Pago Pago, AMERICAN SAMOA — With no local matching funds provided by the territorial government, all services provided by the American Samoa Medicaid State Agency, have been suspended for the rest of this fiscal year 2021, and that includes any medical charters, except for the one already set for today, Thursday, Aug.12.

ASG Medicaid Office director Sandra King-Young made the revelation during her office’s fiscal year 2022 budget hearing before the Fono Joint Budget Committee hearing on Monday, saying that the actual local-match for American Samoa is 30%.

The Medicaid Office is allocated an ASG subsidy of $2 million annually, and every quarter $500,000 is given to the office, but King-Young said the local matching fund is not sufficient or enough to carry out services for the government and people of American Samoa.

Right now, she said the Medicaid Office has no available “local-match”, therefore all programs under Medicaid are halted, including medical charters, until and unless there is financial assistance from the Governor’s Office to continue medical charters and referrals for the months of August and September this year.

While the annual ASG budget provides for a $2 million government subsidy, which goes towards local-match, she said that amount is not sufficient.

Asked by the committee if her office has looked into the “income match” to help with the local match, King-Young responded that “income match” is prohibited under U.S Center for Medicaid and Medicare (CMS) rules and therefore the Medicaid Office cannot charge anyone under Medicaid programs.

“The local match must come from the state, must come from our government. It cannot come from the patient, cannot come from any donors, it must be state funded for the local match,” she emphasized to the committee and expressed appreciation to the Governor’s Office for their hard work in helping with additional funds, under the Special Programs for medical flights.

Responding to more committee questions on the current $84 million, which expires at the end of September this year, she said that the local-match is 30% for every Medicaid dollar and that is just over $30 million needed by American Samoa in order to use up the entire Congressional allocation.

“If we cannot prioritize healthcare and we don’t prioritize the Medicaid match,” services provided by her office are very limited, according to King-Young, who also explained that her office wants to include services such as eye glasses, but that can’t be done right now, “if we don’t have the local match.”

“We want to cover cancer. We don’t right now, because we don’t have local match. So we need the local match, if we want to improve our health care system, increase the medical care quality of our people. We need at least $10 million local match to start,” she said, noting that money allocated to ASG from any federal program, including the US Department of Interior’s annual subsidy to ASG cannot be used for local-match as its prohibited under CMS regulations.

With no local-match available, any unused money under the $84 million will be returned back to the federal government at the end of September — which is also the end of FY 2021.

Regarding Medicaid funding beyond Sept. 30th, Congresswoman Uifa’atali Aumua Amata publicly announced through previous press releases that federal legislation approved by a US House committee would provided 8 years of funding for American Samoa and other US territories.

King-Young gave a similar explanation when asked by the joint budget committee about future Medicaid funding, saying that the federal legislation re-authorizing Medicaid funding for American Samoa over the next 8-years is pending in a US House committee and she suspects that in the U.S. Senate, the bill will be amended down to 5 years.

She said that 5-years or 8-years for continued Medicaid funding would be greatly appreciated.

Responding to questions on options to ensure there is sufficient local-match, King-Young recalled her testimony last year before a local House committee hearing when she was asked the same thing and she recommended two options.

She explained that the first one, is for the Fono to look at a sales tax, where everyone pays, as Medicaid pays for all services to the public at LBJ.The second suggestion, which she says is a “little controversial” — is to “legalize medical cannibas” to provide funding while medical cannibas can also assist with treatment of patients.

Senate President Tuaolo Manaia Fruean posed the question that many are asking since early this year, on who makes the decision to operate a medical charter. There have been accusations on social media lodged against the Medicaid Office as the sole agency that makes such a decision.

King-Young told the committee that it’s the governor who decides on medical charters based on the needs of local residents and the hospital for patients going off island. She explained that if the hospital sees the need of patients going off island and returning home, LBJ sends her office a request.

The request is then reviewed and the Medicaid Office then submits it to the governor and the ASG COVID-19 Task Force for approval. She also says that it’s the task force that makes the decision on repatriation flights.

BACKGROUND

The last repatriation flight from Honolulu was on July 29th. While today’s medical charter as well as the one operated earlier this month — the incoming ferry-flight from Honolulu, which had no passengers — is a decision made by the COVID-19 task force, chaired by Lt. Gov. Talauega Eleasalo V. Ale, who is also the current acting governor.

Samoa News should point out that with local executive branch/ government pay raises going into effect, it is puzzling that the Medicaid matching funds are not a priority, especially considering that the percentage (now at only 30%) has been lowered by the feds in an effort to help American Samoa meet its Medicaid obligations.

Of note, many residents also are using the Medicaid flights to leave island as needed, i.e. Governor’s Office contingent that left for the ASG-Hawaii Office opening ceremony, students accepted at off-island US high learning institutions, etc. It is believed these types of passengers are paying ones, and are subject to ‘seat available’ only after Medicaid passengers are accommodated.