Hawaiʻi Public Radio wraps up a series on Micronesians and Medicaid with a report on the most recent policy changes — and what they mean for the Micronesian community. It’s a story that’s changing this year — as more Micronesians in Hawaiʻi are enrolling in the program.

In just the first five months of 2021, the state reported a 52% jump in citizens covered by Medicaid under the Compact of Free Association, or COFA. This follows a new law that Congress passed at the end of last year.

Five years ago, 62-year-old Efania Miecho of Kalihi couldn’t afford her medical bills. Her coverage had changed from Medicaid to the Affordable Care Act’s Marketplace — which for her was not affordable. Through translator Aritae Epeluk, she says she’s happy to be back on Medicaid.

“That way it will cover all my medication, and I don’t have to worry about being short of money if I cannot afford it, so I am very happy to be back on Medicaid, that way I will get all my medication and they will help with all my health problems,” she told Hawaiʻi Public Radio.

U.S. Sen. Mazie Hirono said she always felt dropping COFA citizens from Medicaid eligibility in the Welfare Reform Act of 1996 was a mistake.

“I came to the conclusion that it was inadvertent. Anyway, that is the conclusion I drew — and what I told people as I tried to get the point across that this should’ve never have happened to the COFA citizens because they were legally in our country without having to go through visas and all that,” Hirono said.

Senator Mazie Hirono official portrait

U.S. Senate Photographic Studio

Official portrait of U.S. Sen. Mazie Hirono

In the wake of that federal legislation, states were left to decide if they wanted to support the Medicaid enrollment of COFA migrants with limited means. Hawaiʻi did so until 2015 when it revoked coverage for so-called able-bodied COFA migrants aged 18 to 64.

Hirono fought to return the COFA population to Medicaid coverage ever since she got elected to the U.S. Senate in 2013. She said she tried many different ways.

“I began to talk about it as a national security responsibility issue. Because I was trying to look for whatever avenues I could to get it into a bill coming out of Finance Committee, in a bill coming out of the Armed Services Committee, under the National Defense Authorization Act.”

Last December, senators used funding from a bipartisan omnibus appropriations bill to permanently restore Medicaid eligibility for COFA citizens living in the U.S.

“We have access to these nation’s lands for national security. We also exposed them to health hazards at the time when we were exploding bombs. And so I think we have a moral responsibility on a lot of levels,” Hirono told Hawaiʻi Public Radio.

Medicaid eligibility has now been restored to the Micronesian community after more than 20 years.

But advocates like Dr. Neal Palafox of the University of Hawaiʻi Medical School say they would also like to see other social justice issues addressed.

“So they still carry what is called a nonimmigrant status, so they didn’t change their status — they changed their ability to get on Medicaid — which is a big win, I’m not criticizing that. But a lot of other things that come along with that, such as housing things, and food stamps, and other things that give populations that are disenfranchised a step-up — some of these things they still can’t do,” he said.

As the Compact of Free Association comes up for renewal in 2023, advocates say it’s an opportunity to make further changes in COFA policy.

This is Hawaiʻi Public Radio’s third report about Micronesians and Medicaid. Read part one and part two, examining the history of COFA and Micronesians’ struggle for health care in Hawaiʻi — by HPR’s Jackie Young.

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