Senate Health Committee hearing gets in-depth explanations from Medicaid, DOH, LBJ & HDC

Pago Pago, AMERICAN SAMOA — The reasons behind the closure of the Hope Dialysis Center (HDC), LBJ's role in the treatment process for HDC’s dialysis patients, and the suspension of Medicaid funding for the patients' off-island referral program were explained in detail in yesterday's hearing of the Senate Health Committee.

Testifying were Medicaid Director Sandra King-Young, DOH Director Motusa Tuileama Nua, LBJ Acting CEO Dr. Maria Guyapa, LBJ COO Dr. Jean Anderson, LBJ Acting CMO Dr. Sunia, HDC Facility Administrator Saluafata Talili, HDC Compliance Officer.

Committee Chairman Senator Tuiasina Salamo Laumoli stated that the reason the HDC officials had been subpoenaed as requested by Senate President Tuaolo Manaia Fruean, was to explain in depth the reasons behind the closure of the private dialysis service provider.

Tuiasina said that he understands it has to do with the lack of funds, but the senators want to know exactly who is responsible for these funds.

HDC Facility Administrator Saluafata Talili explained that Hope Dialysis receives its funding through private insurance — MedicCARE Parts A & B, MediCARE Advantage, and Private Insurance account for 80 percent of their funds.

However in American Samoa, patients do not have insurance to pay for the 20 percent needed, which was why they were requesting the Fono for the opportunity to be a Medicaid provider to help them fund the 20 percent.

She pointed out that if a patient has insurance, 20 percent will amount to about $800 to $1,000 a month. Without insurance, it will cost about $4,000 a month and patients simply cannot pay such an amount every month.

"That is why we have come to ask the Senate to allow Sandra's office to help us out with the 20 percent," the HDC official said.

She said that when they started, they had 8 to 10 patients who all had insurance so it was alright and they also had investors who helped them in the first five years of operations.

However, it was during the pandemic that they began to experience financial problems because some of the patients didn't have insurance while some had lapsed, and they were not able to get the full payment for the dialysis treatments they were giving to their patients.

Senator Magalei Logovi’i argued however that Hope Dialysis Center had been established as a private business venture anticipating a profit but when it failed and the stakeholders retreated, they were now running back to the government for help.

Meanwhile, LBJ has been kind enough to take their patients back for treatment  astheir lives depended on it.

Talili insisted though that when COVID-19 hit the Territory, LBJ did not want to take the dialysis patients.

"Who took them? We did!" she said dramatically.

Senator Utu Sila Poasa intervened and reasoned that American Samoa Medicaid Director Sandra King-Young should be given the chance to explain the connection between the three entities concerning the Territorial Medicaid State Plan.

King-Young stated that she had been involved with HDC since the very beginning when they first approached her in 2017 or 2018 about wanting to set up a private dialysis clinic in American Samoa.

She said that she informed them that she could not enroll them as a private Medicaid provider providing dialysis because those services were already provided at LBJ.

So they opened their doors in 2019 without being a Medicaid provider. In other words, they did it at their own risk.

The Medicaid director said that in 2021 when Governor Lemanu P.S Mauga initiated repatriation efforts, the issue was dialysis patients could not be brought home because they had to be quarantined.

She said it was agreed that they could not be treated at LBJ because of the risk of exposure and they had to be separated from the rest of the population.

The only solution was to use HDC as an emergency Medicaid provider and they were paid $450 per patient every time treatment was needed. HDC's role in this emergency response was admirable but the only problem was — it was temporary.

King-Young said that at the end of the public health emergency time period in November, her office informed HDC of their "dis-enrollment" or the termination of their Medicaid provider status.

She also explained to them that they could not be a permanent Medicaid provider this year because the financial year 2024 had already started.

However, she indicated that her office was willing to take HDC on as a permanent Medicaid provider in FY 2025 which begins in October 2024, and as long as there was a local match for funds to be used.

"Governor Lemanu has already instructed me to move forward with amending the State Plan to allow this to happen for any private dialysis institution, so long as we have the local match increase for the year, and it would be up to me to look at the financial data and set aside an amount to ensure that we provide them with local match," the Medicaid director said.

Samoa News points out that currently the local Medicaid office has suspended all Medicaid services  “including the Off-Island Referral Program, Vision Program DMEPOS, except for payments to the LBJ Hospital, Department of Health- FQHC, and Hope House, as they can provide their (own) local match.”

Medicaid also continues to cover those patients who are in progress of receiving services and who have already started their referral process with Medicaid.

According to King Young in a memo to the top leadership of the local government in Feb. 2024, resumption of Medicaid services is contingent on obtaining supplemental funding.

To date, the Medicaid services continue to be suspended as no supplemental funding has been requested by the government to the Fono.

Notably, in his State of the Territory Address to the Fono on Monday, July 8th, the governor mentioned that $2 million has been earmarked for the Medicaid match. Whether this is for FY 2025 or FY 2024 is not clear. However, the $2 million if earmarked for FY 2024, would still be short the funding King-Young said is needed for her budget — she requested $8 million for FY 2024, and the administration only approved $4 million.

Samoa News will continue to report on the hearing in coming issues.

BACKGROUND

In a July 10, 2024 email, King Young responded to a query from Samoa News about details of the MediCARE vs Medicaid coverage for American Samoa. Her response was:

Medicare is for retired people who have paid into the system with the FICA payments. And generally people who are on dialysis are eligible for MediCARE so long as they have met the requirements for MediCARE eligibility which is 40 quarters of tax payments.

So until you reach MediCARE age of retirement, you are covered under MedicCAID so long as you are a resident of American Samoa —living here, not just born here — and a US national (i.e. US citizens or US Nationals born here).

The other elected covered people under our Medicaid plan are foreign born children 21 years old and under and foreign pregnant women generally at LBJ. They must be residing in AS legally.