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Averil George Commissioner

U.S. VIRGIN ISLANDS

DEPARTMENT OF HUMAN SERVICES

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THE OFFICE OF

Medicaid

Medicaid is a government-sponsored program that provides health care coverage assistance for people with low-incomes. The joint program, funded by the federal government and administered at the state level, varies. Patients receive assistance with paying for doctor visits, long-term medical, custodial care costs, hospital stays, and more.

Medicaid Update My Contact Information (Click Here)

Medicaid Update My Contact Video 

VI Medicaid Program (Medical Assistance Program)

Director: Gary Smith, Gary.Smith@dhs.vi.gov

All of the services provided by CHIPs are free including doctor visits and check-ups, vaccinations, hospital care, dental and vision care, lab services, X-rays, prescriptions, and emergency services.

What is Medicaid?

  • Title XIX or Medicaid provides grants to States for Medical Assistance to the Needy.
  • Medicaid, which is also called Medical Assistance, is designed to make adequate health care available to children and adults who are unable to meet the cost of their medical needs.
  • It is a federally funded assistance program, operated according to the State Plan which was first approved by the US Department of Health and Human Services, July 1, 1966.
  • Medicaid also supplements the insurance plans provided under Title XVIII (Medicare).
  • Medicaid is the largest source of health insurance in the nation.

What is not Medicaid?

  • Medicaid is not Medicare.
  • Medicaid is an assistance program and does not require financial contributions from its recipients.
  • Medicaid, unlike Medicare, is a shared federal state/territory responsibility.

Forms

Medicaid USVI Hospital Presumptive Eligibility Application

Medicaid Application Flyer

Documents Required to Apply to Medicaid – English

Medicaid Application

Room of Board Statement

Authorized Representative Form

Statement of Circumstances

Employment Wage Verification

Self-Employment Income Form

 

 

CHIP

The Children’s Health Insurance Program (CHIP) is offered to parents with children under the age of 19, whose incomes are too high to qualify for Medicaid but can’t afford regular health insurance. Income limits vary, as each state runs a variation of CHIPs under different names and eligibility requirements.

All services provided by the Children’s Health Insurance Program (CHIP) are free for eligible applicants including doctor visits and check-ups, vaccinations, hospital care, dental and vision care, lab services, X-rays, prescriptions, and emergency services.

Groups Covered:

Medicaid covers members of the following groups that meet income, asset, USVI residency, and citizenship criteria:

  • Pregnant women
  • children under age 21
  • CHIP children under age 19
  • TANF children and adults
  • Blind and Disabled
  • The income standard for the categorically eligible for a family of one is $15,654.
  • For Aged, Blind or Disabled, for a family of one the standard income level is $20,833.

The main point of entry into the program is through an eligibility determination performed by the DHS.  Application processing times for Regular Cases should not exceed forty-five (45) days and Disability Cases should not exceed sixty (60) days. 

Clients applying under the permanent and total disability category are required to complete the Medicaid Application for Permanent and Total Disability (APTD) process unless they are already receiving Social Security Disability Benefits.

Person determined eligible are normally eligible for up to 12 months (unless their circumstances change) at which time a redetermination must be performed to continue eligibility.

The VI has also implemented Presumptive Eligibility (PE) as another door to enroll into Medicaid/CHIP Programs.  The PE Process allows uninsured individuals who need medical care to be temporarily determined eligible by certain providers when they appear at their facilities.  The PE Process allows the individuals to complete a brief PE application and self-attest to all information on the application and be immediately determined eligible if they qualify, and receive services immediately paid for by the Medicaid or CHIP Programs.  Note that PE eligibility is very limited and runs only to the end of the month following the month the PE application is completed and only one PE eligibility is permitted in any 12-month period.  PE Individuals must come into the DHS/MAP offices to complete a full Medicaid application to ensure continued eligibility and to ensure continuity of care.  Currently, PE is performed at the hospitals in the territory.

Unlike Medicaid enrollees in the States, VI Enrollees do not have the freedom of choice (FOC) to select their preferred medical providers.

