For now the New Zealand Medicaid Referral Program can no longer take permanent residents except for emergency cases, given that the September 30 deadline for the 100 % waiver for the local match for Medicaid has passed.
But Medicaid Director Sandra King Young says her office is working on something so that permanent residents can again be eligble for the referral program.
She explained that all residents,.are eligible for referral if it’s an “emergency” case.
Emergency is defined as a “traumatic, catastrophic, or IMMEDIATE injury as a result of an accident, that puts the person’s life or limb at a risk of loss.”
She pointed out that non communicable diseases or long term chronic medical conditions that become acute for any reason is not an emergency.
King Young said It’s important for people to understand that the OMR to NZ is not an entitlement.
“Just because you are approved from LBJ Hospital to be refered does not mean that you will go to NZ,” she said.
Explaining the process she said that once Medicaid receives the referral from LBJ, Medicaid must screen for proper referral under the state plan (some medical conditions are not covered under the state plan–like palliative care, rehabilitation, psychiatry, dental, bariatric surgery, medical treatment that is available on island, etc.) and ensure that the patient has valid travel documents and visas are in order.
All patients require “medical” visas. NZ must accept the patient first in order for the patient to travel to NZ for medical care.
“Sometimes NZ denies the case because they have made a clinical decision that the patient does not need referral and can be taken care of on island first or that there is nothing more they can do in NZ–the patient needs palliative care,” King Young explains.
“This is very difficult for families to accept and they still insist on being referred. Even if patients do go, sometimes the referral medical notes are incomplete and the patient cannot be treated until some other medical condition can be
controlled, and the patient is sent back until that is done.”
The Director said Medicaid does not make clinical decisions to deny patients. “But we will deny patients and escorts if they do not meet for example, legitimate residency requirements.
“You must be a legitimate bona fide resident of American Samoa to be covered under the AS Medicaid program, said the Medicaid Director.
“That is how Medicaid works, it is particular to a state or territory and you cannot take your Medicaid coverage from California to American Samoa or vice versa.
“And the American Samoa program is not like the states’ program so please contact our office to understand how the AS program works.
“Because of our cap as a block grant and our high FMAP, services are subject to funding availability.”
