About the OMR Program
The Off-Island Medicaid Referral Program offers medical insurance coverage for eligible patient referrals that receive prior authorization from the Medicaid Office. The eligible patient beneficiaries are referred to New Zealand whereas the eligible patients with Medicare insurance are referred to Hawaii through our authorized Medicaid Provider network.
There are two types of patient referrals:
Emergency and Non Emergency patient referrals. Both types of patient referrals are subject to stringent screening requirements, by the Medicaid Clinical Medical Officer (CMO) and benefits team for eligibility.
An "Emergency" patient referral is defined as an immediate, catastrophic injury caused by an accident putting a patient at immediate risk of loss of life, vision or limb. All other patients referrals are considered "Non Emergency".
Patients must have US passport accepted by Medicaid and valid for 12 Months, except for MedEvac cases. Certificate of Identity (CI) is not allowed.
Eligibility Requirements
For the Medicaid OMR Program of Non-urgent Patient referrals
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U.S National or U.S Citizen
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Lawfully present Non-U.S Nationals/Citizens under 21
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Must be currently and legally residing in American Samoa
What is covered under
the Medicaid OMR Program?
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100% medical care coverage for patient's referral reason.
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100% coverage for patient's necessary air and ground transportation.
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100% accommodation coverage for patient with strict limitations.
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100% coverage for minor patient escorts (17 years and under)
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Partial coverage of visas and travel costs for Adult patient escorts (21 years and older)
Medicaid OMR Process
1
LBJ Physician requests referral to LBJ OMR committee for the patients approval. If approved, the LBJ referral office prepares all medical summary and sumbits to Medicaid.
2
Medicaid reviews for eligibility and processes the referral based on whether it is an Emergency on Non-Emergency referral. If approved, Medicaid seeks acceptance off-island from it's Medicaid Network.
3
If accepted by an off-Island Medicaid Provider, Medicaid notifies LBJ and the patient of acceptance status and issues a Guarantee of Payment for the patient's scope of coverage.
4
Medicaid coordinates patient transfer logistics with LBJ, all other necessary local agencies and off-island providers.
5
Upon completion of the patient referral, patient returns and reports back to LBJ referring physician for referral closure and to the Medicaid Office for exit survey.