Academic journal article Asian American Policy Review

Medicaid Parity for Pacific Migrant Populations in the United States

Academic journal article Asian American Policy Review

Medicaid Parity for Pacific Migrant Populations in the United States

Article excerpt

Abstract

Under the Compact of Free Association (COFA), citizens from Palau, the Federated States of Micronesia, and the Republic of the Marshall Islands--also known as COFA migrants--are granted broad migration rights in exchange for providing the United States the use of and access to strategic military defense positioning in the Pacific. For many years, these citizens have lived and worked in cooperation with the U.S. military even as their health was being detrimentally impacted by exposure to nuclear weaponry. Unfortunately, in the passage of the Personal Responsibility and Work Opportunity Act in 1996, COFA migrants were stripped of their eligibility for most federal benefits, including Medicaid. In the aftermath of this decision, some states continued to provide health care to COFA migrants using state funds, however, the current fiscal crisis is forcing many states to reduce funding for these efforts, putting the health of this population at risk. It is the responsibility of the federal government to honor the terms of the Compact by restoring eligibility to Medicaid for COFA migrants.

Introduction

This article aims to provide an in-depth analysis on the health care options for migrants from the Freely Associated States (FAS)--which includes the Republic of Palau, the Federated States of Micronesia (FSM), and the Republic of the Marshall Islands (RMI)--who currently reside in the United States and its territories. The analysis will include a brief background on the Compact of Free Association (COFA; the Compact), a unique agreement that established the working relationship between the United States and the FAS countries. It will also provide a history of the major events leading up to today's current immigration status of more than 56,000 FAS citizens residing in the United States, commonly referred to as COFA migrants. (1) Ultimately, this article highlights the need for responsible policy reform to restore access to entitlement programs previously afforded to COFA migrants before the changes to eligibility under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. (2)

Historical and Demographic Background

The Trust Territories of the Pacific Islands

Micronesia is a region in the Pacific Ocean comprising independent island nations that share a cultural and ethnic identity. East of the Philippines and north of Papua New Guinea, islands in Micronesia have a long history of foreign occupation and colonial administration. As early as the seventeenth century, Spanish, German, Japanese, American, and British international agreements decided the ownership and territorial boundaries of the region with little regard for its native population and traditional claims to the land. After World War II, the islands that make up modern-day Palau, the Commonwealth of the Northern Mariana Islands (CNMI), the Republic of the Marshall Islands, and the Federated States of Micronesia were taken from Japanese control and organized as the Trust Territory of the Pacific by the United Nations and placed under U.S. administrative authority. The Trust Territory specifically included Yap, Pohnpei, and Chuuk from the FSM; Koror from Palau; Majuro from the Marshall Islands; and Saipan from the CNMI, which served as the capital of the Trust Territory. The Trust Territory was officially organized in 1947 and included the Pacific Proving Grounds, an area spanning the Micronesian region in the Pacific used for nuclear testing from 1947 to 1962. U.S. administrative jurisdiction ended in 1990, after the independence of the RMI and the FSM in 1986 and Palau in 1994.

Compacts of Free Association (3)

After U.S. administration of the Trust Territory ended, a new relationship between the United States and the newly independent nations of Palau, the RMI, and the FSM developed. In 1986, the United States negotiated an agreement of free association with Palau, the RMI, and the FSM: these island nations make up the Freely Associated States as outlined in the Compact. …

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