Puerto Rico: Efforts to Improve Competition for Medicaid Procurement, Statement of Carolyn L. Yocom, Director Health Care, Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives [open pdf - 228KB]
From the Document: "Thank you for the opportunity to discuss the Medicaid program in Puerto Rico. Among the U.S. territories, Puerto Rico administers the largest Medicaid program, covering over 1 million beneficiaries at a total cost of $2.5 billion in 2018. Like other states and territories, Puerto Rico implements major functions of its Medicaid program by procuring a variety of administrative and other services from contractors. In calendar year 2018, states and territories paid contractors at least half of the $619 billion in total Medicaid expenditures. In that same year, Puerto Rico paid contractors at least 96 percent ($2.4 billion) of its $2.5 billion in total Medicaid expenditures, primarily to managed care organizations (MCO) for coverage of Medicaid services."
Government Accountability Office: https://www.gao.gov/