American Samoa Governor Looks At Sustainability Of Universal Health Insurance

Use of Medicaid to provide coverage explored as option

By Joyetter Feagaimaali’i-Luamanu

PAGO PAGO, American Samoa (The Samoa News, Jan. 10, 2017) – The Lolo and Lemanu Administration is looking at the future sustainability of a Universal Health Insurance Program for the territory by expanding the Medicaid Program. This is according to Governor Lolo Matalasi Moliga’s State of the Territory Address Comprehensive Report in English that was handed out to lawmakers and others at the opening of the Fono yesterday.

The governor delivered his Address in Samoan only, but there was no mention of health, education or Manu’a matters, instead he offered a brief summary of the state of the Territory.

However, the 83-page Comprehensive report, which looks at the last 4 years of the Administration that took office in January 2013, does include review and discussion of health, education and Manu’a matters.


The comprehensive report notes the territory’s inability to set up an Insurance Exchange has allowed the addition of $16.5million of the Affordable Care Act funds to expand the Territory’s Medicaid program. To Access ACA funds, American Samoa had to expand all of its regular Medicaid funds for allowable expenses.

As a result, ACA funding has significantly improved funding opportunities for the LBJ hospital and all the Community Health Centers (CHC) under DOH.

There are also efforts currently being made to address the future sustainability of a Universal Health Insurance Program for American Samoa. Medicaid is aggressively exploring the viability of the program before ACA funds expire by 2019.

Therefore, ASG is venturing towards the option of expanding the Medicaid Program as a Universal Health Insurance Plan. “With a universal insurance coverage in place, Medicaid could provide legal residents of American Samoa with affordable health insurance and access to various healthcare providers both local and abroad.”

The report says through a verbal agreement with the CMS — the CMS Deputy Administrator and Director of Medicaid and Services — Medicaid has been affirmed to utilize the Territory’s Medicaid program to provide universal coverage by including off island coverage for legal residents of American Samoa.


The report notes that the local Medicaid Office has been working with the Center of Medicaid and Medicare Services to lower the local match from 45% to 30% and increase the federal contribution from 55% to 70% or at the same level as other US States.

The Medicaid office has also been working with the CMS leadership and the USDOI Office of Insular Affairs to lower or remove the statutory cap behind the Medicaid Assistance Program (MAP), which is based on a set population formula that only Congress can change.

“This cap has affected the amount of funds American Samoa receives every year. This issue has been recognized by President Barrack Obama; and submitted legislation to the US Congress to remove the Medicaid cap for all five US Territories in 2015.

“The Medicaid Program also recently received a 2.2% increase in the Federal MAP percentage, which reduces the local match requirement for Medicaid funds and generated an additional $1.8million to its revenue steam for over a two-year period. The completed reconciliation of the 2012 Medicare Cost Report by Medicaid in 2015 yielded an additional distributional payment of $2.3million of incentive funding for LBJ without need for a local match.”

According to the report, CMS also approved the Medicaid office application for the State Innovation Model Design Grant, which netted $750,000 to finance the implementation of Phase 1 of the SIM Program in the territory.

The approval also provides eligibility for American Samoa to financial resources under the State Health Care Innovation and Health Improvement Plan and additional benefits to improve both healthcare delivery and reduce healthcare costs for residents of American Samoa.

The report notes that with Phase 1 that’s currently ongoing, Medicaid might receive an additional $30million to implement Phase 2 of the SIM program.


The report says that the Territory’s State Plan Amendment Reimbursement for prosthetics coverage has received CMS approval.

“It means local residents may now receive coverage services for prosthetics through the local Medicaid program. To facilitate the coverage more effectively, Medicaid has been working with LBJ to resolve and identify a suitable payment and reimbursement methods for the program. One of the payment options being currently considered by Medicaid to resolve the issue is through direct payments to vendors.”


Lolo said that to ensure that more funding opportunities are available for the Territory, the Medicaid Office has been working to revise the American Samoa Medicaid State Plan to bring the territory’s healthcare delivery and accessibility up to standard.

He noted, “Unfortunately, the existing State plan fails to recognize the healthcare services provided by the Community Health Centers. It further undermines DOH’s eligibility for other technical assistance available under the Medicaid program. The Medicaid Office anticipates a revised final draft of the Medicaid State plan before the end of this year.”

Samoa News will report on the other matters that are reviewed and discussed in the Territory Address Comprehensive Report in English and were not during the governor’s Samoan Address — Education and Manu’a.

The Samoa News
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