Gov. Lolo Matalasi Moliga has approved the Medicaid Office’s move to pursue a Medicare Buy-In option and enrolling new Medicaid Providers for American Samoa, according to a news release from the ASG Medicaid Office, headed by Sandra King-Young.

Further, the governor’s approval triggers processes for the Medicaid Office to define and implement procedures with the Center for Medicaid and Medicare (CMS) approval, for the following Medicaid benefits: Medicare Buy-In, Off-island referral and New Medicaid Provider Enrollment.

“It's important to note that the Governor has approved the Medicaid office with moving forward to secure these new benefits under the Medicaid program,” King-Young said Thursday.

“Before we can utilize these benefits, we must first finalize procedures with CMS and secure the local matching requirement. When these two issues are met, the Medicaid office will do public outreach to enroll Medicare beneficiaries and new providers,” she added.

MEDICARE BUY-IN

Under this benefit, the local Medicaid program will help pay a certain percentage of Medicare premiums for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with ESRD (End-Stage Renal Disease—permanent kidney failure requiring dialysis or a kidney transplant), the news release says.

“What this percentage will be is yet to be confirmed but will include payment for Medicare Part A and Part B. The key benefit of Medicare coverage is that eligible beneficiaries, especially retirees and the disabled who cannot afford to keep their Medicare coverage will now have financial assistance to keep their coverage,” it says.

“It is very important to the eligible population to sign up for Medicare coverage once they first become eligible when the premiums are lower. If people wait too long after they become eligible, then the premiums increase and these premiums become permanent for the duration of the Medicare coverage,” the media release says.

Further, the “Medicaid Office is working with CMS to define and clarify procedures on how to make the premium payments given our presumptive eligibility model.”

OFF ISLAND REFERRAL

Medicaid can help pay for this benefit in order to send patients deemed to have “medically necessary” services that cannot be provided for on-island, but ASG must meet the match requirement for this program at 45%.

The 2% wage tax that LBJ hospital receives is allocated to the off-island referral program and can be used as a match — unless the government provides an alternative source for the match, the news release says.

“Obviously, the off-island referral program is not the end objective on how to provide medical care for our people,” it says, adding that the “key objective in providing better care for our people and controlling costs is to invest in the development of a high quality local primary care system.”

“However, until we get to a place that ensures we have built that system, currently, the off-island referral program has to be a part of our current medical care system. The Medicaid office is still in the process of negotiating Medicaid reimbursement rates with one Hawaii hospital, and possibly considering another provider hospital,” the statement points out.

NEW MEDICAID PROVIDERS

It also says that the “future of our sustainable medical care system” is the investment in the primary care model — focused on prevention and maintenance of medical conditions before they become critical care needs.

A key component to this that can be implemented immediately is the investment in upgrading local FQHCs (federally qualified health centers) and community health centers under Health Department, and encouraging the entrepreneurship of private clinicians and other private health care services - long term care, dental, vision, rehabilitation, etc., it says.

“Most important is the investment in the human resources with credentials and licenses to help deliver quality medical care to our people,” the release says. “Opening up the Medicaid program to new Medicaid providers will create a competitive environment to drive improvement in quality services and provides more options for patients.”

According to the Medicaid Office it is currently working with CMS to define enrollment procedures and reimbursement methods for new providers.

U.S. Department of Health and Human Services says FQHCs include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits.

Additionally, FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.