Skip to content

Hawaii Delegation Fights To Restore Medicaid Access For COFA Migrants With New Legislation

WASHINGTON, D.C. – Today, Senator Mazie K. Hirono, Senator Brian Schatz, Congresswoman Tulsi Gabbard, and Congressman Mark Takai introduced legislation to reinstate Medicaid eligibility for Compact of Free Association (COFA) migrants.

In 1996, Congress passed a law that made migrants from Micronesia, Palau, and the Marshall Islands ineligible for federal Medicaid dollars. Without federal dollars, Hawaii has borne the cost of care for COFA migrants which has strained the state’s resources. Each year, the state spends an estimated $30 to $40 million to provide health care to these families. By making all COFA migrants eligible for Medicaid, the Restore Medicaid to Compact of Free Association Migrants Act requires the federal government to honor our Compacts of Free Association and share the cost of providing health care. Restoring Medicaid eligibility for these compact migrants has been a priority of Hawaii leaders for more than a decade.

“In the history of our country, many migrant groups have had growing pains and it is our duty as a nation of migrants and immigrants to welcome new people and their families to our communities. Addressing the Compact impact on local communities has been a long-standing challenge for Hawaii and continues to be a major priority for me,” said Senator Hirono. “We must live up to the promise we made and the federal government should pay its fair share to meet those commitments. Right now, Hawaii is unfairly bearing the cost of providing services like Medicaid for COFA migrants.  Both Republicans and Democrats supported legislation to restore Medicaid eligibility to COFA migrants in the 2013 comprehensive immigration reform legislation that passed the U.S. Senate but died in the House. I will continue to work with my colleagues on both sides of the aisle to pursue this goal and uphold the promises we made in these Compacts.”

“Providing health care to compact migrants is not only a legal obligation, it is a moral obligation,” said Senator Schatz. “Hawaii has spent millions on health care for migrants to comply with the Compacts of Free Association.  Our legislation will restore federal Medicaid funding so that the costs of providing critical health care to migrants is shared by the state and the federal government.”

“This bill will right a wrong that has gone on for far too long,” said Congresswoman Gabbard. "The Federal Government made a promise to these individuals, and it must uphold that commitment, and provide Medicaid to COFA migrants from Micronesia, Palau, and the Marshall Islands.”

“I join with my colleagues from the Hawaii Delegation in supporting the restoration of Medicaid eligibility for the people of Micronesia, Palau, and the Marshall Islands,” said Congressman Takai. “COFA migrants prior to 1996 had access to Medicaid, which allowed them to receive much needed medical attention to address health concerns linked to the nuclear testing conducted by the United States. Since that eligibility was removed, Hawaii and other affected regions have had to pay more than their fair share of medical costs for COFA migrants.  This legislation provides a way for the Federal government to honor the commitments it made under the Compact of Free Association.”

In 2013, Senator Hirono championed an amendment that would restore COFA migrant access to Medicaid, which was passed by the U.S. Senate Judiciary Committee and included in the final comprehensive immigration reform bill which passed the Senate 68-32. Additionally, the Medicare Access and CHIP Reauthorization Act of 2015, which passed the Senate earlier this year and was signed into law, continued Medicaid eligibility for COFA children and pregnant women.

Advocates for the COFA community in Hawaii praised the Hawaii delegation’s introduction of the Restore Medicaid to Compact of Free Association Migrants Act:

"The ultimate goal of the COFA treaty, highlighted in the open immigration and shared national security responsibility, has to be the full integration of our common values for wellbeing, security, and the opportunity to contribute to society. However, continued denial of basic healthcare access for our COFA Micronesian citizens is a sure path towards continued marginalization and segregation." said Josie Howard, Director of We Are Oceania. "We are grateful to Sen. Mazie Hirono and Rep. Tulsi Gabbard for their support and initiative in this bill. This is testimony to their proactive vision and recognition for the many contributions of the COFA citizens in our state and the whole nation."

“As someone who has worked closely with the Micronesian community in Hawaii, both as an attorney and as a fellow organizer, this bill is meaningful both materially and symbolically.  It will undoubtedly save lives, and it also acknowledges the many contributions of the COFA Micronesian nations to U.S. interests,” said Dina Shek, Legal Director of the Medical-Legal Partnership for Children in Hawaii.