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Only US citizens and nationals are eligible for the Medicaid off island referral program

Director of the local Medicaid Office, Sandra King-Young and Attorney General Talauega Eleasalo Ale
AG and Medicaid Office director say it's federal law… we can't change it
ausage@samoanews.com

Pago Pago, AMERICAN SAMOA — American Samoa permanent residents as well as legal residents are not eligible under the Medicaid off island referral program to New Zealand, which is fully funded by the federal government. However, they are eligible for the Medicaid program if they are treated at the LBJ Hospital in Faga’alu.

Under a law passed by the US Congress, based on US immigration laws, only US citizens and US nationals, including those born in American Samoa, are eligible for the Medicaid off island referral program.

The only two exceptions to the law — after amendments were passed by Congress in 2009 — are foreign children and pregnant women.

This was the testimony of local Medicaid Office director, Sandra King-Young during a hearing before the House Health Committee yesterday morning.

King-Young and Attorney General Talauega Eleasalo Ale testified on the issue ,which was raised by Rep. Faimealelei Anthony Fu’e Allen last week.

The hearing was chaired by Rep. Vesi Talalelei Fautanu Jr. who wanted King-Young to explain why AS permanent residents are not eligible under the program, although they've lived in the territory for many years, pay taxes to the government, and contribute to the economy.

King-Young explained that AS permanent residents are not considered US citizens or US nationals, and that's why they are not eligible under the Medicaid program.

However, AS permanent residents can be eligible for the off island referral program to New Zealand, under local funding from the American Samoa Government (ASG).

“It’s very clear under the Medicaid program requirements, our local Medicaid office can only draw down federal money to pay for treatment for those who are eligible under the program,” King-Young told the committee.

“For people who lived here in AS for over 20 years and they are given a 3-year immigration Identification Card (ID), we can’t do anything to help them from the Medicaid program because it's federal law. However, our government can do something to help them — that is, we can draw down 100% local funding to cover their off island treatment — but not from federal dollars.”

Basically, all AS permanent residents and legal residents are eligible under the Medicaid program if they are treated at the LBJ, but not off-island.

According to King-Young, there is a “special narrow exception” for the off island program for non US citizens and non US Nationals under Medicaid — but only for emergency situations. And that exception is very expensive and the costs will not be covered 100% with local funds.

She said Medicare is a different program, because it's like retirement and all legal residents in AS are eligible under Medicare. She said her office is encouraging everyone living in American Samoa who are medicare beneficiaries to travel to any part of the United States for their treatments, because they are all covered by Medicare.

The explanation did not sit well with Vice Speaker, Rep. Fetu Fetui Jr.

He said it’s very sad to hear that people who have lived in the territory for many years, including those from neighboring Samoa, who have served the government, villages, churches, and have contributed to many local developments are not eligible under the Medicaid program.

“These people have been residing in the territory for many years, paying taxes and they consider American Samoa their home. Why are we treating them like this?” Fetu asked.

“What are you doing to help these people?” Fetu asked Talauega.

The AG referred to King-Young's statement regarding the requirements set up by the federal government on how to use federal money. “This is a federal program and we can't change anything… Our government is only a poor government, not compared to the mighty US government which has a lot of money,” Talauega told the committee.

He said we can't use other people’s money to show our love for other people. We have to earn money to do what we want to do. He said his wish everyday is that our government has a lot of money, so we can help everyone who considers American Samoa their home.

“I know how you faipule feel about this issue; however, our government has a lot of other essential obligations that need to be prioritized, such as bringing good doctors to care for our people and building a new hospital for us. Let us pray that God will show us a way to help these people,” Talauega said.

Rep. Gene Luaitaua Pan asked Talauega if the Fono can amend the federal law so the government can help these people who are not eligible under the Medicaid program. Talauega said, “No, this is a federal law and we can’t do anything to change it.”

He said the reason why AS permanent residents are not eligible is because they are not considered by the United States as their residents; and pointed out that American Samoa controls its own borders.

Talauega said, “Once the federal government steps in and controls our immigration laws, things will be very hard for our families in Samoa. If they want to come here they will have to apply for a visa to enter American Samoa…”

When asked about data for the New Zealand off island referral program, King-Young said that since the start of the program, over 200 people have already been sent to New Zealand for treatment. Two of them are AS permanent residents, who were sent under the emergency situation, and the costs of their travel and treatment were fully paid with local funds.

As of now, 40 patients are on the waiting list. The director revealed that of  the $2 million allocated by the Fono as matching funds for the Medicaid program for the current fiscal year, $500,000 remains and it is expected that the fund will run out by August of this year.