Stay informed

Drop us your email and we’ll keep you up-to-date on Medicaid issues.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Post ·

2021 Spotlight Award for Innovation: American Samoa

Situations can demand Medicaid “build the plane while flying it”. For American Samoa this literally happened when planes stopped flying, stranding citizens, and disrupting access to care. This Spotlight recognizes their innovation.

NAMD’s annual Spotlight Award recognizes the unparalleled work Medicaid agencies have done in service to the 80 million people covered by program. In the face of COVID-19 disruptions, Medicaid leaders used creativity, fearlessness, and tenacity to face the disruptions wrought by COVID-19 and leveraged this moment to address long-standing challenges in Medicaid. It is in this spirit, that we recognize American Samoa.


The analogy “building the plane while flying it” suits nearly every system of response to the COVID pandemic. There are some circumstances unique to the state’s disease course, populations and existing infrastructure that shaped it’s response to COVID. But, Medicaid agencies share common experiences in rapid shifts to systems, programs and workforce.  In the case of American Samoa, the common analogy takes a unique and literal twist when planes stopped flying altogether.


In March 2020 the American Samoa Government closed its borders stranding 2,000 of its residents in Hawaii, the US mainland and other countries.  It was a lockdown with no flights in or out for nearly a year, and was a crisis on two shores:

  • On-island residents lost access to advanced medical care only available off the island.
  • Off-island residents endured heightened stress, trauma and hardship during separation.

Solutions, Spearhead by Medicaid

An urgent and untenable situation required a history-making response. The AS Medicaid agency led the territory’s first-ever medical transport program, orchestrating the first step of a complicated, repatriation process. Under its State Plan, the agency chartered a plane to transport 200 patients and escorts to Hawaii to access medical care.

The work to reopen access to care was a foundation from which the Medicaid agency and partners in the American Samoa Government COVID-19 Task Force could envision and execute broader repatriation. Together, they created the Safe Travels program. The program was phased (1) to maintain closed borders except for medically qualified (2) and later when travel resumed, to protect the territory from COVID. Each phase had challenges:

  • Cost: AS Medicaid sought and secured a Disaster Relief SPA to cover medical referral services, on-site care, and travel costs associated with rigorous safety and quarantine.
  • Technology: When pre-travel quarantine was lifted a sophisticated electronic system was required to manage traveler health status, testing and vaccination data. TALOFAPass is the technology platform that made it possible to implement the Safe Travels Program.

Innovations to Build From

TALOFAPass and the State Travels Program were built out of necessity and built from collaboration. Multiple state agencies, state governments and private sector partners needed the ability to quickly work together as a team. Their disparate information systems and mismatched processes hindered communication, workflow and problem-solving. The successful roll out of technology and the program demonstrated a new “trusted partner ecosystem.”  Partnership and infrastructure solved pandemic problems and positions American Samoa for future innovation.

Spotlight Award

For these innovations, American Samoa is a recipient of NAMD’s 2021 Spotlight Award.

Related resources

Stay Informed

Drop us your email and we’ll keep you up-to-date on Medicaid issues.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.