By Emmanuel T. Erediano
emmanuel@mvariety.com
Variety News Staff
THE chief executive officer of Kagman Community Health Center, which operates the Isla Community Health clinics, has raised concerns over Gov. David M. Apatang’s designation of Commonwealth Healthcare Corp. CEO Esther L. Muna as the Centers for Medicare & Medicaid Services’ primary point of contact in the CNMI.
In her appointment last month, Apatang tasked Muna with representing the CNMI on Medicaid-related programs and policy matters, including state plan amendments, strategic direction, program oversight and integrity, and coordination of federal and territorial funding.
In a letter to the Legislature, KCH CEO Dr. Cindy Hoepner said she supports accountability and compliance but fears the designation “may unintentionally harm the very people it is meant to protect — our patients.”
Hoepner said naming Muna as CMS’s sole liaison “creates an unavoidable conflict of interest,” arguing that CHCC, as the hospital authority, is both a major provider and now the Medicaid coordinator.
She warned that such an arrangement could “prioritize hospital interests over community-based primary care, despite clear evidence that strong primary care lowers costs and improves health outcomes.”
Hoepner added that the change “diminishes transparency and reduces input from other providers who serve Medicaid beneficiaries daily across our island.”
While affirming KCH’s support for CMS oversight, she said the CNMI needs “balanced, inclusive governance” and outlined current community health centers challenges:
– Burdensome regulations strain limited workforce.
– Delays or reductions in Medicaid reimbursement directly affect whether patients can be seen.
– One-size-fits-all rules don’t reflect the realities of remote island communities where costs are higher, staffing is limited, and the safety net is thin.
Hoepner urged CMS to ensure that “all providers have a seat at the table when Medicaid decisions are made, not just one institution.”
She said centralizing Medicaid oversight solely under the hospital CEO “risks undermining years of progress toward a healthier CNMI.”
“This is not about ‘an organization.’ It is about sustaining the most critical services for our islands. Isla Community Health centers were built for the people, by the people, with one vision: to create a thriving, healthy community,” she told lawmakers.
Hoepner asked legislators to consider their patients and work toward a Medicaid governance structure that is “fair, transparent, and inclusive — so together we can protect the health of our islands and the families and individuals we serve.”
She also expressed gratitude to Medicaid Director George Cruz, crediting him for helping advance Medicaid services in recent months and assisting primary care providers in continuing treatment for those most in need.
CHCC responds
Asked for comment, Muna said CHCC welcomes feedback from providers, especially in light of the governor’s recent designation. However, she said, “there is some misunderstanding regarding this appointment.”
She explained that as the territorial health official and head of the CNMI’s sole state health agency, she has been authorized to coordinate with the CMS Medicaid Division on the governor’s four outlined priorities. Given the economic challenges residents face, she said access to care is a shared concern for both CHCC and the administration.
“It’s crucial that Medicaid and CHCC align their goals and enhance coordination to improve health outcomes for our community,” she said, adding that she looks forward to working with CMS to further those efforts.
Muna rejected claims of a conflict of interest, saying many U.S. jurisdictions have state health agencies that oversee both a public hospital and the Medicaid program. She noted that CMS and the U.S. Department of Health and Human Services recognize CHCC as a “sister agency” to Medicaid under 45 CFR § 95.4.
She also emphasized CHCC’s commitment to supporting private providers. In a recent meeting with the Medicaid director, she said she encouraged exploring options under 45 CFR § 95.4 and Section 1903 of the Social Security Act to reduce the CNMI government’s financial burden while strengthening partnerships with non-government clinics.
“Together, we can effectively deliver health services to the community,” she said.
