Over 20 years later, expanded Medicaid brings affordable health care back to Micronesian patients


Hawaiʻi Public Radio wraps up a sequence on Micronesians and Medicaid with a report on the latest coverage adjustments — and what they imply for the Micronesian group. It’s a narrative that’s altering this 12 months — as extra Micronesians in Hawaiʻi are enrolling in this system.

In simply the primary 5 months of 2021, the state reported a 52% soar in residents lined by Medicaid beneath the Compact of Free Affiliation, or COFA. This follows a brand new legislation that Congress handed on the finish of final 12 months.

5 years in the past, 62-year-old Efania Miecho of Kalihi couldn’t afford her medical payments. Her protection had modified from Medicaid to the Inexpensive Care Act’s Market — which for her was not inexpensive. By way of translator Aritae Epeluk, she says she’s joyful to be again on Medicaid.

“That method it should cowl all my treatment, and I don’t have to fret about being wanting cash if I can’t afford it, so I’m very joyful to be again on Medicaid, that method I’ll get all my treatment and they’re going to assist with all my well being issues,” she advised Hawaiʻi Public Radio.

U.S. Sen. Mazie Hirono mentioned she all the time felt dropping COFA residents from Medicaid eligibility within the Welfare Reform Act of 1996 was a mistake.

“I got here to the conclusion that it was inadvertent. Anyway, that’s the conclusion I drew — and what I advised folks as I attempted to get the purpose throughout that this could’ve by no means have occurred to the COFA residents as a result of they have been legally in our nation with out having to undergo visas and all that,” Hirono mentioned.

U.S. Senate Photographic Studio

Official portrait of U.S. Sen. Mazie Hirono

Within the wake of that federal laws, states have been left to resolve in the event that they needed to assist the Medicaid enrollment of COFA migrants with restricted means. Hawaiʻi did so till 2015 when it revoked protection for so-called able-bodied COFA migrants aged 18 to 64.

Hirono fought to return the COFA inhabitants to Medicaid protection ever since she bought elected to the U.S. Senate in 2013. She mentioned she tried many alternative methods.

“I started to speak about it as a nationwide safety duty challenge. As a result of I used to be attempting to search for no matter avenues I may to get it right into a invoice popping out of Finance Committee, in a invoice popping out of the Armed Companies Committee, beneath the Nationwide Protection Authorization Act.”

Final December, senators used funding from a bipartisan omnibus appropriations invoice to completely restore Medicaid eligibility for COFA residents residing within the U.S.

“We’ve entry to those nation’s lands for nationwide safety. We additionally uncovered them to well being hazards on the time after we have been exploding bombs. And so I believe now we have an ethical duty on lots of ranges,” Hirono advised Hawaiʻi Public Radio.

Medicaid eligibility has now been restored to the Micronesian group after greater than 20 years.

However advocates like Dr. Neal Palafox of the College of Hawaiʻi Medical College say they might additionally wish to see different social justice points addressed.

“In order that they nonetheless carry what known as a nonimmigrant standing, so that they didn’t change their standing — they modified their skill to get on Medicaid — which is an enormous win, I’m not criticizing that. However lots of different issues that come together with that, reminiscent of housing issues, and meals stamps, and different issues that give populations which can be disenfranchised a step-up — a few of these issues they nonetheless can’t do,” he mentioned.

Because the Compact of Free Affiliation comes up for renewal in 2023, advocates say it’s a possibility to make additional adjustments in COFA coverage.

That is Hawaiʻi Public Radio’s third report about Micronesians and Medicaid. Learn half one and half two, inspecting the historical past of COFA and Micronesians’ wrestle for well being care in Hawaiʻi — by HPR’s Jackie Younger.