Over on Saipan, one lawmaker is concerned about pharmacies on Guam not accepting NMI Medicaid for medical referral patients seeking treatment. The Commonwealth Health Care Corporation says they're working to expand access to care even if their hands are tied. 

CHCC CEO Esther Muña announced, "Any Medicaid program, any state Medicaid, does require that you comply with the state plan. And we do have a state Medicaid plan."

Officials from the NMI's only hospital providing some clarity after one lawmaker raised concerns over pharmacies on Guam not accepting CNMI Medicaid for medical referral patient treatment.  Vicenta Borja, the acting director of the CNMI State Medicaid Agency, noted, "For our referral patients, in order for CNMI Medicaid to pay for services outside of the CNMI, contracts need to be executed. With Guam, it is mandatory, so any patient that will be sent to Guam, a contract must be in place in order for us to reimburse the providers."

She says if CNMI patients are referred to the states, there isn't a need for that provider agreement as long as the patient is enrolled in their state's Medicaid. But what about Guam?

"There is a limited amount of providers in Guam who are contracted with us, however we are trying to expand," Borja continued. She says there are no contracts with a pharmacy on Guam, with Muna adding, Not every provider wants to be a Medicaid provider, so we seek providers that are willing to take our patients and sometimes it is very limited on Guam so we have them sent beyond Guam, basically."

Muna emphasized that medical referral is not a "payer," rather it's focus is to efficiently coordinate access to care. But, the hospital has advocated for expanded access for reimbursements when it comes to care on Guam. 

"GMH is a new contractor, for a long time, for many years, GMH is not a Medicaid provider," noted the CEO.

She says unless the state rules change, their hands are tied, but there still willing to help patients who are stuck navigate the system to get the care they need.