Dear Editor,
American Samoa is facing a critical and urgent gap in long-term care—and the solution is within reach through the expansion of Medicaid Home and Community-Based Services (HCBS) waivers.
Today, too many families are left to manage complex medical conditions at home with little to no support. Individuals recovering from surgery, living with post-stroke paralysis, or managing multiple chronic illnesses require consistent, skilled care. Yet for many low income, Medicaid-eligible households, these essential services simply do not exist in a structured, accessible way.
Without HCBS waiver-funded services, families are forced to shoulder overwhelming costs—purchasing wound care supplies, personal care items, and medical equipment out-of-pocket. Many caregivers reduce work hours or leave employment entirely to provide full-time care. This not only deepens financial hardship but places caregivers at risk of burnout, while compromising the quality and safety of care for vulnerable individuals.
Expanding Medicaid HCBS waivers would allow American Samoa to provide critical services such as adult day programs, personal care assistance, respite care, and post acute in-home recovery support. These services enable individuals to remain safely in their homes and communities while receiving appropriate care—an approach that is both culturally aligned and cost-effective.
States and territories that invest in HCBS have demonstrated reduced hospitalizations, improved health outcomes, and stronger family stability. More importantly, HCBS affirms the dignity of our elders and those living with disabilities by allowing them to age and heal in place.
This is a policy opportunity we cannot afford to delay. We urge local and federal partners to prioritize the development and approval of Medicaid HCBS waiver programs in American Samoa, allocate necessary resources, and support community-based providers ready to meet this need.
Our families are doing everything they can. It is time for our systems to do the same.
Sincerely,
Empowering Pacific Island Communities-EPIC
