Medicaid demande 769,2 Md$ au niveau national ; Porto Rico reste sous plafond

The FY 2026 CMS Congressional Justification —Estimates for Appropriations Committees— is the budget request of the Centers for Medicare & Medicaid Services to Congress. The date of this note is September 16, 2026; the byline is the institutional PDF on cms.gov. It does not have a “check to ASES” on the cover, but it sets the ocean of Grants to States for Medicaid within which Puerto Rico navigates under different rules (chapter 1108, statutory FMAP).

CMS requests $769.2 billion for Grants to States (Medicaid) in FY2026, $57.5 billion above the FY2025 level, composed of $508.1 billion for FY2026 and $261.1 billion in advance appropriation from FY2025. With offsetting collections from the SMI Trust Fund and Medicare Part D, it estimates $770.9 billion in gross obligations for FY2026: mostly medical assistance benefits, plus administration (survey/certification, Medicaid fraud control units) and Vaccines for Children via CDC. In the CJ table, Grants to States (Medicaid) appears as $769,212.611 million in the President’s Budget FY2026 compared to $711,733.765 million in the FY2025 comparable level.

Payments to the Health Care Trust Funds: request of $593,817.0 million (+$32,802.0 million vs FY2025 estimate), to make whole the SMI and HI Trust Funds for costs chargeable to the General Fund —including Part D general revenue and HCFAC. The total CMS justification moves around $1.367 trillion ($1,367,435.002 million) in the budget table of the document. These are national magnitudes; Puerto Rico is a fraction under capped funding, not an open-ended draw.

That is why you have to read the CJ together with CRS IF11012 and bills like H.R. 6494. Under current law described by CRS, Puerto Rico has annual federal capped funding set in statute for FY2023–FY2027 and a significant cliff in FY2028; temporary FMAP 76% until September 30, 2027, then gradually down to 55%; possible add-ons of $300 million/year for physician payment floor (75% Medicare Part B) and $75 million/year for program integrity leads in FY2026–FY2027 if HHS certifies. The CMS CJ does not erase that territorial framework: it budgets the entire federal program.

The document also mentions Puerto Rico in quality and program operations metrics—participation in measure reporting alongside states, DC, Guam, and USVI; data repositories accessible by PR; and the fact that CMS manages programs primarily through contractors, with site visits to states and territories. That speaks of compliance and integrity, not of uncapping. If ASES wants the add-on for integrity or for physician rates, the clock is on CMS/HHS determination, not on the headline of $769.2 billion.

Obligations in the CJ are federal budget estimates. They are not awards to Puerto Rico, nor disbursements to managed care organizations, nor “CMS released X to the Island.” Confusing the President’s Budget request with money in the Health Department’s account is the shortcut that produces misinformation. What is useful in the PDF for Borinquen is the size of the program, the year-over-year growth, and the reminder that the territorial architecture continues to be the exception within that ocean.

End-of-week file closure (Sep 16, 2026): among a bill to lift the cap (H.R. 6494), a Senate summary with DRF of $26.367 billion, an SBA FR by Ernesto, the CRS of Irma/María, the HAF 100% disbursed, the rules of physical loans, and this CMS CJ, the common thread is federal funding literacy. Appropriated ≠ obligated ≠ awarded ≠ disbursed. Without that grammar, any figure in billions becomes a myth.

The CJ also requests Program Management and discretionary HCFAC for integrity. That reinforces the point of a program integrity lead that Puerto Rico needs for the $75 million add-on in FY2026–FY2027: the national CMS budget does not replace territorial certification on a case-by-case basis.

Fuente: Centers for Medicare & Medicaid Services (CMS) — https://www.cms.gov/files/document/fy2026-cms-congressional-justification-estimates-appropriations-committees.pdf