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Senator Hirono Continues Advocacy for Restoring Medicaid Coverage to COFA Citizens

WASHINGTON, D.C. –Senator Mazie K. Hirono (D-Hawaii) highlighted the importance of restoring equal access to Medicaid for citizens of the Freely Associated States (FAS) living in the United States during a Senate Energy and Natural Resources Committee hearing on the United States’ critical national security interests and partnerships with the FAS nations of Micronesia, the Marshall Islands, and Palau. Under the Compacts of Free Association (COFA), COFA citizens are allowed to live and work in the United States as legal non-immigrants.

While questioning Douglas W. Domenech, the Assistant Secretary for Insular and International Affairs at the U.S. Department of the Interior, Senator Hirono advocated for reinstating Medicaid coverage for COFA citizens living in the United States as they were prior to 1996. The 1996 Personal Responsibility and Work Opportunity Act (the “Welfare Reform Law”) inadvertently cut off COFA citizens from accessing Medicaid and most other federal benefits, despite being legally present in the United States. According to Assistant Secretary Domenech, at least 38,000 COFA citizens live in the United States, including 16,680 in Hawaii. In February during a Senate Energy and Natural Resources Committee hearing to examine the state of U.S. Territories, Senator Hirono highlighted the serious economic impact lost Medicaid eligibility has on COFA citizens.

From Senator Hirono’s Remarks:

“When you say 38,000, because the populations of these countries are not that high, it’s a little over 130,000 maybe, and when you have 38,000 plus – or more – of them living outside their countries, we’re talking about a pretty significant number. Now at the same time, yes many of them do live in Hawaii, 17,000 or so, and there are large numbers in Guam. Because of the responsibility and mutual relationship that we have with them, don’t you think it’s important that as we deal with the Compact and whatever provisions of the Compact that will be subject to any kind of negotiation, that when they do come to our country, they are able to live, work, and access healthcare, like anyone else who is legally present in our country? Wouldn’t that be an important thing to pay attention to?

“I want the record to reflect that they’re both nodding yes.

“The main reason is that, way back in 1995, 1996, or so, when the Welfare Reform Law was enacted, there was a definition relating to – there was a definition excluding – it was an inadvertent exclusion of citizens from FAS states that prohibited them from being eligible for Medicaid coverage.

“And I know that was inadvertent because that section I am referring to in the Welfare Reform Bill had to do with services that’s available to all those who are legally present in our country. And the citizens of FAS were not included, even though it is very clear that they are legally present in our country.

“I am hopeful that as you proceed with negotiations that there is some way we can pay attention to that, that they should not be discriminated against in services that others who are legally present in our country can access. So I just wanted to put that out there.” 

Senator Hirono also pressed Randall Schriver, the Assistant Secretary of Defense for Indo-Pacific Security Affairs at the U.S. Department of Defense (DOD), to provide an update for the Committee on the Department of the Navy’s implementation of biosecurity measures and recommendations to mitigate the threat of invasive species. She also questioned Assistant Secretary Schriver on what steps the DOD plans to take to mitigate the effects of climate change, which it has noted as a credible threat to island nations and political stability in the Indo-Pacific region. Senator Hirono noted, “There’s no question that island states are seeing the impact of climate change.”