Medicaid & CHIP in American Samoa
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Medicaid Overview
The Medicaid program in American Samoa differs from Medicaid programs operating in each of the 50 states and the District of Columbia. Some of the key differences are:
- American Samoa became a territory in 1900 and its Medicaid program was established in 1983. It is a 100% fee-for-service delivery system with one hospital servicing the territory. There are no deductibles or co-payments under the American Samoa Medicaid program however there are some fees charged by the hospital located in American Samoa. Unlike states, American Samoa residents are not eligible for Medicare Part D low-income subsidies; instead the Medicaid program receives an additional grant through the Enhanced Allotment Plan (EAP) which must be utilized solely for the distribution of Part D medications to dual-eligible or low-income Medicare eligible individuals.
- American Samoa operates its Medicaid program under a broad waiver granted under the authority of Section 1902(j) of the Social Security Act. This provision allows the Secretary to waive or modify any requirement of Title XIX, in regards to American Samoa’s Medicaid program, with the exception of three: the territory must adhere to the funding cap set under Section 1108 of the Act; the territory must adhere to the statutory Federal Medical Assistance Percentage (FMAP); Federal medical assistance payments may only be made for amounts expended for care and services described in a numbered paragraph of section 1905(a).
- Through Section 1108 of the Social Security Act (SSA), each territory is provided base funding to serve their Medicaid populations. Over the past decade Congress has temporarily increased federal funding for the territories’ Medicaid Programs via a number of specific statutory provisions. For federal fiscal year 2021 American Samoa’s ceiling is $85.6 million.
- Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures at the appropriate federal matching assistance percentage (FMAP) rate for that state, in American Samoa, the FMAP is applied until the Medicaid ceiling funds and any other specified federal funds are exhausted. The statutory FMAP rate increased to 55% effective July 1, 2011. Starting in January 2014 Congress has temporarily increased the FMAP along with federal funding, bringing American Samoa’s FMAP to 83% for federal fiscal year 2021.
Medicaid-Marketplace Overview
American Samoa was awarded $16.5 million for its Medicaid program in lieu of establishing a health marketplace. American Samoa must exhaust its Affordable Care Act (Section 2005) allotment prior to using these funds.
Medicaid and CHIP Standard Monthly Income Eligibility Levels
Eligibility in American Samoa differs from eligibility in the states. American Samoa does not have a TANF or SSI program and does not determine eligibility on an individual basis. Rather, the territory uses a system of presumed eligibility. Each year the percentage of the population below 400% of the federal poverty level is estimated and, after CMS approval of the estimate, CMS pays expenditures for Medicaid based on that percentage.
Monthly Medicaid and CHIP Enrollment Data
For federal fiscal year 2021, 37,756 people are considered eligible for the Medicaid and CHIP program in American Samoa based upon the presumed eligibility percentage
Medicaid and CHIP Applications
- As previously mentioned American Samoa does not determine individual eligibility and has no Medicaid/CHIP application.
Medicaid and CHIP State Plan Amendments
The state Medicaid and CHIP plans spell out how each state has chosen to design its program within the broad requirements for federal funding. As always, states amend their Medicaid and CHIP state plans in order to inform CMS of programmatic and financing changes and to secure legal authority for those changes. The Affordable Care Act included many new opportunities for states to augment and improve their Medicaid and CHIP programs. As a result, there has been a great deal of state plan amendment activity over the past several years in the areas of eligibility, benefits design and financing, as well as new approaches to providing health homes, long-term services and supports, and enrollment strategies like hospital presumptive eligibility. See below for a state-specific list of approved Medicaid and CHIP SPAs.
Demonstrations and Waivers
Demonstration and waivers are vehicles states can use to test new or existing ways to deliver and pay for health care services in Medicaid and CHIP. The primary types of waivers and demonstration projects include section 1115 demonstrations, section 1915(a) and 1915(b) managed care waivers, and section 1915(c) home and community-based services waivers. More information about waivers is available on the Waivers page.
- Currently, American Samoa has no demonstration projects or waivers.
Medicaid Delivery System
States have choices in their approach to delivery system design under the Medicaid and CHIP programs. States are increasingly moving to the use of managed care and other integrated care models in serving their Medicaid beneficiaries. At this time, American Samoa is 100% fee-for-services (FFS) and does not offer managed care services to its beneficiaries.
CHIP Program Information
The Children’s Health Insurance Program was established in 1997 to provide new coverage opportunities for children in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage. Like Medicaid, CHIP is administered by the states, but is jointly funded by the federal government and states. States had the opportunity to design their CHIP programs (PDF 216.11 KB) as an expansion of Medicaid, as a stand-alone program or through a combined approach.
American Samoa has elected to operate a title XXI funded Medicaid Expansion program.