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Help needed for Medicaid issues re: care services for “our people”

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Pago Pago, AMERICAN SAMOA — In a May 1st letter, Gov. Lolo Matalasi Moliga requested two senior senators of the US Senate Committee on Finance for “help in addressing long standing Medicaid issues that continue to place financial hardships on our local government and significantly reduce access to medical care services to my people.”

The “two biggest chronic problems” faced by ASG, says Lolo, are the “disparate application” of the Federal Medicaid Assistance Percentage (FMAP) matching formula to the territories and the statutory capped funding for Medicaid block grant.


In the letter addressed to Sens. Chuck Grassley (committee chairman) and Ron Wyden (ranking member), the governor requests waiving the FMAP requirement for American Samoa through September this year “so we can effectively draw critical needed Medicaid federal dollars to provide needed medical care for our people.”

According to the governor, the local match requirement of 45% is equivalent to other wealthy US states, yet, 80% of American Samoa’s population fall within the federal poverty line. He asked that under federal disaster supplemental bill (pending in Congress), American Samoa is able to draw 100% federal match to draw available Medicaid federal dollars.

He explained that the reason American Samoa cannot draw most of its Patient Protection and Affordable Care Act (PPACA) Medicaid funds is because the territory cannot come up with sufficient local match dollars to draw down the corresponding federal share.

Lolo said ASG faces challenges in generating and collecting local revenues to provide sufficient matching dollars for Medicaid to fully implement the requirements of the American Samoa Medicaid State Plan.

Additionally, the territory cannot provide enough government subsidies to LBJ Medical Center.

“This is a problem across our government for other programs requiring local match,” the governor points out. “It is particularly difficult for Medicaid which requires a substantial local match.”

“What small local match dollars our Legislature is able to appropriate for the Medicaid program — once it is expended, our government has no choice but to suspend medical care services, including life-saving services, to protect the government from going into debt and compromising our credit worthiness with our Medicaid vendors,” he explained.

Lolo tells the Senate committee that it was last month that the ASG Medicaid Office announced suspension of medically necessary services not available on island for off island referral because of the depletion of FY 2019 local matching funds.

Further, Medicaid is currently unable to reimburse the government-run Federally Qualified Health Centers (FQHC) community clinics due to FQHC’s inability to provide local match.

Without a wavier of local match through Sept. 30, 2019, Lolo said American Samoa will be unable to draw down any further Medicaid funds until Oct. 1, 2019. “This leaves American Samoa without funds to provide basic health benefits and off-island medically necessary care to our people in need of life-saving treatments,” he points out.


According to the governor, American Samoa’s block grant is $12 million, which covers about 46,000 lives, and its “significantly less than what the territory actually needs to fully cover medical care services for all residents.”

He explained that the territory receives an annual increase of about 2.5% a year and the PPACA provided significant relief to the territory for the past 8 years. Lolo requested that America Samoa “needs an increase of up to $30 million for its annual Medicaid funding with an inflationary clause pursuant to the Cost of Living Adjustment increase.”

Lolo revealed that American Samoa exhausts its annual Medicaid block grant usually at the end of the second-quarter, and without additional PPACA funding or an increase in the annual Medicaid block grant, “the one and only local hospital may have to adopt” cost cutting measures - such as reduce medical care services, reduce personnel hours, reduce workforce numbers or take out a loan to keep the hospital in operation until the next budget cycle - which have all occurred prior to the availability of PPACA funds.

In addition, services for medically necessary care not available on island, payments to the FQHC’s, payments for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies and payments for Medicare Co-Pays assistance “will all cease”.

“One key aspect of the American Samoa Medicaid program is that Medicaid is the only health insurance provider for American Samoa,” he said, noting that unlike those who have benefit of health insurance coverage from other sources - such as Medicare beneficiaries, Tricare and other US federal employees who live on island - “nearly 80% of our population are presumptively covered under the Medicaid program.”

Lolo explained that numerous attempts by local government to attract private health insurance providers “were unsuccessful due to our largely high risk and low-income population.”

“As further consequence, our people do not have health insurance coverage that follows them outside of American Samoa,” he points out.

“Without the Medicaid program, our government-run health system would become insolvent and our territory would not be able to provide adequate medical care. Medicaid is the life source of our health care system,” he said and thanked the two US senators for considering his request “on behalf of my government and my people.”