Pago Pago, AMERICAN SAMOA — The American Samoa Medicaid State Agency has provided the Fono with an “Expenditures Summary Financial Report” covering fiscal years 2013 up to 2022, for expenses covered by Medicaid for medial providers eligible to receive federal Medicaid funding support.

The summary report — distributed to lawmakers after the Medicaid agency’s FY 2023 budget hearing more than a week ago — also explained the importance of sufficient local matching funds for the Medicaid program. (See Samoa News edition Sept. 14 for details.)

LBJ MEDICAL CENTER

For 35-years since the inception of the Medicaid program in 1982, LBJ hospital was the sole Medicaid provider for American Samoa, for the federal program, in which funds were distributed by the U.S Centers for Medicaid and Medicare (CMS).

The report points out that the annual Medicaid funding allotted for medical purposes was capped at $9.9 million in 2013. But an overhaul of the Medicaid program under the Lolo Administration in 2013 — with the appointment of Sandra King-Young as the Medicaid Director, and the availability of funding under the federal Affordable Care Act, led to new Medicaid-covered services.

With the expansion of Medicaid covered services, the Medicaid program saw an overall percentage increase of 262% in spending from FY2013-FY2022. As of Aug. 2022 — and since FY 2013, Medicaid has reimbursed more than $270.20 million to LBJ.

OFF-ISLAND REFERRAL PROGRAM

The report explains that the Off-Island Medical Referral (OMR) program was reinstated under Medicaid in 2018 to refer critical patients to New Zealand for treatment unavailable on island utilizing the $181 million under the federal Affordable Cares Act, funding which was set to expire at the end of FY2019.

Medical costs, air and ground transportation, emergency air ambulance transport and accommodation are all reimbursable costs under the OMR. And the Medicaid agency initiated the OMR-US program in 2020 during the border closure as a result of a medical bottleneck at LBJ Medical Center with patients desperately needing to seek medical attention not readily available on island.

In 2022 Medicaid launched its Non-Emergency Referral program to Hawaii for eligible beneficiaries.

To date, local Medicaid has paid and reimbursed more than $24.472 million towards the OMR programs to New Zealand, Hawai’i and the U.S mainland.

DOH HEALTH CENTERS

The report explains that the Health Department’s federally qualified Health Care Facility (FQHC) — which are the DoH Community Health Centers — became the second Medicaid provider in February 2017, utilizing an initial encounter-based rate of $50 that increased to $150 in October of the same year.

As a result, the total expenses increased by 47% between 2013 and 2017. It further increased during COVID-19 when additional funds under the American Rescue Plan Act (ARPA) were separately granted at 100% federal medical assistance percentage (FMAP), covering only eligible encounters at designated quarantine facilities.

To date, American Samoa Medicaid has reimbursed more than $24.11 million to DOH for FQHC facilities and FQHC related services during COVID-19.

COVID-19 RESPONSE

According to the report, Medicaid — which was an important partner during the COVID-19 response — provided medical care services and funding to assist in the repatriation of patients and operate COVID safety measures.

Repatriation costs, according to the report, covered Vaccine Administration; COVID-19 Testing for Travelers; Meals and Accommodation Costs for Medicaid Eligible Passengers; and Dialysis costs for dialysis patients in quarantine – US Renal Care

To date, Medicaid has paid and reimbursed a total of more than $9.34 million in support of ASG’s COVID-19 response efforts.

EQUIPMENT & PROSTHETICS

The report also summarized Medicaid benefits for Durable Medical Equipment & Prosthetics (DMEPOS) such as:

• wheelchairs,

• semi-electric hospital beds for home use, and

• Other Eligible Equipment, Prosthetics, Orthotics and Supplies

And to date, local Medicaid has reimbursed a total of $960,405 to its DMEPOS providers.

MEDICARE CO-PAY

Another program cited in the report is the Medicare Co-Pay. Medicaid enabled the Medicare Dual Eligible coverage in 2019. While Medicare covers 80% of medical costs for eligible beneficiaries, the American Samoa Medicaid’s Medicare Dual Eligible Co-payment program covers the remaining 20% not covered by Medicare.

To date, the local Medicaid has paid a total of $583,274 in Medicare Co-Payment costs to vendors across the US on behalf of the Medicare and Medicaid dual eligible referral patients.