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House hears from Director of local Medicaid Office about off-island referral program

Sandra King-Young testifying at the hearing
Says the way the program is administered dictates who is eligible

Pago Pago, AMERICAN SAMOA — It was during a House Health Committee hearing with the Director of the State Medicaid Office, Sandra King-Young, that she said the reason why Hawaii does not allow patients under the referral program to be treated at their hospitals anymore was because the American Samoa Government (ASG) still owes over $10 million to hospital institutions in Hawaii for off-island medical referrals, medicine, pharmaceutical supplies and other general expenses.

According to King-Young, these debts are from the previous administration. She did not name which previous administration she was referring to.

Faipule advised King-Young to work together with ASG leaders to find ways to address the issue of the debts because they believe Hawaii should be the first option for our local patients to be treated under the off island referral program.

It was Vice Speaker of the House, Fetu Fetui Jr who asked King-Young why the ASG sent their patients under the referral program to New Zealand instead of to Hawaii.

King-Young told committee members that ASG leaders approached leaders of the Hawaii government in an effort to continue the off-island referral program for American Samoa. However, their request was denied due to the fact that ASG owed over $10 million to the Hawaii Government.

“That’s the reason why Gov. Lolo Matalasi Moliga and government leaders reached out to the New Zealand Government for help and they immediately accepted our request to send our patients over there for treatment,” she said.

King-Young also noted the cost of a Air Ambulance Medivac flight to Hawaii is a little bit over $190,000, while sending a patient to New Zealand by an Air Ambulance is only $60,000.

According to the Medicaid office director, permanent residents as well as legal residents are not eligible under the Medicaid off island referral program to New Zealand, which is fully funded by the federal government. However, they are eligible for the Medicaid program if they are treated at the LBJ Hospital in Faga’alu.

When asked by committee members to explain the reason why legal residents are not eligible for the Medicaid program, King-Young said that American Samoa (AS) is the only jurisdiction in the United States that uses a Presumptive Eligibility (PE) model to administer its Medicaid program.

It was designed this way when the AS Medicaid program was first created in 1982 when the territory’s population was 88% Medicaid claimable. At this time, according to King-Young, given the majority of the population was Medicaid claimable, the policy was that it was presumed that everyone is covered under Medicaid at the LBJ hospital, but the territory’s claiming of federal dollars would be limited to the percentage of residents who are U.S. Citizens and U.S Nationals.

Currently, King-Young said that the Medicaid eligible claiming population of AS has significantly decreased to 46% due to the changes in population and the Children’s Health Insurance Population eligibility rules.

The director further stated that all 50 states and the other four U.S. territories utilize the Individual Enrollment (IE) model to administer their Medicaid program. The need to transition to IE is becoming more urgent due to the increased reporting and compliance requirements of the Medicaid program, and due to the increase in the territory’s Medicaid funding cap passed in 2019, raising our cap from $11 million a year to $84 million a year throughout 2021.

Congress is requiring more stringent reporting on utilization and expenditures of Medicaid funds including the adoption of more rigorous systems reporting under T-MSIS (Transformed Medicaid Statistical Information System).

These reporting requirements according to the Medicaid office director cannot be met under a PE model where there is no enrollment of individual beneficiaries.

Under the current PE model, the current local match rate is 36% while the federal match rate is at 64%. If AS were to utilize an IE model, Medicaid could claim up to 83%in federal dollars and the local government would only have to pay 17% in local match.

If the AS Medicaid program was able to transition onto the IE model, the territory could provide more comprehensive services to Medicaid beneficiaries, according to King-Young.

Under the IE model according to the director of the Medicaid office, the challenge would then be the coverage of non-Medicaid patients. She also stated that the protection solution would be to implement a self-insurance plan for non-Medicaid patients and to increase the LBJ hospital subsidies to cover non-Medicaid patients.

Basically, all AS permanent residents and legal residents are eligible under the Medicaid program if they are treated at the LBJ, but not off-island.

Fetui Jr said it’s very sad to hear that people who have lived in the territory for many years, including those from neighboring Samoa, who have served the government, villages, churches, and have contributed to many local developments are not eligible under the Medicaid program.

He said that these people have been residing in the territory for many years, paying taxes and they consider AS their home.

King-Young told the committee that she understands their concern but this is a federal program and her office or ASG can’t change anything.

The committee was told that AS permanent residents can be eligible for the off island referral program to New Zealand, under local funding from the ASG. Furthermore, it’s clear that under the Medicaid program, the local Medicaid office can only draw down federal money to pay for treatment for those who are eligible under the hospital program.

In response to Rep. Larry Sanitoa’s question, King-Young told the committee that a little over $20 million from the $84 million of the Medicaid funding has been used, and a little over $16 million of this fund went to LBJ.

Committee chairman, Rep. Vesi Talalelei Fautanu Jr thanked King-Young for the opportunity that our people received through the medical charter flight on Hawaiian Airlines last week to seek medical treatment in the mainland.

Vesi then requested the director of the Medicaid office for a second medical charter flight to send more people to the mainland for treatment. He also said that a lot of US Nationals, who are stuck in Hawaii and the mainland, want to return home.

He requested the witness to talk to the Governor to discuss the issue of whether the government is considering bringing our people who are stuck off island home.