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Medicaid & CHIP in American Samoa

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

Core Set Data

CMS developed the Medicaid and Children’s Health Insurance Program (CHIP) Core Set Data Dashboard to improve accessibility of data about the quality of care provided to Medicaid and CHIP beneficiaries. CMS encourages users to explore Core Set Data to examine performance across states and to inspire and inform efforts to improve the quality of care provided to Medicaid and CHIP beneficiaries.

Starting with the 2024 Core Set, reporting of the Child Core Set and the behavioral health measures on the Adult Core Set is mandatory for states. The term “states” in this context refers to the 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. More information on mandatory Core Set reporting requirements is available in 42 CFR Parts 433, 437, and 457, and the Initial Core Set Mandatory Reporting Guidance State Health Official Letter.

The Child and Adult Core Sets assist CMS, states, and the public in understanding and monitoring access and quality of health care provided to individuals enrolled in Medicaid and CHIP. The Core Sets include measures of health care quality across the lifespan and domains of care.

CMS reports state performance on the Child and Adult Core Set measures annually. The Core Set Data Dashboard shows detailed information, including state-specific performance and national medians, on each measure that was reported by at least 25 states and met CMS’s standards for data quality for the reporting year. Data include measures reported by states and on behalf of states.

Territory Allotment