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ABOUT AMERICAN SAMOA MEDICAID PROGRAM
Medicaid is a federal-state shared insurance program established to serve low-income families. Medicaid was approved and passed in Congress under Title IX of the Social Security Act. The American Samoa Medicaid State Agency consists of six imperative divisions. Enacted in 1965, Medicaid provides the Federal matching funds available to states/territories for the cost they incurred in paying health care providers for delivering covered services to eligible individuals. State/Territory participation is voluntary, and American Samoa has participated since 1984. Medicaid operates as an assistance program and does not require financial contribution from the recipients. The State Medicaid Agency under the Office of the Governor is committed in becoming an effective and efficient agency that administers the Medicaid Program in American Samoa to achieve its mission. The State Medicaid Agency is funded by both the Federal and the American Samoa Government. Each division serves significant roles in fulfilling the mission, vision, goals, and objectives of the Medicaid program in American Samoa. Each division consists of a Division Head and support staff under the leadership of the Medicaid director. The Governor of American Samoa appoints the Medicaid director (governor appointee) to lead
and guide the Medicaid program in fulfilling its mission, vision, goals, and objectives.

WE PUT YOUR CARE IN THE HANDS OF THE QUALIFIED
Our Medicaid team is filled with the most qualified people. Each with their own set of abilities and skill, working together in a highly collaborative environment, to bring to the island of American Samoa, the medical care and help it deserve. We work tirelessly for the people, because we are the people. Each born and raised within the shores of American Samoa.
History of American Samoa Medicaid State Agency
The American Samoa Medicaid program was approved in 1982 under a General Waiver, more commonly referred to as American Samoa’s 1902(j) Waiver under the Social Security Act of 1965. This waiver grants to American Samoa a unique program that does not do individual eligibility and enrollment. Instead, American Samoa’s Medicaid beneficiaries are determined by a presumptive eligibility model that bases eligibility on the territory’s total foreign population versus the total US National population data—there is no eligibility determination and no enrollment. The rationale of the American Samoa Government at the time was that American Samoans would not want to enroll in the Medicaid program because it was described as a welfare program. The eligible population of the territory in the early 1980’s was more than 80% of the population. It was this population data which correlated to a low foreign population count that decided the policy of presumptive coverage given the population of about 60,000 people.
This perception of Medicaid as a welfare program, however, has significantly changed and people now view the Medicaid program as a necessary lifeline for medical care in the territory. The Medicaid program evolved to become a true health insurance safety net for all beneficiaries who were categorically eligible for the program. The stigma of a welfare label disappeared, and all residents now desire Medicaid coverage. At the same time, 40 years since the establishment of the Medicaid program in the territory, the eligible population numbers have decreased due to out-migration and the foreign population have significantly increased. The Federal Medical Assistance Percentage (FMAP) was approximately 88% in 1982. This has now decreased to 67% in 2023. The higher the foreign population, the lower American Samoa’s federal claiming percentage under the presumptive eligibility model. This has become more evident with the downward trend of presumed eligible Medicaid/CHIP populations from past Presumptive Eligibility Reports submitted to CMS annually.