Provider Enrollment

Effective March 2, 2026, the US Virgin Islands Medicaid Program is implementing an on-line Provider Enrollment Application (PEA) process.  If you are an active, enrolled provider, then you can access the US Virgin Islands Medicaid Program’s on-line Provider Enrollment Application (PEA), using your trading partner account (TPA) login credentials by going to VIMMIS.com and selecting the “Provider” tab to access Provider Enrollment Application. VIMMIS User Guides are available to help you navigate this new application.

If you do not yet have a USVI Medicaid trading partner account (TPA), refer to the USVI Trading Partner Agreement Registration User Guide at VIMMIS User Guides. All providers, including those already enrolled, must use this on-line provider enrollment application (PEA) beginning March 2, 2026.  Providers will be able to ensure its enrollment data is up-to-date, as well as track its provider enrollment status with the US Virgin Islands Medicaid Program.

Be sure to have the required information, forms, and other documents on hand as outlined in the Medicaid Program Provider Enrollment Checklists.

USVI Medicaid General Information Manual (Click Here)

Note: The US Virgin Islands Department of Property and Procurement actively engages with existing and potential vendors and partners seeking to do business with GVI. All vendors or partners of the Government are required to become registered vendors to participate in solicitations for goods and services. To enroll with the USVI Medicaid program, a vendor ID is required.  Please visit GVIBUY to register and obtain a vendor ID.

Call Center:(340) 715-6929 |Email:vimmis@dhs.vi.gov

MMIS EDI HelpDesk:(855) 248-7536

Email:VIEDIHelpdesk@MolinaHealthCare.com

Special Services:
(340) 774-0930×4352 St. Thomas
(340) 773-1311×6224 St. Croix

Please visit www.vimmis.com, reference materials or register as a user for enrollment application form.

Every contractual Agreement with the Government of the US Virgin Islands typically requires the following supporting documentation:

Group Providers/Corporations/Limited Liability Companies:

  • Current, valid business license for the entity;
  • Current, valid professional licenses for individual providers;
  • License Verification/Good Standing for individual providers, dated within the last year;
  • Current DEA Registration, if applicable;
  • Current Healthcare Professional Liability/Medical Malpractice;
  • Current Certificate of Government Insurance Coverage/Workers’ Compensation;
  • Current Certificate of Good Standing; note this expires June 30th each year;
  • Articles of Incorporation or Organization establishing the entity and any subsequent amendments;
  • Resolution authorizing the Agreement signatory to execute any agreement on behalf of the establishment. This must be signed by the Corporate Secretary;
  • Current Tradename Certification, if applicable;
  • Sam.gov registration; and
  • Completed W-9 form.

Hospitals, Laboratories and Federally Qualified Health Centers:

  • Current, valid business license for the entity/facility;
  • Current Healthcare Professional Liability/Medical Malpractice (or Commercial General Liability and Automobile Liability Coverage for transportation services);
  • Current Certificate of Government Insurance Coverage/Workers Compensation;
  • Current Certificate of Good Standing; note this expires June 30th each year;
  • Current Accreditation Certificate;
  • Articles of Incorporation or Organization establishing the entity and any subsequent amendments;
  • Resolution authorizing the Agreement signatory to execute any agreement on behalf of the establishment. This must be signed by the Corporate Secretary;
  • Current SAM.gov registration;
  • Completed W-9 form; and
  • Current Tradename Registration, if applicable.

Individual Providers:

  • Current, valid professional license;
  • Current Health Care Professional Liability/Medical Malpractice Insurance coverage (or Commercial General Liability and Automobile Liability Coverage for transportation services);
  • Licensure Verification/Good Standing dated within the last year;
  • Current DEA registration;
  • Current Certificate of Government Insurance Coverage/Workers Compensation;
  • Current Sam.gov registration;
  • Completed w-9 form; and
  • Current Tradename Registration, if applicable.

Call Center:(340) 715-6929 |Email:vimmis@dhs.vi.gov

MMIS EDI HelpDesk:(855) 248-7536

Email:VIEDIHelpdesk@MolinaHealthCare.com

Special Services:
(340) 774-0930×4352 St. Thomas
(340) 773-1311×6224 St. Croix

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