Senators begin Legislative session with update about healthcare issues

Pago Pago, AMERICAN SAMOA — Members of the Senate on Tuesday morning met for the official beginning of the 4th Regular Session of the 38th Legislature officially. They last met during the Special Session called in April this year by the governor.

Only Senator Fonoti Tafa’ifa Aufata was absent and President Tuaolo Manaia Fruean commended the senators for making the effort to be present. He stated that he was especially proud of this during Monday’s opening ceremony at the Gov. H. Rex Lee Auditorium because it reflected solidarity and accountability in the Senate.

Chairman of the Senate Health Committee, Senator Tuiasina Salamo Laumoli revealed what had transpired in a hearing called by his committee at the beginning of last month, while the Fono was in recess and reported on the latest update.

According to Tuiasina, the hearing had been called to ascertain why the off-island referral program for LBJ patients funded by Medicaid was put on hold and the closure of the Hope Dialysis Center in Vaitogi on June 30, 2024.

Medicaid Director Sandra King-Young testified that this happened because there were not enough funds to implement their services.

She told the Senate Health Committee that the quickest way to get the funding needed to restore Medicaid services, including the off-island medical referral program is for the Fono to pass a supplemental appropriation.

Senator Magalei Logovi'i pointed out that any appropriation passed by the Fono must have a funding source.

King-Young said she had requested funding of $8 million in her budget submission for the current fiscal year; however, the administration only approved $4 million.

She explained that the off-island referral program funded by Medicaid was started six years ago, without any specific revenue earmarked to fund it. She said to sustain the program, it needs a new revenue measure to fund it.

Yesterday morning, Senator Tuiasina reminded senators that Governor Lemanu had mentioned in his State of the Territory speech on Monday that a total of $2 million of local revenue has been earmarked for the Medicaid matching fund.

This would bring the total of matching funds to $6 million.

The Health Committee chairman in his update to the Senate clarified that LBJ Hospital is continuing its off-island referral program but for only those patients who have Medicare. He said LBJ pays for only the airfares of the patient and the escort. All other costs like medical care and accommodation are paid by the patient.

On the other hand, patients without Medicare are fully funded by Medicaid, he said.

(Samoa News should point out that Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources and varies from state to state or territory to territory. Patients without Medicare do not necessarily qualify for Medicaid.)

Tuiasina also revealed the latest update on the Hope Dialysis Center saying that he had been informed on Monday by the LBJ CEO Dr. Akapusi Ledua that the Hope Dialysis Center had now been closed.

This was because it could no longer afford the cost of dialysis treatment with the suspension of Medicaid funds.

Tuiasina stated that the 41 patients who had been treated at the Hope Dialysis Center were now transferred back to LBJ.

LBJ had been treating 198 patients and the new addition brings the total number of patients to 239.

The number of treatments (3 times per week) needed for the 41 additional patients in one year is $5,490, which translates to $1.3 million of additional revenue for LBJ, the senator reported.

Senate President Tuaolo asked Tuiasina if they had asked the Hope Dialysis Center management why they were closing their doors. Tuiasina replied that they did not get a clear answer from the private dialysis treatment center.

However, their committee had been told by Medicaid Director Sandra King-Young, that her office was not obligated to cover treatment for patients at Hope Dialysis Center.

Senator Togiola Tulafono said that he had heard rumors on Monday that negotiations were underway between LBJ and the Hope Dialysis Center to help carry out treatment for patients at LBJ.

He requested the Health Committee to investigate these rumors.

Togiola revealed that he had been heavily involved in the establishment of Hope Dialysis Center and that LBJ had harbored animosity against the private dialysis center.

He said that LBJ did not want patients to transfer treatment and Medicaid funding to Hope Dialysis and did all it could to shut down its operations.

And now that Hope Dialysis has closed its doors, LBJ is now whining about the added workload.

Togiola stated that he had been involved with Hope Dialysis in the early stages of its inception but had stepped away when he had been selected to represent his constituency in the Senate.

