Hawai‘i Delegation Leads Effort to Restore Healthcare for FAS Citizens

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Sens. Mazie K. Hirono and Brian Schatz, and Reps. Colleen Hanabusa and Tulsi Gabbard introduced legislation to reinstate Medicaid coverage for Freely Associated States (FAS) citizens living in the U.S.

The Covering our FAS Allies (COFA) Act would restore Medicaid coverage, known in Hawai‘i as Med-QUEST, for FAS citizens.

The U.S. entered into the Compacts of Free Association (COFA) with the governments of the Freely Associated States, which include the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau that allow FAS citizens to live in the U.S. and receive certain benefits, including medical coverage.

However, in 1996, Congress cut off FAS citizens from access to certain Medicaid benefits.


“We have a moral obligation to provide FAS citizens living in Hawai‘i and across our country with access to medical care,” said Sen. Hirono. “The COFA Act will ensure that each FAS citizen in the United States can access healthcare and help states like Hawai‘i dealing with unfunded mandates creates by the compacts.”

“This bill seeks to restore much-needed federal medical benefits to COFA beneficiaries residing in the United States,” said Rep. Hanabusa. “It also seeks to ensure that the State of Hawai‘i, along with other states where COFA beneficiaries reside, are not forced to shoulder the financial burden associated with providing medical care to COFA beneficiaries, benefits arising out of COFA agreements negotiated and entered into by the United States.”

“This bill is about the federal government taking responsibility,” said Sen. Schatz. “Hawai‘i has shouldered the costs here because we know it’s the right thing to do. But at the end of the day, the U.S. government—through Medicaid—should provide coverage to FAS citizens.”

“This bill will right a wrong that has gone on for far too long,” said Rep. Gabbard. “The federal government made a promise to these individuals and it must uphold that commitment, and provide Medicaid to FAS citizens from Micronesia, Palau and the Marshall Islands.”


Reps. Michelle Lujan Grisham (D-N.M.), Raul Grivalja (D-Ariz.), Madeleine Bordallo (D-Guam), and Keith Ellison (D-Minn.) cosponsored the House version of the COFA Act.

Since FAS citizens lost their Medicaid coverage, states with large populations of FAS citizens like Hawai‘i have taken on a large share of uncompensated care, putting strain on local resources, including utilizing emergency room visits for basic or regular healthcare.

The COFA Act continues the Hawai‘i Congressional Delegation’s efforts to restore Medicaid eligibility to FAS citizens. The delegation introduced similar legislation in previous Congresses, and in 2013, Sen. Hirono included an amendment that would have restored FAS citizen access to Medicaid in the Senate’s comprehensive immigration reform bill.

Advocates for FAS citizens praised the Hawai‘i Congressional Delegation’s introduction of the COFA Act:


“Our COFA communities are grateful to Sen. Mazie Hirono and her colleagues in the U.S. Congress for recognizing the fundamental need to provide equitable healthcare for our citizens and their families living and working in the United States,” said Jocelyn Howard, program director at We Are Oceania. “This restoration of fair and accessible healthcare support for everyone is consistent with the enduring partnership that has existed between our peoples for many years. It’s a relationship built on trust, shared sacrifice and our common faith in democracy.”

“The Medicaid restoration will go a long way to addressing the disparities in healthcare for our hard-working COFA residents and their families in the nation,” said Joakim Peter, chairman of the COFA-Community Advocacy Network. “We pay our taxes just like everyone else but we do not have equal access to the fundamental solutions to our healthcare needs. We cannot tell a COFA resident, who has limited to no income, that she is treated justly and fairly in giving her a different coverage from everyone else, one based solely on her national origin.”

“COFA communities have contributed to our nation’s security and welfare, and as a country, it is our responsibility to honor the treaty agreements by allowing COFA communities the same access to affordable health programs that their tax dollars support,” said Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum. “We thank Sen. Hirono and Rep.e Hanabusa for their leadership in introducing this important bill to ensure America fulfills its promise to COFA communities.”

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