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Am Samoa Medicaid recognized for repatriation efforts during COVID-19

Matilda Kruse and NAMD Director Matt Salo
Medicaid leaders used creativity, fearlessness, and tenacity

Pago Pago, AMERICAN SAMOA — The American Samoa Medicaid State Agency is a recipient of the National Association of Medicaid Directors (NAMD) annual Spotlight Award for 2021. The award recognizes the unparalleled work Medicaid agencies have done in service to the 80 million people covered by the program, according to a NAMD post, dated Nov. 14, 2021, on its website:

“In the face of COVID-19 disruptions, Medicaid leaders used creativity, fearlessness, and tenacity to face the disruptions wrought by COVID-19 and leveraged this moment to address long-standing challenges in Medicaid.

“It is in this spirit, that we recognize American Samoa,” the blog states.

Of the award, local Medicaid director, Sandra King Young told Samoa News via email, "Most people do not realize the difficult work that our government and its several agencies undertook to make repatriation flights happen.

“The federal, state and private sector coordination posed a multitude of daily challenges that required prompt high level problem solving and effective solutions.

“For example, no other territory or country went to the extent we did to cover dialysis services onsite in the hotels to maintain the bubble, in order to safely repatriate our residents who are on dialysis. This was an innovative solution that even the dialysis industry recognized.

“This award truly belongs to all the government agencies, government staff, volunteers, and vendors who were on the front lines to make repatriation flights possible,” the AS Medicaid director said.

The award was accepted by Matilda Kruse, Program Integrity Division head for AS Medicaid, at the Annual NAMD Spotlight Award, from NAMD Director Matt Salo, during the Annual NAMD Conference in Washington, D.C.

According to the blog, in selecting AS Medicaid as the recipient of the 2021 Spotlight Award, the following was the focus of NAMD’s criteria:


The analogy “building the plane while flying it” suits nearly every system of response to the COVID pandemic. There are some circumstances unique to the state’s disease course, populations and existing infrastructure that shaped it’s response to COVID. But, Medicaid agencies share common experiences in rapid shifts to systems, programs and workforce.

In the case of American Samoa, the common analogy takes a unique and literal twist when planes stopped flying altogether.


In March 2020 the American Samoa Government closed its borders stranding 2,000 of its residents in Hawaii, the US mainland and other countries.  It was a lockdown with no flights in or out for nearly a year, and was a crisis on two shores:

On-island residents lost access to advanced medical care only available off the island.

Off-island residents endured heightened stress, trauma and hardship during separation.

Solutions, Spearhead by Medicaid

An urgent and untenable situation required a history-making response. The AS Medicaid agency led the territory’s first-ever medical transport program, orchestrating the first step of a complicated, repatriation process. Under its State Plan, the agency chartered a plane to transport 200 patients and escorts to Hawaii to access medical care.

The work to reopen access to care was a foundation from which the Medicaid agency and partners in the American Samoa Government COVID-19 Task Force could envision and execute broader repatriation. Together, they created the Safe Travels program. The program was phased (1) to maintain closed borders except for medically qualified (2) and later when travel resumed, to protect the territory from COVID. Each phase had challenges:

Cost: AS Medicaid sought and secured a Disaster Relief SPA to cover medical referral services, on-site care, and travel costs associated with rigorous safety and quarantine.

Technology: When pre-travel quarantine was lifted a sophisticated electronic system was required to manage traveler health status, testing and vaccination data. TALOFAPass is the technology platform that made it possible to implement the Safe Travels Program.


TALOFAPass and the State Travels Program were built out of necessity and built from collaboration. Multiple state agencies, state governments and private sector partners needed the ability to quickly work together as a team. Their disparate information systems and mismatched processes hindered communication, workflow and problem-solving. The successful roll out of technology and the program demonstrated a new “trusted partner ecosystem.”  Partnership and infrastructure solved pandemic problems and positions American Samoa for future innovation.


For these innovations, American Samoa is a recipient of NAMD’s 2021 Spotlight Award.