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Update: Deadlines loom for using Medicaid’s off island medical funding

 The American Samoa Medicaid Agency Director Tofoitaufa Sandra King Young

Pago Pago, AMERICAN SAMOA — The American Samoa Medicaid Agency Director Tofoitaufa Sandra King Young attended a House Health Committee hearing last week to report on the status of the American Samoa Off-Island Medical Referral Program (OMR). She presented documents to the committee that while they did not include the name of the patients, due to HIPPA requirements, they did layout the budget position and patient data for FY 2018 & 19 as of Aug. 26, 2019.

The American Samoa OMR as of last Monday, had a balance of a little over $135Million and it has only until Sept. 30, 2019 — this month — to use it or lose it, as previously reported.

Further, on Oct. 1, 2019 — the market place funds of $16Million will be made available to American Samoa; however this also has a deadline — that of Dec. 31, 2019 — when it expires.

According to Tofoitaufa, “This is a relief given our capped funding of $12Mil for FY 2020, but as always, we need the local match for the $16Mil.”

She noted that the current Medicaid OMR program has a 100% payout by Medicaid. However, come Oct. 1st — the Medicaid program goes back to the 45%/ 55% match. And, she points out, the “FY2020 ASG budget only has $1Mil for the OMR program under the Governor’s Special Projects account.”

Tofoitaufa said, “Unless the Territories bill currently in the U.S House moves or passes, we will return to having to put up the 45% match.” (This would be $7.2Mil.)

DATA FOR FY 2018- 2019

The FY 2018 & 19 budget position shows an ‘actual balance- OMR’ of $135,162, 235.00, as of Aug. 26, 2019 — with a and FY 2018 plus FY 2019 ‘Approved Working Budget’ of $143, 200,000.00, for Total Paid Expenditures of $8,037,765.00.

The largest expense is in Transportation, showing $987,248.00 with a breakdown of Non-Emergency (Samoa Airways) at $505,169.00 and Emergency (NZ Air Ambulance Services) at $482, 079.00.

The next largest expense is found in Administration Fees, which includes Pacific Medical Assistant Limited (PMAL)- $704, 269.00; MedAssist NZ Limited (MedAssist)- $53, 372.00 and Medicaid Office Site Visit- $112,131.00.

Accommodations is next in line with a total of $625,165.00; while Medical Services comes in last with Pacific Medical Assistance Limited (PMAL) and MedAssist NZ Limited (MedAssist) for total expenditures of $5,555,580.00.

Patient Data by Nationality lists: 381 patients of which 248 or 65% are US Nationals, 38 or 10% are US citizens, 87 or 23% are Samoa Nationals, and 8 or 2% are listed as ‘Other’.

Patient Data by Status of Referral notes that out of the 381 patients, 114 or 30% are pending; 55 or 14% are pending; 157 or 41% are completed; 19 or 5% have been denied by NZ; 11 or 3% have been denied by Medicaid; 11 or 3% are Medicare patients; and 14 or 4% have been cancelled.

In 2018 there was a total of 99 referrals, and in 2019 there are 282 referrals for the total of 381 patients. Age groups patient data show the largest group is 55+ with 146; the second largest is Age 37- 54 at 129, Age 0- 18 comes in 3rd with 49, while Age 37- 54 is 43. Age ‘Other’ is also listed but not defined, it is at 14.

The high amount of referrals in 2019 corresponds with the larger amount of funds available in 2019. Compared to 2018 — of only $4,200,000 — the 2019 (to date) amount is $139 Million to equal the Grand Total Approved Working Budget of $143+ Million.

Tofoitaufa said the “types of referrals are too numerous to list, but include cardiology, urology, lots of cancers — some too late since the availability of the DRA funds — pediatrics, lots of ENT cases, and orthopedics.”

She noted they are working to refine their data collection system, which would include the “types” of cases using medical codes and “hope to have this competed in the next few months.”

Of interest, is that there are 23% Samoa Nationals that are listed in the patient data, calling to mind the program is not only for US nationals or citizens. However, as previously explained by Tofoitaufa, “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.”

Eligibility for the off-island medical referral program (OMR), under which locals are sent to New Zealand for treatment, under a partnership between the American Samoa Government and the New Zealand government, according to Tofoitaufa, is “only available for those categories of the population allowed for under the Children’s Health Insurance Program Reauthorization Act.”

This means that “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,” she said.