“Matching Funds” part of the local Medicaid program hiccup


Director of the American Samoa Medicaid Ofice, Tofoitaufa Sandra King-Young says that since American Samoa’ s Medicaid State Plan had never been changed in over 30 years to add more Medicaid providers, “our territory had to overcome several obstacles like lack of financial and utilization data to properly conduct financial impact analysis on our local budget and to the federal Medicaid budget for American Samoa.”

She added, “There is so much we would like to do to improve patient care using the Medicaid program, but it is all dependent on the availability of local match and increased federal funding.”

Tofoitaufa was responding to Samoa News inquiries regarding the Medicaid Program, which was one of the issues discussed during a Congressional hearing last month in Washington DC, where she, along with LBJ Medical Center CEO Taufete’e John Faumuina provided testimony on issues relating to conditions at the territory’s only hospital.

According to her, the financial and program analysis is a requirement of the Centers for Medicare & Medicaid Services (CMS), which she said “won’t move any changes to our program until we fully address any financial impact on the Medicaid budget.” She continued, “Our policy has always been to rst ensure that the funding stream to the hospital remains stable; so adding to our Medicaid provider network requires our of ce to determine the availability of local funds, and the sustainability of our federal Medicaid funding.” Tofoitaufa told Samoa News that after working hard on bringing about changes to better implement the Medicaid program, starting this past February, “some of the changes we started working on and negotiating with CMS from 20142015 started getting approved.”

First, she pointed out, “we successfully negotiated a new payment method to make the FQHC (Federally Qualifed Health Centers) and its five community health centers an offcial Medicaid provider.” Tofoitaufa said there is a need for local match to pay the FQHC community health centers.

Secondly, payment methods have been created for off-island providers both in the US and in New Zealand, where it is more affordable for excellent healthcare services.

“We now need the local match from the local government to implement the OIMR. Without a local match, we cannot reinstate the OIMR,” Tofoitaufa explained. “We are now working on developing fair and equitable policies and procedures to implement the OIMR. These policies and procedures must be transparent, have clear checks and balances, and must have appeals rights for patients.”

She explained that these are the minimum standards required by CMS, and added that their office will be conducting community outreach through the media “to explain all these changes as soon as we finalize the implementation procedures with the Governor’s Office and with CMS.”

Unfortunately, some people still do not fully understand the program, especially with regards to ‘matching’ funds.

Tofoitaufa explained that the Medicaid program is a reimbursement program and it has a fundamental requirement mandated by federal law.

“Every state and territory, in order to draw federal Medicaid funds, must first provide a local match from local funds — through expenditures or a cash match, depending on the payment method for providers,” Tofoitaufa pointed out and added that she does not want to go in depth about payment methods because this is the technical work they do behind the scenes to allow anyone to receive Medicaid reimbursement.

“In most states and territories, local matching funds come from taxes imposed on the public and providers,” she said.

In other words, in order for American Samoa to draw Medicaid funds, the territory must first pay for all our medical care services. Then — and only then — can the local Medicaid Office submit approval to draw Medicaid federal funds to reimburse the eligible portion of what the territory already paid, back to the territory.

“Medicaid funds cannot be advanced, cannot be used for unallowable costs like buying vehicles, medical equipment, administration costs, hospital renovations or construction,” Tofoitaufa pointed out, adding that eligible costs are generally medical visits costs incurred by patients for medical treatment services.

“The key for any provider to properly cover its allowable costs is to adequately capture the costs of delivering medical care services in their charge masters or fee schedules,” she concluded.

For now, Tofoitaufa says there is a need for American Samoa to get help to extend the timeline for the territory to expend its share of the Affordable Care Act (ACA) Medicaid funds, estimated to be $150 million.

The under-spending has to do with a plethora of issues, which according to Tofoitaufa, include ASG being limited by facilities, demand, and matching requirements in what it can spend, with regards to Medicaid.

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