Dear Editor,
American Samoa urgently needs greater transparency and legislative action regarding Medicaid funding for elderly residents and persons with disabilities.
CMS has approved Personal Care and Home Health Aide Services for Medicaid-eligible residents. These services can help people who are bedridden, medically frail, living with disabilities, or managing multiple chronic illnesses remain safely in their homes. They also provide critical relief to family caregivers who are carrying an overwhelming responsibility with limited assistance, supplies, or respite.
Despite this federal approval, the Medicaid Director has advised Empowering Pacific Island Communities that additional service providers cannot be enrolled because the local Medicaid match is insufficient. This means an approved Medicaid benefit remains inaccessible to many of the residents it was intended to serve.
The public and the Fono deserve a clear explanation.
Was the Legislature’s intent that the local Medicaid appropriation be used as the required match for services provided to Medicaid-eligible residents? Or was the funding also intended to pay 100% of the cost of care for people who are not Medicaid eligible and whose services receive no federal reimbursement?
If the same local appropriation supports both groups, how much is used to draw down federal Medicaid funds, and how much is spent entirely as local funding? Was the local match exhausted during the prior fiscal year? Which services and expenditures caused the shortfall? How much additional local funding is necessary to implement Personal Care and Home Health Aide Services and enroll qualified community providers?
These are not merely accounting questions. They directly affect whether an elderly parent receives help bathing, dressing, eating, transferring safely, or remaining in the family home. They determine whether a person with a disability receives essential daily assistance and whether an exhausted family caregiver receives even a few hours of respite. Families also need access to personal care supplies and other long-term services and supports necessary to provide safe care at home.
CMS approval should lead to actual access—not an approved benefit that exists only on paper.
We respectfully call upon the Fono to review the appropriation and use of the Medicaid local match, examine the basis for the reported funding shortfall, and determine whether local funds intended to draw down federal Medicaid dollars are being used as effectively as possible.
We also ask the Fono to consider a dedicated or restricted local appropriation for Home and Community-Based Services, including Personal Care, Home Health Aide, respite, and other long-term care supports for elderly individuals and persons with disabilities. A supplemental appropriation may be necessary so qualified providers can be enrolled and services can begin without further delay.
American Samoa’s families are already providing most long-term care without compensation, adequate supplies, professional support, or meaningful respite. They can not continue carrying this burden alone while an approved Medicaid service remains unavailable because of an unresolved local-match problem.
Our elderly residents and persons with disabilities deserve dignity, safety, choice, and the opportunity to remain in their homes and communities. The Fono, Medicaid Office, service providers, advocates, families, and caregivers must come together now to identify the funding required and establish a clear implementation plan.
Respectfully,
Kathryn McCutchan
Executive Director / Project Director
Empowering Pacific Island Communities
epic.samoa@gmail.com
