Mi­grant mal­con­tent

Pa­cific Is­lan­ders protest cuts in Hawaii health plan

Modern Healthcare - - The Week In Healthcare - Re­becca Ve­sely

The state of Hawaii is start­ing a new free health plan for some Pa­cific Is­land mi­grants but is meet­ing re­sis­tance from the peo­ple it aims to cover who say the ben­e­fits are much worse than what they re­ceive to­day.

Peo­ple from Mi­crone­sia, the Mar­shall Is­lands and Palau have since the mid-1990s re­ceived free health­care in Hawaii through ex­ist­ing state health pro­grams.

Cit­i­zens of th­ese is­lands can live and work legally in the U.S. without a visa or time lim­its through the Com­pact of Free As­so­ci­a­tion, or COFA, an agree­ment that guar­an­tees fi­nan­cial as­sis­tance and mi­gra­tion to the is­land na­tions in ex­change for mil­i­tary and de­fense rights. How­ever, in 1996, Congress made COFA mi­grants in­el­i­gi­ble for Med­i­caid and other fed­er­ally funded ser­vices, ex­cept in emer­gen­cies.

Hawaii picked up the slack by pro­vid­ing the health cov­er­age. But a bud­get crunch this past year caused the state to re-ex­am­ine ben­e­fits to COFA mi­grants. In Au­gust 2009, the state no­ti­fied about 7,500 of the cov­ered mi­grants that they would be en­rolled in a new state health plan called Ba­sic Health Hawaii, which would of­fer less-gen­er­ous ben­e­fits, in­clud­ing an elim­i­na­tion of chemo­ther­apy treat­ments and dial­y­sis, start­ing Sept. 1, 2009.

By switch­ing the mi­grants to a lower-cost health plan, the state ex­pected to save about $15 mil­lion an­nu­ally and close a bud­get short­fall, ac­cord­ing to the Hawaii Hu­man Ser­vices Depart­ment. Preg­nant women and chil­dren un­der age 19 were ex­empt from the change.

The COFA mi­grants filed a class-action law­suit, and on Sept. 1 of last year, they were granted a tem­po­rary re­strain­ing or­der in fed­eral court halt­ing im­ple­men­ta­tion of Ba­sic Health Hawaii. In his rul­ing grant­ing the stay, Judge J. Michael Seabright of the U.S. District Court in Honolulu wrote that the state failed to prop­erly no­tify the COFA mi­grants of the switch and that it could cause ir­repara­ble harm to pa­tients.

The state back­tracked, and on Dec. 21, 2009, it is­sued new pro­posed cov­er­age rules for Ba­sic Health Hawaii. The re­vised plan of­fers up to 12 out­pa­tient physi­cian vis­its a year; 10 hospi­tal days; six men­tal health vis­its; three out­pa­tient pro­ce­dures; and emer­gency med­i­cal and den­tal care. Up to four pre­scrip­tion drugs are cov­ered per month, in­clud­ing chemo­ther­apy drugs. Emer­gency dial­y­sis will be cov­ered through Med­i­caid, ac­cord­ing to the depart­ment.

The state will save about $8 mil­lion an­nu­ally with the pro­gram changes, said Lil­lian Koller, di­rec­tor of the state Hu­man Ser­vices Depart­ment. “Be­cause the state’s fis­cal con­di­tion is wors­en­ing, DHS will likely need to cut ben­e­fits in other med­i­cal as­sis­tance pro­grams,” Koller said in a writ­ten state­ment.

The new pro­posal may not be ad­e­quate, said Vic­tor Gem­ini­ani, ex­ec­u­tive di­rec­tor of Honolulu-based Lawyers for Equal Jus­tice, which rep­re­sented the COFA mi­grants in the law­suit. For in­stance, the state now cov­ers pa­tient trans­port to treat­ment, while Ba­sic Health Hawaii would not, ac­cord­ing to the pro­posed reg­u­la­tions. “We want to see what the fi­nal reg­u­la­tions look like,” he said.

The mi­grants may file an­other law­suit against the state on grounds it is vi­o­lat­ing the equal pro­tec­tion clause un­der the 14th Amend­ment, Gem­ini­ani said.

In the mean­time, rep­re­sen­ta­tives for COFA mi­grants are lob­by­ing Congress to re­in­state Med­i­caid ben­e­fits in all states. The House in­cluded such a mea­sure in its health­care over­haul bill; the Se­nate did not.

A pub­lic hear­ing on the re­vamped Ba­sic Health Hawaii plan is slated for Jan. 25 in Honolulu. The state has set an im­ple­men­ta­tion dead­line of no later than July 1.

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