He reiterated that he wants the committee to investigate if the rumors are true and if there is a way for LBJ to help restore Hope Dialysis services for the benefit of dialysis patients.

BACKGROUND

MEDICAID

Samoa News reported in March of this year that the American Samoa Medicaid State Agency (ASMSA) notified Gov. Lemanu P.S. Mauga and Lt. Gov. Talauega E.V. Ale in a memorandum dated January 16, 2024 of the depletion of local match at the end of the 2nd quarter of FY 2024 on March 31, 2024.

At the time the Medicaid office requested additional funding for a supplemental appropriation to continue the Medicaid programs until the end of FY2024. “… to continue Medicaid programs until the end of the fiscal year (September 30, 2024), I respectfully submit this request for an additional $6 million for a supplemental appropriation,” King Young explained in her Jan. 16th memo.

In the same memo, She pointed out that per government policy the agency cannot spend beyond their appropriations, “which is $4 million for FY 2024.”

A month later, Feb. 16, ASMSA informed the top ASG leaders through a memo that all Medicaid services would be suspended by March 1, 2024, a month ahead of their previously stated suspension date of April 1, 2024 “due to the Medicaid subsidy funds (local matching funds) being ‘significantly decreased to a remaining balance of $200K for the 1st & 2nd quarter of FY2024, and $1 million remaining for Budget and Treasury department to load’.”

The ASMSA director pointed out in her Feb. 16th memo that the funding “is insufficient to sustain services” until the end of FY 2024. She explained that, “given the existing number of patients in New Zealand and Hawaii, along with patients awaiting travel, it is impossible to cover the costs associated with medical services, lodging and transportation…”

 King Young does note that ASMSA “will continue to cover those patients who are in progress of receiving services and who have already started their referral process with Medicaid.” 

In a vendor notification letter, dated Feb. 29, 2024, Medicaid explained the reason for the suspension of all Medicaid services, and when it will resume — that is, it is contingent on obtaining supplemental funding. There would not be any new referral requests until the funding issue was resolved, the vendors were told.

HOPE DIALYSIS CENTER

Samoa News reported on the issue, on July 1, 2024 — the day the private dialysis center officially closed its doors, according to John Wasko, one of the partners in Hope Dialysis (HD).

“Too bad,” he said in his email response to Samoa News queries. “Only fully CMS approved (no waivers) medical facility on island. 

“ASG refuses to contribute to Medicaid state plan.

“Health care not a priority in Pago Pago, American Samoa,” he concluded.

Wasko is referring to the 20% local match that HD said it needed to stay open in a letter it distributed to its patients/ clients notifying them of the closure.

The Samoa News story also reported that the LBJ Tropical Medical Center in a press release, dated Friday, June 28, 2024, and signed by Dr. Akapusi Ledua, LBJ CEO, that all HD patients needed to report to LBJ over the weekend to conduct blood tests necessary to transition dialysis treatment from HD to the LBJ Dialysis clinic.

HD employees in the same press release, were also asked to report to the LBJ Human Resources Office on Monday, July 1, 2024 to begin the process to transition to the LBJ Dialysis Unit.

HD patients and their families were concerned over the closure of the privately-owned dialysis center, with several reaching out the Fapule Larry Sanitoa about the issue. In turn, the faipule wrote to the LBJ CEO, who responded in an email.

Ledua wrote that he had been in discussion with Dr Letarte from Hope Dialysis 3- 4 months ago regarding his plan of providing dialysis services on island.

At the same time, Dr. Ledua wrote, “…our hospital senior leaders and I have been having discussions and plans on the Hope Dialysis closure and our dialysis service to accommodate all Hope Dialysis patients.”

He said the short-term solution to the closure of Hope Dialysis was outlined in the press release they sent out on Friday, June 28th to the media and it was also on the LBJ website.

Dr. Ledua further noted that “our dialysis unit has scheduled shifts to accommodate all the patients that were using Hope Dialysis.

“We have also prepared supplies to meet this need.”