In a historic and transformative milestone for American Samoa, Governor Pulaali’i Nikolao Pula has signed Executive Order 009-25, formally establishing the first Home and Community-Based Services (HCBS) Commission. This action marks a groundbreaking step toward building long-needed support systems for older adults, individuals with disabilities, and other vulnerable populations – services that currently do not exist in any U.S. Territory at this scale.

 

According to Governor Pulaali’i, “It is essential to recognize and acknowledge that this concept of establishing the HCBS and with Money Follows the Person (MFP) is very much part of our Fa’aSamoa (Samoan Way of Life) on how we care for our elders and individuals living with disabilities within our homes and communities. The principles of respect, love, and responsibility towards our elderly and individuals living with disabilities not only enrich our cultural heritage but also strengthen our community bonds. In this modern age, we must embrace the Fa’aSamoa values that emphasize family connections and communal support, ensuring that our elderly receive the care and dignity they deserve. It is our collective responsibility to foster an environment where they can thrive, surrounded by the warmth of family and community."

 

Establishing this Commission, American Samoa reaffirms its commitment to ensuring that residents requiring long-term support can live with dignity, independence, and choice within their own homes and communities. Building a system of care requires a collective discussion that incorporates health data, policy mapping, and an examination of the root causes of health outcomes within a person’s living environment

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A Landmark Towards Independence and Quality of Life

 

Home and Community-Based Services (HCBS) provide essential support that allow individuals to avoid institutionalization in settings such as nursing homes and hospitals. These services empower people to remain in familiar environments, stay connected to family and culture, and continue contributing to the life of their community. The need in American Samoa is great. Target populations include:

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● Older adults (age 65+)

● Individuals with intellectual and developmental disabilities

● Individuals with physical disabilities

● Individuals with mental health or substance use disorders

● Individuals with chronic health, HIV, or other qualifying needs

 

“For years, families and caregivers have carried these responsibilities alone and uncompensated. This Executive Order begins laying the foundation for a Territory-wide system that will, for the first time, enable HCBS to provide financial support”, stated Governor Pulaali’i. The action is especially critical as American Samoa’s older adult population continues to grow, and many residential homes remain inaccessible for people with disabilities or mobility limitations.

 

Mandate of HCBS Commission

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Although services will not become available immediately, the Commission’s establishment initiates the structural, regulatory, and policy groundwork required to transform care in American Samoa. The Governor’s Executive Order outlines a robust and comprehensive mandate with timeline responsibilities, such as:

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1. Develop a Territory-wide Olmstead Plan to ensure individuals with disabilities and older adults can live and receive        services in the most integrated settings.

2. Create policies and regulations that set quality standards.

3. Recommend long-term HCBS funding strategies.

4. Develop and enforce data policies and interagency agreements.

5. Monitor and evaluate implementation and continuous improvements.

 

Commission Rooted in Community Representation

 

The HCBS Commission will include members with lived experience, subject matter experts, family representatives, community organizations, and key government agencies. This broad representation ensures the Commission’s decisions reflect the real needs and voices of the people it serves. The Governor has already appointed a Commissioner to lead administrative and operations, stakeholder engagement, and the development and implementation of the Olmstead Plan.

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Building a Sustainable Future for Long-Term Care in American Samoa

 

The establishment of the HCBS Commission, American Samoa takes a vital first step in building a modern, person-centered system of care that aligns with federal standards and strengthens support for families and caregivers.

 

While services will take time to develop, the Executive Order creates the infrastructure necessary to ensure that eligible residents requiring long-term support can eventually access the care they need- right here at home.

 

The work of the Commission is 100% funded under the U.S. Department of Health & Human Services - Center for Medicaid and Medicare Services (CMS) - American Samoa Money Follows the Person grant award 1LICMSS331881-01-00.

 

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