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Medicaid office receives approval for off-island accommodations

Medicaid Director of the American Samoa Mediaid State Agency, Sandra King Young
Source: American Samoa Medicaid State Agency, Office of the Governor

Pago Pago, AMERICAN SAMOA — Medicaid Director of the American Samoa Mediaid State Agency, Sandra King Young, has relayed to Gov. Lolo M. Moliga the news that after 3 months of negotiations, CMS has approved American Samoa’s request to do cost-share on accommodations costs for the Off-island Referral Program.

The State Planning Amendment to cover accommodations for the Off-Island Referral program was submitted on June 28, 2019 and approved Sept. 18, by CMS Director of Western Regional Working Group, Richard C. Allen. 

This means that accommodations for the Off-island Medical Referral- NZ will now be an allowable cost and the Medicaid program can draw the 55% federal share for the total cost of accommodations while the government puts up the other 45%.

Since the program began, Medicaid used 100% local funds from its $2 million local match to pay for patient accommodations. King Young stated, "When we started our program, our goal was to build our people's confidence about going to NZ for medical care by ensuring that we cover all their costs, except food. This is key to building a sustainable future for the off-island program — that our people become willing to go to NZ where it is more affordable given our Medicaid cap and limited local match."

She further added, “When we negotiated the OMRNZ State Planning Amendment in 2014, the accommodations provision was removed as unallowable and the OMR SPA was approved in 2017.

“But this year this issue was revisited with CMS leadership along with the request for reconsideration based on other states' allowable accommodations. CMS agreed for us to resubmit the SPA. When we designed the OMR to NZ, Medicaid covering accommodations was a huge consideration because without it, our patients would not seek medical care in NZ. We are very thankful for this added financial assistance to our Medicaid program.”

Medicaid Director King Young expressed her gratitude to Gov. Lolo and Lt. Gov. Lemanu Peleti Palepoi Sialega Mauga for the confidence and trust placed in her to vigorously pursue all these Medicaid options to ensure that our people sent to New Zealand for medical treatment are comfortably accommodated. Gratitude is expressed as well to the Fono for supporting our off-island referral program evident by its support of the $2 million fund earmark to meet the required local match that allows Medicaid to implement the OMR and other Medicaid services.