Medicaid Unwinding in American Samoa: What You Need to Know
Key takeaways:
Medicaid renewals in the U.S. are changing because of the end of the COVID-19 public health emergency (PHE) on May 11, 2023. This is being called the unwinding of Medicaid, and some people will lose coverage during this process.
During the PHE, Medicaid renewals were automatic, and enrollees had continuous coverage. As part of the unwinding process, automatic renewals for Medicaid and the Children’s Health Insurance Program (CHIP) stopped nationwide on March 31, 2023.
Medicaid is not individually determined in American Samoa, so there are no renewals to resume. As a result, people in this territory are not expected to lose coverage like in other parts of the U.S.
The U.S. Department of Health and Human Services declared a public health emergency (PHE) for COVID-19 in January 2020. The PHE was renewed a dozen times through February 2023.
People who qualified for Medicaid during the COVID PHE were able to keep their coverage throughout the pandemic without having their eligibility reviewed. This is because all states and territories were required to provide continuous coverage during the PHE.
But the PHE ended on May 11, 2023. And that marked the end of most COVID provisions, like automatic Medicaid renewals, which stopped nationwide in March. These changes could cause 8 million to 24 million Medicaid enrollees across the country to lose coverage.
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However, Medicaid programs operate differently in the five U.S. territories with permanent populations:
American Samoa
Guam
U.S. Virgin Islands
Medicaid eligibility depends on the incomes of individuals or households in all of these territories — other than American Samoa.
In American Samoa, Medicaid coverage is not individually determined. Instead, all residents can receive needed care in qualified medical settings and are only responsible for small copays. The Centers for Medicare & Medicaid Services funds Medicaid in American Samoa based on the percentage of people who potentially qualify.
For this reason, American Samoa doesn’t have a redetermination process for individuals. So residents of this territory are not expected to lose coverage due to the end of the PHE, like in other places in the U.S.
Why is Medicaid changing nationwide?
Now that the PHE has come to an end, COVID will remain a public health priority — just not an emergency. As part of this process, Medicaid renewals will no longer be automatic. This is being referred to as the unwinding of Medicaid.
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The unwinding will affect Medicaid in every state, Washington, D.C., and five U.S. territories.
How does Medicaid work in American Samoa?
The American Samoa Medicaid State Agency is responsible for overseeing the territory’s Medicaid program. The territory has about 50,000 residents, and most of them — about 38,0000 in fiscal year 2021 — qualify for Medicaid, the Children’s Health Insurance Program (CHIP), or expansion coverage.
Residents do not have to apply for Medicaid or CHIP in American Samoa. Instead, the territory uses presumptive eligibility to estimate its need for healthcare. Residents can access services covered by Medicaid at the LBJ Tropical Medical Center, the territory’s only hospital, and participating community health centers. Medicaid also covers air evacuation and off-island referrals for specialized care — such as cancer treatment — in New Zealand.
Medicaid funding in American Samoa
American Samoa received extra funds for its Medicaid program instead of establishing an Affordable Care Act (ACA) marketplace. That means residents can’t enroll in ACA coverage.
During the COVID PHE, Medicaid funding was increased in American Samoa. The territory’s pandemic-era 83% federal match was permanently extended in a budget bill signed in December 2022 by President Joe Biden. This will allow American Samoa to continue delivering low-cost primary care to residents and provide cancer treatment on the main island.
If you need to reach the American Samoa Medicaid State Agency by phone, call 684-699-4777.
The bottom line
Automatic Medicaid renewals stopped on March 31, 2023 in advance of the COVID-19 public health emergency (PHE) ending on May 11. Unlike other parts of the U.S., where Medicaid renewals are resuming, there is no individual eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) in American Samoa. So residents are not expected to lose coverage as a result of the end of the COVID PHE.
If you have questions about accessing healthcare in this territory, call the American Samoa Medicaid State Agency at 684-699-4777.
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References
Administration for Strategic Preparedness & Response. (2020). Determination that a public health emergency exists.
Administration for Strategic Preparedness & Response. (2023). Renewal of determination that a public health emergency exists.
American Samoa Medicaid State Agency. (n.d.). Lyndon Baines Johnson (LBJ) Tropical Medical Center.
American Samoa Medicaid State Agency. (n.d.). Who is eligible for Medicaid assistance?
Hofschneider, A. (2022). Federal budget bill permanently increases Medicaid funding for US Pacific territories. Honolulu Civil Beat.
Medicaid.gov. (n.d.). Medicaid & CHIP in American Samoa.
Medicaid.gov. (n.d.). Renew your Medicaid or CHIP coverage.
Medicaid.gov. (n.d.). Unwinding and returning to regular operations after COVID-19.
National Association of Medicaid Directors. (2019). Territory operations survey.
Office of the Governor American Samoan Government. (2023). Governor Lemanu P.S. Mauga testimony.
Pacific Island Health Officers Association. (n.d.). American Samoa.
Tolbert, J., et al. (2023). 10 things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation.
U.S. Census Bureau. (n.d.). 2010 Census of American Samoa and 2020 Census of American Samoa.
