The U.S. Supreme Court upheld Monday a ruling by the 9th Circuit Court of Appeals that allows the state to reduce its health care coverage of noncitizens, which includes 13,700 Micronesian migrants.
The state might begin cutting some medical services by the end of this week to nonpregnant, adult noncitizens receiving state-funded medical assistance.
In anticipation of the ruling, the Department of Human Services had prepared emergency rules addressing the immediate needs of nonpregnant adult noncitizens, which will be sent to the governor for review and approval, DHS said in an email response to questions from the Honolulu Star-Advertiser. Upon approval, the emergency rules will be posted on the lieutenant governor’s website, which the department anticipates will happen by the end of the week.
The department will later begin new administrative rules for adult noncitizens, and it will provide more details once they are approved and posted.
"State-funded medical assistance for eligible aged, blind and disabled noncitizens will continue without interruption," the department said by email.
Micronesian officials are hopeful a new governor will be open to continue vital health services for Micronesians living in Hawaii, in addition to seeking more federal money, despite the U.S. Supreme Court ruling.
"We’re waiting for a new administration," Marshall Islands Consul General Noda Lojkar said. "We have tried to schedule a meeting with the governor for a long time now, but for the past four months now, we haven’t gotten one. … It’s either the new governor will say yes or no as to eliminate the whole case or not."
In 1996 Congress cut health care funding for migrants, including those from Palau, the Federated States of Micronesia and the Republic of the Marshall Islands, which have a Compact of Free Association with the United States to live and work in this country in exchange for U.S. control of extensive strategic land and water in the Pacific.
Hawaii had been including COFA residents in its health insurance plans until Gov. Linda Lingle’s administration, in cost-cutting attempts, tried to reduce coverage in 2009 and 2010.
U.S. District Judge Michael J. Seabright had issued a preliminary injunction prohibiting the state from denying migrants full Medicaid benefits.
But in April the 9th Circuit Court, in Korab v. McManaman, sided with the state and against plaintiffs, who are COFA residents.
In Monday’s ruling the high court rejected the plaintiffs’ appeal of the 9th Circuit decision.
The Department of Human Services did not specify what changes will be coming, but the Lingle administration provided a sample of what could happen if the Micronesian population is denied some of its health care benefits.
"When the Lingle administration implemented it for three months, it really affected people getting chemotherapy and dialysis," Lojkar said. "Without dialysis for a week, you’re dead."
For three months the Lingle administration reduced health care coverage for Micronesians, including eliminating chemotherapy and dialysis treatment.
That sent many to emergency rooms, which are ill-prepared to provide such treatment, Lojkar said.
Attorney Paul Alston, who represented the state’s Micronesian migrants, said in April that Seabright’s injunction prevented a public health disaster.
The state expects the U.S. District Court to dissolve the injunction soon.
Lojkar said COFA nations will continue to pursue talks with the federal government, to see whether it will put up more money under the treaty they have with the U.S. He said the federal impact aid the state receives is $11 million for COFA migrants, but the state claims COFA migrants are costing $110 million.
"We wanted to know how they came up with that and how much our citizens are providing while they work here," he said.
He is also hopeful the Hawaii congressional delegation can help "get us back on Medicaid."
Joakim Peter, a University of Hawaii graduate student who heads the COFA Community Action Network, said: "The concern that we have is the fact that we have an open immigration that allows people to come freely and establish residency, and we contribute right away to society.
"We’re still relegated to a different tier of eligibility for the same services that we’re paying for," he said.
Gov. Neil Abercrombie said in a news release Monday, "My administration is committed to the principle that all Hawaii residents should have health insurance. The state will strive to ensure that our neediest residents, including noncitizens, have access to quality health coverage."
Human Services Director Patricia McManaman said, "The state’s plan going forward includes a program that provides Medicaid-like coverage to our neediest, aged, blind and disabled noncitizens. Coverage for children and pregnant adults will remain unchanged."
She plans a transition for nonpregnant adult noncitizens to get insurance through the Hawaii Health Connector, and a state-funded program to help very low-income noncitizens pay their share of health insurance premiums. "Adult noncitizens who are not pregnant will continue to receive the same benefits until new programs are implemented," a news release from DHS and the Attorney General’s Office said.
