Hawaii lawmakers ask feds to front Medicaid costs of COFA citizens

Hawaii Independent Staff

HONOLULU—Hawaii’s Congressional delegation and its Governor are asking that the federal government foot the bill on promises made in The Compact of Free Association (COFA), which involves citizens of the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI) and the Republic of Palau.

U.S. Senator Daniel K. Akaka (D-Hawaii) introduced the Medicaid Restoration for Citizens of Freely Associated States Act (S. 1502) Tuesday to re-establish Medicaid eligibility for citizens of COFA nations living in the United States. Senators Daniel K. Inouye (D-Hawaii) and Jeff Bingaman (D-New Mexico) were the original cosponsors.

To read the Medicaid Restoration for Citizens of Freely Associated States Act (S. 1502), click here

Under the Compacts, the U.S. government agreed to provide economic assistance to Freely Associated States (FAS) citizens, allowing them to enter, reside, and work in the United States and participate in certain federal programs. This included health benefits under Medicaid. 

However, when the Personal Responsibility and Work Opportunity Act of 1996 established further restrictions on the eligibility of non-U.S. citizens for certain federal assistance programs, FAS citizens became ineligible to receive federal benefits. Since then, states with Compact Migrants have been forced to absorb the costs of providing health and social services, education, and public safety in accordance with unfunded federal mandates.

Akaka said of the U.S. government’s duties to COFA: “Since 1996, state and territorial governments have had no choice but to serve as the sole sources of funding to meet the social service and public health needs of our growing Compact migrant population. This is putting an additional strain on states and territories—especially Hawaii and Guam—at a time of severely constrained budgets. Hawaii has deep compassion and aloha for our brothers and sisters across the Pacific. I call on the federal government to make good on its commitments. This bill would restore the federal government’s role in providing needed services for the migrants that it has invited to live in the United States and give relief to the states that have been footing the bill for this federal mandate.”

The 2008 census estimated there were 12,215 COFA citizens living in Hawaii, up from 7,297 in 2003. However, State program data suggest these estimates are under-representative of the actual number of COFA migrants residing in Hawaii. 

“Since 1996, the federal government has neglected to provide funds to support their basic needs—social services, education, or healthcare,” Inouye said. “Last year alone the State of Hawaii paid about $150 million to subsidize the Compact Migrants, and this sum is only expected to rise. We are all aware that government funding of any kind is difficult to come by, and my hope is that this legislation will ensure that states like Hawaii are not unfairly burdened with an initiative started by the federal government.”

According to a report released by Gov. Neil Abercrombie this week, the State of Hawaii spent over $100 million last year alone on needed services for COFA migrants. Spending included $52.1 million to provide 20,720 clients with financial assistance, medical assistance, and emergency housing outreach, $55.1 million to educate 5,508 students, and $872,820 on 2,117 arrests, 775 convictions, and 249 incarcerations.

“The State of Hawaii can no longer absorb the rising costs caused by the agreement between the U.S. and nations of the Compacts of Free Association,” Abercrombie said. “The federal government needs to take responsibility for providing adequate support to offset the costs incurred as a direct result of increased migration.”

The Governor said that he has asked the Department of Interior to work with the Congress to increase the amount of direct assistance to the State of Hawaii relating to Compacts of Free Association. 

Congresswoman Mazie Hirono (D-Hawaii) has introduced a similar bill in the House of Representatives, cosponsored by Representatives Colleen Hanabusa (D-Hawaii), Eni Faleomavaega (D-American Samoa), and Madeleine Bordallo (D-Guam).

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