American Samoa’s Medicaid off-island medical referral program is unique
Pago Pago, AMERICAN SAMOA — “Medicaid in American Samoa is very unique and not the same as the rest of the US because eligibility and claiming is based on US immigration law — which does not apply here,” according to local Medicaid Agency Director Sandra King-Young.
King-Young was responding to questions sent by Samoa News asking about the issue of eligibility for the off-island medical referral program, under which locals are sent to New Zealand for treatment, under a partnership between the American Samoa Government and the New Zealand government.
Rep. Faimealelei Allen brought up the issue during a House session last week.
As an LBJ board member, Faimealelei told his colleagues that he strongly supports sending patients to New Zealand for treatment. However, the issue he wanted clarified is why only patients born in American Samoa are eligible for the Medicare program.
Faimealelei said it's very sad to hear from people who have lived in the territory for many years — including those from neighboring Samoa, who have served the government, villages, churches, and have contributed to many local developments — but when they are sent for treatment in NZ under the referral program, they are not eligible for Medicare.
“These people have been residing in the territory for over 30 years, paying taxes, contributing to the betterment of our government and also paying Medicare; but when they are sent under the referral program for treatment in NZ, they have to pay for their own treatment and accommodations,” Faimealelei said.
“This is not fair to them. Something is not right and we need to do the right thing.”
King-Young confirmed to Samoa News that the off-island referral program in partnership with New Zealand is a Medicaid program, not Medicare.
She further explained that the American Samoa Medicaid program is unique because in the US “eligibility and claiming is based on US immigration law—which does not apply here.”
The local Medicaid Agency director said, “our program is a presumptive eligibility, one where everyone is presumed eligible but claiming is only available for those categories of the population allowed for under the Children’s Health Insurance Program Reauthorization Act.
“We can only claim federal Medicaid dollars for US nationals, US citizens, “US” permanent residents, foreign children under the age of 21 years and foreign pregnant women.
“Those numbers determine how much we can claim for every dollar we incur in allowable Medicaid expenditures. Basically, anyone that does not fall under the above categories, we must omit from eligible claiming costs formula calculation.”
According to King-Young, when she spoke to Samoa News in November 2017, the Medicaid State Agency’s responsibility is to develop referral procedures pursuant to Medicaid regulations and approved by CMS. It is a reimbursement program and it has a fundamental requirement mandated by federal law.
Faimealelei said during the House session that he was not complaining. Instead, he just wanted the Fono to know so they can be informed and do something about it.