Talofa lava Editor,
I read EPIC’s letter with deep recognition not from a distance, but from the inside of that very gap they are describing. I am a resident of American Samoa, a U.S. citizen, and a public servant who has dedicated over thirty years to serving this community because it has always been my passion to serve the underserved and the unserved. I am also a caregiver. Every word in EPIC’s letter is true. I know, because I lived it.
More than fifteen years ago, my mother-in-law suffered a major stroke. From that moment, our family’s life changed completely. We did not have the luxury of choosing between professional care and family care we had no choice but to do both, and to pay for all of it ourselves. I hired two caregivers at the same time to manage her around-the-clock needs at home. The cost came out of my pocket and out of her Social Security income. Because she was not a U.S. citizen or national, she did not qualify for any structured Medicaid-funded support. There was no waiver program to turn to, no adult day service, no respite care, no home health aide covered by any public program just our family, two hired girls, and a financial and emotional weight that grew heavier with every passing month.
For my sister-in-law, whose needs were beyond what we could safely manage at home, we turned to Hope House the one facility in this entire territory that provides that level of care. Hope House is a blessing, and the people there are dedicated and compassionate. But it operates on a waitlist and runs largely on the generosity of the Catholic Diocese and community donations. It is not a system. It is a lifeline held together by faith and private sacrifice.
Caring for my family cost me more than money. It cost me my own health and well-being. Like so many others, I showed up every day to work, and then came home to keep caring. Caregiver burnout is real, and it does not always show on the outside. There were days when I did not know how we would manage the next month.
This was over fifteen years ago, and yet the same gap that broke our family’s finances and health then still exists today in 2026. That is not an oversight it is a failure of systems and policy that has quietly devastated family after family across this territory, generation after generation.
EPIC is right. This is not a personal failing it is a system failing. Our families are doing everything they can. Many families in American Samoa are doing what mine did, quietly, without recognition, without support, and without a safety net. The fact that there are no Medicaid Home and Community-Based Services waivers in this territory no structured program to pay for personal care aides, respite care, adult day services, or in-home post-acute support is a policy gap with real and lasting human consequences.
I strongly support EPIC’s call for the expansion of Medicaid HCBS waiver programs in American Samoa. I urge the newly established HCBS Commission, our Medicaid office, and our federal partners at CMS to accelerate this work urgently because an executive order alone does not feed, bathe, or care for anyone.
To every family in American Samoa who is right now caring for a stroke survivor, an elderly parent, a sibling with a disability with no help, no reimbursement, and no end in sight I see you. Your service to your family is not invisible. And your story, like mine, deserves to be part of this conversation.
Ma le fa’aaloalo tele,
Alisi I. Filiaga
American Samoa Committed to Serving the Underserved
aifiliaga@gmail.com
