The Social Security Act 42 CFR 430-480 (Act) and the Personal Responsibility and Workforce Opportunity Reauthorization Act (PRWORA) Public Law 104-193 authorize the American Samoa Medicaid State Agency to develop, promulgate, and publish policies and procedures for implementing the Medicaid program in the territory. An important consideration in developing policies and procedures for the Medicare Copay Assistance Program through the Medicaid State Agency is the principle of ensuring equitable access to Medicare copay assistance for dual eligible beneficiaries residing on-island. The presumed dual-eligible beneficiaries of the territory are entitled to both emergency and non-emergency medically necessary services that are not available in American Samoa. To ensure fairness, equitable access, cost management, and program integrity, policies and procedures must be transparent. Clearly defined roles and responsibilities are essential to prevent indiscriminate beneficiaries and to effectively manage limited financial resources. Medicaid shall provide Medicare Copay Assistance for dual eligible beneficiaries defined and identified in Section V. Medicaid can review and approve Medicare copay assistance requests from eligible dual beneficiaries. Medicaid requires that dual eligible beneficiaries submit a Medicare Copay Assistance Patient Consent Form, physician referral letter (if requested), insurance and residency documentation to the Medicaid Office. This approval must be made prior to the dual beneficiary’s medical travel to the U.S.