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COFA citizens in Oklahoma report follow up from VOICE2015

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COFA citizens in Oklahoma report follow up from VOICE2015

  1. 1. COFA citizens in Oklahoma Moving Health Forward Many COFA migrants suffer from chronic diseases and health conditions that can be linked to the medical effects of U.S. nuclear testing in the region. The current fiscal crisis, however, has forced many states to reduce funding for these efforts in the absence of federal dollars. By: TERRY L. MOTE Micronesian Community Health Coordinator Garfield County Health Department
  2. 2. COFAcitizensinOklahoma 1 Report Backgrounds: Following information were captured from my notes that I took and also the handouts during the VOICES2015 Conference that I went to in Washington, D.C. The conference was about “Moving Health Forward”, to help supporting the COFA health access issue. Participants were from difference states representing their coalitions and communities. It was encouraging on our hill visit to our respective legislators. It was a time for many of us to voice our concerns and needs on Medicaid issues for the COFA migrants in the U.S. No matter what the outcome will be for the bill, but I think we’ve started by joining together as COFA migrants to move health forward. COFA citizens in Oklahoma Moving Health Forward Who are COFA migrants? Since 1986, the Compacts of Free Association (COFA) have defined the relationship between the United States and the independent governments of the Freely Associated States (FAS) including: the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau. Under the Compact, in exchange for permitting the U.S. exclusive use and military strategicpositioning in the Pacific, the U.S. provides grants to fund education, health care, and infrastructure in the FAS. Maintaining good relationships with the FAS is imperative to our national security as other countries seek to grow their influence in the Pacific region. Under the COFA, these individuals have a unique relationship with the United States that allows them to freely travel without a visa and with no time restraints. The Compacts also permit citizens of the FAS broad migration privileges to the U.S. and its territories. Known collectively as “COFA migrants” when they enter the U.S., the Compacts allow citizens of the FAS to apply for admission to the U.S. as “non-immigrants” and without visa requirements. Currently there are at least 56,000 migrants from the COFA nations legally residing, working and studying in the U.S. These COFA migrants pay taxes and play a role in driving our economy, but arenot eligible for many of the programs that their tax dollars support.
  3. 3. COFAcitizensinOklahoma 2 Are COFA migrants immigrants? While they are not immigrants, COFA Migrants share many of the same difficulties faced by immigrants trying to access affordable health insurance and care. Their unique status has caused unexpected health carecosts on the states and territories where they reside. COFA migrants reside in all states, with the largest concentration in Hawaii, the territory of Guam, California, Arkansas, Oklahoma and Washington. COFA migrants were formerly eligible for federal health programs: In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), commonly referred to as welfare reform, changed the categories of persons eligible for certain federal safety-net programs including Medicaid and the Children’s HealthInsurance Program (CHIP). As a result, COFA migrants were stripped of their ability to qualify for these programs. In the aftermath of PRWORA, some states continued to provide health care services to COFA migrants using their own funds, recognizing the contributions and health needs of COFA migrant populations in their states. Many COFA migrants suffer from chronic diseases and health conditions that can be linked to the medical effects of U.S. nuclear testing in the region. The current fiscal crisis, however, has forced many states to reduce funding for these efforts in the absence of federal dollars. Coverage options are limited: Because COFA Migrants arestatutorily barred from Medicaid, regardless of their income or length of time in the U.S., they are left with few coverage options. COFA migrants are subject to the Affordable Care Act’s (ACA) individual mandate, which requires nearly all citizens and lawfully present persons to have minimum essential coverage or pay a penalty. While COFA migrants are eligible to purchase health insurance plans in the newly createdMarketplaces with the support of subsidies, many still struggle to afford these plans. The lack of affordable coverage options is becoming increasingly problematic as more COFA migrants move out of the Compact designated impact jurisdictions of Guam, the Commonwealth of the Northern Mariana Islands (CNMI), American Samoa, and Hawaii. Nine additional states have COFA migrant populations exceeding 1,000: California, Washington, Oregon, Utah, Oklahoma, Florida, Arkansas, Missouri, and Arizona. Even with this financial help in the Marketplaces, however, coverage is unaffordable for most. Many COFA migrants work in low-paying jobs, such as poultry processing or the hospitality industry.
  4. 4. COFAcitizensinOklahoma 3 Why is the relationship to Hawaii litigation? Because COFA migrants are statutorily excluded from Medicaid, states must use their own dollars to pay for their care if they are uninsured. This has placed large economic burdens on states like Hawaii. On Nov. 3, 2014, the Supreme Court issued an order denying certiorari of plaintiff’s appeal in Korab v. McManaman, a case challenging Hawaii’s decision to remove COFA migrants from full-scope Medicaid. The result is that the decision by the Ninth Circuit Court of Appeals in favor of Hawaiistands. Hawaii does not have to use its own dollars to provide care for COFA migrants within its borders. Since the decision, Hawaii has shifted COFA migrants to private coverage in the Marketplace Impacted Jurisdictions:
  5. 5. COFAcitizensinOklahoma 4 CONGRESSIONAL EFFORTS TO REINSTATE COVERAGE Since 2001, 21 bills have been introduced to reinstate COFA eligibility for Medicaid. In the 114th Congress, Senator Hirono (D-HI) and Representative Gabbard (D-HI) introduced S. 1301 and H.R. 2249, the Restoring Medicaid for Compact of Free Association Migrants Act of 2015. How much would it cost? There is no Congressional Budget Office (CBO) score for the COFA Medicaid restoration bills pending in the 114th Congress. In 2013, the CBO scored an amendment by Sen. Hirono to the Senate immigration reform bill (S. 744), estimated that restoring eligibility for COFA migrants would increase Medicaid spending by $200 million over a 10 year period (FY2014-2023). That amendment was adopted and included in S. 744, as passed by the Senate. What can be done for COFA migrants in Oklahoma? More than 30 years agoafter the first Marshallese arrived in Oklahoma, this state does not have an exact data of COFA populations. In an effort to enforce civic rights, we need a collection and a reporting system that can feed our state government about our population. The failure of many state agencies to consistently implement state standards, especially on budget policies for COFA citizens, is a result of inequitable access to resources and data for the population. The COFA communities face disproportionately high rates of health illnesses. However, many are still uninsured and lack of culturally and linguistically appropriate services createsignificant barriers to become a healthier and more productive community. The policy makers, health careproviders, insurance companies, organizations that advocate for healthier communities including the following:  Make certain that the linguistic and cultural appropriate health careservices  Encourage access to affordable health care for all COFA citizens regardless of immigration status  Available Funding for research on the issues that arecritical to COFA, such as diabetes, cancer, obesity, asthma and other illness.  Dilate the participation of COFA in health care through workforce diversity initiatives and inclusion of COFA on local and state boards and committees that address health issues relevant to COFA citizens.
  6. 6. COFAcitizensinOklahoma 5  Increasing Federal Funding for states to adequately offset the impact of COFA citizens.  COFA citizens need a Champion! As of today, we have no voice or representation with our City or Stateto address our concerns.

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