system to provide patients with access to their health information. Additionally, PL 21-28 requires the CMA to establish a Medicaid Fraud Control Unit (MFCU) and submit data to the Transformed Medicaid Statistical Information System (T-MSIS).