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High stakes for American Samoa with push to extend higher Medicaid funding for Puerto Rico and other U.S. territories

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Source: Amerian Samoa Medicaid State Agency

Washington, D.C. — American Samoa Medicaid issues are being deliberated on at high levels and impacting Continuing Resolution (CR) negotiations in Congress —and this is historical — according to Sandra King Young, Medicaid Director, American Samoa Medicaid State Agency.

Trade mitigation assistance and Medicaid funding for U.S. territories were standing in the way of agreement on a stopgap funding measure Tuesday, sources said.

According to a senior democratic aide, the bill was likely to include an increase in the Commodity Credit Corporation's $30 billion borrowing cap that the Trump Administration asked for earlier this month. But provisions on "accountability and transparency" were still under discussion, the aide said.

Without the increase in the cap, the White House wrote in an "anomalies" request to lawmakers, the agency "would have to stop making payments as soon as the borrowing ceiling is reached," which was expected sometime after the end of the fiscal year on Sept. 30th. The Trump Administration announced a $16 billion aid package in July for farmers and ranchers hit by retaliatory tariffs imposed by China and other trading partners.

There's also a push to extend higher Medicaid funding for Puerto Rico and other U.S. territories that advocates say is needed before the end of the fiscal year because previously-appropriated funds are running out. But sources involved in the talks said Puerto Rico was not likely to receive any of the aid under the plan.

Resident Commissioner Jennifer Gonzalez-Colon, R-P.R., wrote in a letter Friday to congressional leaders that without more money in the stopgap measure, managed care plans won't be able to negotiate the higher reimbursement rates necessary for providers to serve Medicaid patients.

The letter says required funding cuts under the 2016 financial oversight law for Puerto Rico would result in additional loss of coverage, plus three new HIV drugs won't be covered and planned coverage of Hepatitis C drugs won't go forward. 

The Medicaid matching funds issue also affects other territories, such as the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands. The dispute now was mainly over how much assistance for the other territories would be included, sources said.

The stopgap funding bill, expected to run through Nov. 21st, was also expected to include a package of health care program extensions, such as funding for community health centers.

The discussions are ongoing with about eight legislative days before the end of the fiscal year on Sept. 30th, when current government funding expires.