Medicaid State Plan needs to be changed


Dear Editor,

This letter addresses some core deficiencies and offers corrections to American Samoa’s (AS) healthcare strategy for improving access to primary care.

In 2018, Bishop Vaifanua Mulitauaopele, a Vietnam veteran and pastor, his wife Eva, and Stuart Hamilton, MD of the Eau Claire Cooperative Health Center, Columbia, South Carolina, met with ASG Leaders to outline an initiative to build a community sponsored non-profit primary care clinic—the Mission of Hope Clinic in Tafuna—and to staff it with U.S. licensed medical providers; a physician and a nurse practitioner.

The Mission of Hope American Samoa Board was informed, by the ASG Medicaid Director, that a few words in the Medicaid State Plan needed to be changed for the Mission of Hope Clinic to receive Medicaid Reimbursement. Presently, the State Plan allows only government sponsored primary care practices to receive Medicaid reimbursement for services, and there is no provision for such reimbursement for community non-profit clinics. There has been no government movement on the requested change for almost five years. On the other hand, Mission of Hope, AS secured land, designed a facility, obtained building funds, secured sources of supplies and equipment, and has tentative agreements for U.S. trained physicians. In order for the non-profit clinic to become self-sustaining, reimbursement for services is required and in high poverty population, this means Medicaid reimbursement.

Modifying the State Health Plan will also address the current healthcare personnel shortage by allowing innovative solutions and stimulating more jobs for nurses, technicians, and office support staff in AS.

The current American Samoa Medicaid System does not support healthcare which allows access to multiple levels and types of care. Government care is the only supported primary care. Community initiatives are not supported. A certified VA style clinic for the public is out of the question. Given the opportunity, Mission of Hope AS would launch such a community clinic with the help of Eau Claire Community Health Center that Bishop Vaifanua Mulitauaopele worked to plant seeds, before God called him home.

This letter is presented as my humble opinion as a retired RN with Training as a Women’s Healthcare Nurse Practitioner, and having experience locally with LBJ, DOH, Hope House, ASCC-AHEC and Mission of Hope AS, and also worked in Washington and California. I have tried to highlight the urgent need to adapt the American Samoa Medicaid State Plan in order to save lives and better steward funds, and address the needs of low resource families in AS. If all our leaders value life for everyone, it should be manifested in modifying the Medicaid State Plan to allow for a U.S. certified Primary Care Clinic in American Samoa like the MOH Clinic to serve all people.

Sincerely and respectfully,
Sailitafā Sione Samoa, RN, WHCNP, Retired