Pago Pago, AMERICAN SAMOA — The lack of local matching funds for the $86 million annual allocation to the American Samoa Medicaid State Agency has resulted in the return of millions of dollars in Medicaid funds in the last two years back to the U.S Centers for Medicare and Medicaid Services (CMS), according to the ASG Medicaid Office summary of the agency’s financial report presented to the Fono last week.

Lawmakers say the report was distributed after the Fono Joint Budget Committee hearing on the Medicaid Office’s proposed fiscal year 2023 budget last week Thursday.

Two lawmakers told Samoa News about their colleagues reviewing the report and that they would probably hold a committee hearing specifically on any questions about the overall finances of the Medicaid Office.

And that the report has reiterated what the Medicaid Office has said in past years — that there is a need for an increase in local matching funds, but that remains to be seen at this point during the FY 2023 budget review by the Fono — which is slated to be completed by Friday this week.

“Due to the limited local match, Medicaid returned back to CMS” — $55 million in FY 2020; $42 million in FY 2021 and an “anticipated” $37 million for FY 2022, which officially ends on Sept. 30, 2022, according to the ASG Medicaid Office summary report, which points out that Medicaid services, outside of LBJ Medical Center and the Health Department’s Federally Qualified Health Care Facility (FQHC), are entirely dependent on the availability of the cash for the local match.

The report points out that the American Samoa Medicaid program continues to cover new medical services that benefit the territory. And with the launch of the Vision & Eyeglasses enrollment early last week and other services such as Telehealth, “there is a foreseeable increase in future Medicaid costs.”

It also notes that the American Samoa Medicaid program anticipates a continued hike in Medicaid claims in the new fiscal year 2023 — which begins on Oct. 01, 2022 — and as long as the federal COVID-19 Public Health Emergency (PHE) Declaration for American Samoa remains in effect.

“Under the PHE, American Samoa can only claim Medicaid expenditures at the rate of 66.7% instead of the enhanced rate of 89.2%,” the report explains and points out that after the PHE period, American Samoa “returns to our historic PE percentage of 55% Federal, 45% Local” match.

According to the report the American Samoa Medicaid office has been drawing federal funds utilizing the 66.7% federal medical assistance percentage (FMAP) since March 2020.

For the new fiscal year 2023, with $3 million in local match, “we will only be able to draw down $3 million in federal funds under the 67% PE. After the PHE, if Congress does not adjust our regular FMAP of 55%, we will return to a 45% match requirement resulting in a $6 million federal drawdown.”

“The ability of the Medicaid office to utilize the $86 million of the program and to provide new services is incumbent on the availability of a local match,” the report points out. “For FY2023, Medicaid anticipates the same federal funding level of $86 million for 12 Months.”

The report emphasized that: “Having an adequate local match to support the federal Medicaid grants each year helps to achieve the agency's goals and ensures uninterrupted access to care for Medicaid beneficiaries.”

“Once the local match is depleted, Medicaid will be forced to suspend all services to protect our credit with our providers,” the report said. (Samoa News will report in future editions on other issues in the financial report.)