Pago Pago, AMERICAN SAMOA — Gov. Lemanu P. S. Mauga shared with a U.S. Senate committee last Thursday, American Samoa’s “dilemma” in which a percentage of local residents, who have made the territory their home for 20 years, don’t qualify for the federally funded Medicaid program.

“Our dilemma in American Samoa” is that “most of us who are American Samoa born qualify for Medicaid,” the governor told a U.S. Senate Committee on Energy and Natural Resources hearing on the state of U.S territories.

However, “there’s a percent of American Samoa residents, that are legal residents, in our terms in American Samoa, that do not qualify under the Medicaid program,” the governor said referring to the category of “American Samoa Permanent Residents” — foreign nationals who have legally resided in the territory for a minimum of 20-years.

“And we’re looking for internal revenues from the government to make sure that we’re taking care of this part of the population,” said Lemanu, who was responding to a committee question posed to all insular area governors who attended the hearing.

Lemanu shared with the committee that a lot of revenue coming into the territory through federal grants, does not benefit this group of American Samoa’s population.

“They don’t qualify for federal scholarships, nor qualify for a lot of educational benefits that those born in American Samoa qualify for,” he said, and he also thanked Congress for approval of the federal Consolidated Appropriations Act of 2023, which includes provisions that permanently increase the federal Medicaid match to 83% for the territories.

In his written testimony to the committee, the governor spoke further about American Samoa Permanent Residents. He points out that unlike U.S. permanent residents, American Samoa Permanent Residents are required to have lived continuously in American Samoa for 20 years to gain permanent residency status.

“These residents are ineligible for Medicaid except on a limited basis for emergency services,” the governor explained.

He suggested that a change in the federal Medicaid law would allow the American Samoa Government “to provide needed medical care for this group who have contributed 20 years of their lives living in our U.S. territory, paying taxes and contributing to the welfare of our community — a U.S. territory.”

“They need to be treated equally like U.S permanent residents that are eligible for Medicaid, but only require five years [to live] in the US to become eligible for Medicaid under federal law,” he said.

As previously reported by Samoa News, ASG Medicaid director Sandra King-Young last year made the rounds in Washington D.C. talking to Congressional committees with jurisdiction over the federal Medicaid program speaking about two issues important to American Samoa — including Medicaid coverage eligibility for American Samoa Permanent Residents.

“The American Samoa Permanent Resident eligibility issue can only be addressed by Congress,” King-Young told Samoa News last year.

She had said that the governor requested the help for permanent residents and it was presented at the time to Congressional committees and Congresswoman Uifa’atali’s Office. (See Samoa News edition Sept. 16, 2022 for details.)

FEDERAL MEDICAID MATCH (FMAP)

In his written testimony to the Senate committee, the governor expressed appreciation for the permanent increase in federal Medicaid match to 83% for American Samoa and the other U.S. territories.

“This monumental change has brought equity to the matching issue for the territories Medicaid programs,” he said. “This will help make programmatic improvements to our Medicaid programs and increase provider payment rates for the U.S. Territories.”

The governor noted that “American Samoa has a unique Medicaid model that does not allow us to claim the full 83% FMAP, but we are working on addressing this complex issue” with the U.S Centers for Medicare and Medicaid Services (CMS).

“Like all federal programs that require local matching funds, as a small territory with a limited economic base, American Samoa continues to face challenges in generating local revenues to meet the matching requirements in order for our territory to fully expand our Medicaid benefits,” he said.

As reported by Samoa News last Friday, through a Feb. 06, “Controller Alert” memo to federal agencies, the Acting Controller of the Office of Management and Budget with the Executive Office of the U.S President, announced new matching funds waiver requirements for four insular areas.

The Alert, titled “Waiving Matching Fund Requirements for Insular Areas”, informed federal agencies of the legal requirement regarding waiver of local matching funds requirements for financial assistance to the U.S. territories of American Samoa, the Commonwealth of the Northern Mariana Islands, Guam and U.S. Virgin Islands.

According to the alert, federal agencies “are required” to waive any requirement for local matching funds under $200,000 for grants to the four insular areas.

For local matching funds for grants $200,000 and greater, federal agencies “may waive” the matching requirement for the four territories.

 The alert also said that federal agencies “should work judiciously to ensure implementation of these provisions, absent an agency-specific statute that conflicts with these provisions.”

The U.S. Department of Interior last week announced that it’s waiving local matching funds for all its grants. Lemanu made this fact known to the U.S. Senate committee through his written testimony, and expressed appreciation to the US-DOI.

“We hope this initiative can be extended to other federal agencies providing funding to the territories. The waiver of local cost matching will relieve fiscal strain on our limited local funding,” he said.

At press time, there’s been no other federal agency to publicly announce waiving local matching requirement for their grants.