Health care
Free Care at Puerto Rico Municipal and State Health Facilities
Municipalities and the Commonwealth must supply medical care, hospitalization and medication at no cost to veterans and their families at their own health facilities, on federal Medicaid income criteria, with the deductible waived if you are insured.
Also called: medical services, hospital, servicios médicos, Artículo 4D, Ley 203-2007, Medicaid, Título 19, deductible, children under 25.
For: Veteran or service member, spouse, child, survivor.
Where it applies
Written for the jurisdictions listed here.
- Puerto RicoTerritory
Article 4D of Ley 203-2007 places an obligation on the municipalities and the Commonwealth government, through all of their health facilities, to supply at no cost the necessary medical assistance, treatment, hospitalization and medications to veterans, their spouses and their children.
This is not VA care. It is the territorial and municipal health system, and it exists alongside the VA Caribbean Healthcare System rather than instead of it. For a veteran who is not enrolled in VA health care, or who is far from a VA clinic, or who needs something VA will not cover, this is a separate door.
The conditions. The care must be on prescription by a physician, and it follows an evaluation of the person's economic situation "a base de los criterios del Programa Federal de Asistencia Médica (Título 19 de la Ley de Seguridad Social Federal)," that is, the federal Medicaid criteria. So it is a means-tested benefit with the test borrowed from Medicaid, not an unconditional entitlement.
Who is covered. Veterans, their spouses, and their children up to the age of majority, or up to twenty-five if they are students, on presentation of valid student identification. Children of veterans who are physically or mentally impaired receive the benefits with no age limit at all. And the rights extend to the children of veterans killed on the battlefield, to the age of majority, to twenty-five for students, and without age limit for physically or mentally impaired children.
The insurance clause is the one to know. Where the veteran, spouse or children hold any kind of prepaid medical insurance, the state or municipal institution providing the service may bill that plan for the services rendered, "eximiendo al veterano, su cónyuge e hijos, del pago correspondiente del deducible." The facility bills your plan and you do not pay the deductible. For a veteran with a plan carrying a high deductible, that is the substance of the benefit.
The article ends by requiring that this law appear in visible places in all public health facilities, municipal and state. If it is not posted, that is a compliance point the Procurador del Veterano can take up under Article 9, which allows administrative fines of up to five thousand dollars per violation against government bodies and municipalities.
Two practical notes. The economic evaluation is done by the facility, so what is required will vary; ask in advance rather than at the point of care. And because this duty falls on municipalities as well as the Commonwealth, the place to ask first is often the municipio's own health office rather than a central agency.
Thresholds
| Gate | Rule |
|---|---|
| No rating requirement | Article 4D turns on veteran status and an economic evaluation, not on a service-connected disability percentage. |
| Means tested on federal Medicaid criteria | The care is supplied after an evaluation of economic situation based on the criteria of the federal Medical Assistance Program under Title XIX of the Social Security Act. The evaluation is done by the facility, so ask what it requires before you need care. |
| Children to majority, to twenty-five as students, without limit if impaired | Spouses and children are covered to the age of majority, or to twenty-five with valid student identification. Physically or mentally impaired children of veterans are covered with no age limit, as are the children of veterans killed on the battlefield on the same terms. |
| If you are insured, the facility bills the plan and waives your deductible | Where the veteran, spouse or children hold prepaid medical insurance, the state or municipal institution may bill that plan for services rendered and must exempt the veteran, spouse and children from paying the corresponding deductible. |
Sources
Updated
Last updated .
Request an update
Out of date, a broken link, or something else wrong? Say what you found, and an editor checks it against the official source.
Disclaimer
VetTOC is not affiliated with the U.S. Department of Veterans Affairs or the Department of Defense. Information is for reference only and is not an eligibility determination. Verify with VA, the relevant state or territory, or an accredited VSO.