Medicaid Director, Sandra King Young, relayed to Governor Lolo M. Moliga the wonderful 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 and approved September 18 by CMS Director of Western Regional Working Group, Richard C. Allen.
This means that accommodations for the OMRNZ 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.”
The Medicaid Director 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 withthe request for reconsideration based on other states’ allowable accommodations. CMS agreed for us to resubmit the SPA.”
According to King Young when the OMR to New Zealand was designed, 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,” she stated.
The Medicaid Director expressed her gratitude to Governor Lolo M. Moliga and Lieutenant Governor Lemanu Peleti Mauga for the confidence and trust placed in her to vigorously pursue these Medicaid options to ensure that our people sent to New Zealand for medical treatment are comfortably accommodated.
She also expressed gratitude to the Fono for supporting the 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.
