Effective October 1st, 1020 for 3 years the work force will be growing to 
administrate Medicaid. They presently offer Medicare and commercial insurance in Puerto Rico. When it comes to having all the data and algorithms needed to administer the insurance plans have the data bases all wrapped up with the information. This has been a very long process and way back contracts were awarded by the government to do all of this and now to administer the plans the only ones out there to have the IT capabilities are insurance companies.
You can read more about how this works under the comment section of the post below where a reader was kind enough to trace back the history a bit and bring us all up to date. BD 
Medicare Contractor Gets Deal to Monitor Physician Incentive Payments
LOUISVILLE, Ky.--(EON: Enhanced Online News)--Humana Inc. (NYSE: HUM) announced today that it has been awarded three contracts with the Puerto Rico Health Insurance Administration to administer medical benefits to approximately 500,000 Medicaid beneficiaries in Puerto Rico. This expands the company’s current Medicaid membership in Puerto Rico by approximately 140,000 individuals.
Humana Awarded Contracts for Puerto Rico Medicaid Program | EON: Enhanced Online News