Background on the Situation
Nine Mexican states have maintained their independent healthcare systems while the remaining 23 states have transferred control to the federal IMSS Bienestar program. This shift is reflected in a transfer of over 26,800 million pesos from direct allocations to state governments through the Fondo de Aportaciones para los Servicios de Salud (FASSA) to the federal partida No Distribuible Geográficamente.
Federalization of Health Services
The IMSS Bienestar agreement allows state governments to voluntarily transfer the operation of their health services for the uninsured population to the federal government, which assumes control through the Instituto Mexicano del Seguro Social (IMSS).
In return, the federal resources previously allocated to states in the FASSA are redirected to the Fondo de Salud para el Bienestar (Fonsabi) for centralized management. As of now, 23 entities have signed this agreement, enabling the federal government to directly provide free medical care.
Impact on States
Out of the 23 states that have ceded their health service operations to IMSS Bienestar, most are governed by Morena or its allies. Meanwhile, nine states—Aguascalientes, Chihuahua, Coahuila, Durango, Guanajuato, Jalisco, Nuevo León, Querétaro (governed by PAN, PRI, or Movimiento Ciudadano) and Yucatán (which intends to join the agreement)—have retained their autonomy.
- Budget Cuts: The average allocation for these nine states increased by 4.2%, while the 23 states that signed the IMSS Bienestar agreement experienced a 53% reduction on average in direct allocations compared to 2025, resulting in a decrease of 26,710 million pesos.
- No Geographically Distributable Part: The non-geographically distributable part of the FASSA budget increased from 81.2 million pesos in 2025 to 28,908 million pesos in 2026. This increase corresponds directly to the 26,800 million pesos that the 23 state governments no longer receive.
Centralization of Resources
Financial analyst Kristobal Meléndez clarified that the concentration of resources under the non-geographically distributable category “is not inherently negative,” as it implies that funds are being directed to an institution with national coverage, such as IMSS Bienestar.
IMSS Bienestar will manage these centralized resources for operational expenses. Meléndez added, “The institution knows how to distribute it to attend the population of those federated entities with the agreement, thus generally resulting in an increase in resources.”
Although the funds are no longer subject to federalized state-by-state audits under Ramo 33, they remain subject to the internal controls of the executing institution.
Historical Context
President Claudia Sheinbaum highlighted on January 13 that the model implemented since the 1990s, where states took charge of public education and healthcare, led to diminishing resources and worsening services over time.
Key Questions and Answers
- What is the IMSS Bienestar agreement? It’s a voluntary transfer by state governments of their health service operations for the uninsured population to the federal government, which assumes control through IMSS.
- How many states have signed the agreement? Twenty-three states have signed the IMSS Bienestar agreement.
- Which states maintained their healthcare system autonomy? Nine states (Aguascalientes, Chihuahua, Coahuila, Durango, Guanajuato, Jalisco, Nuevo León, Querétaro, and Yucatán) have maintained control over their healthcare systems.
- What is the No Geographically Distributable Part of FASSA? It’s a portion of the FASSA budget that is not allocated based on geographical distribution, which has increased significantly to support the IMSS Bienestar program.
