The Journal of the Arkansas Medical Society Issue 12 Vol 114 | Page 16

On March 29 , 2017 , in the presence of more than 100 members of the public , Gov . Asa Hutchison signed resolution HCR 1012 , which encourages “ a state plan amendment to the Centers for Medicare and Medicaid to provide access to coverage for migrant children and pregnant women from the Compact of Free Association Islands .”
olution , put forward by Rep . Jeff Williams and Sen . Lance Eads , had strong bipartisan support from both the House of Representatives and the Senate . The state plan amendment extends ARKids First to COFA children ; this change will make an important impact on the health of Arkansans . Marshallese COFA children were being served by local doctors , clinics , and health systems in Arkansas ; however , this care was often sporadic and unreimbursed .
It is estimated that approximately 2,000 children will benefit from this coverage . School officials report that many Marshallese children do not get the immunizations and preventive care needed to optimize their learning experience . Now that they are eligible for ARKids First , these children will have better access to lower-cost preventative care , immunizations , and acute-care services . Access to these services is important to the health of these children and to the overall health and economy of Arkansas . The Marshallese community suffers from disproportionate rates of chronic ( type 2 diabetes , hypertension ) and infectious ( hepatitis and tuberculosis ) diseases that can be prevented or managed with appropriate care
11 , 14 , 15
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More Work Ahead
Taking the state option to cover COFA migrant children is an important step toward providing equitable access to care to lawfully residing COFA migrants ; however , more work is still needed . First , the Arkansas Department of Human Services and community partners need to provide bilingual outreach to help Marshallese sign up for and understand ARKids First coverage . Recent research shows that many Marshallese are unaware of how to use insurance and the nuances of using a primary care provider and referrals to specialty care . 12 Bilingual community health workers are needed to ensure Marshallese families sign up and use ARKids First coverage appropriately .
While COFA children will be covered under ARKids First when the state takes this option , many COFA migrant adults are still without adequate insurance or access to health care . 11 , 12 After PRWO- RA , coverage has been incrementally restored for many legal immigrant groups ; however , COFA migrants continue to be excluded . It is imperative that Medicaid coverage be restored for COFA migrants .
As more COFA migrants move to the middle of the U . S ., Compact Impact Aid is needed to provide financial support to those states . Under the 1986 COFA agreement , Compact Impact Aid was allocated for Hawaii , Guam , the Commonwealth of the Northern Mariana Islands , and American Samoa to offset costs associated with COFA migrants . 16 It has been more than 30 years since the COFA agreement , and large numbers of COFA migrants have moved to Arkansas , Oklahoma , Oregon , Utah , and Washington , but these states are not receiving any Compact Impact funds . U . S . Rep . Colleen Hanabusa of Hawaii put forth an amendment to the 1986 COFA agreement in 2011 and in 2013 that would have provided aid to states like Arkansas to cover any “ costs incurred by affected jurisdictions as a result of increased demands placed on health , educational , social , or public safety services or infrastructure .” 17 However , the legislation was not granted a vote in committee either year . Compact Impact Aid must be provided to all states with significant numbers of COFA migrants . We must continue to pursue these important issues until all lawfully residing COFA migrants receive the coverage they need and states are equitably provided resources for the support services they provide .
Conclusion
With the passage of HCR 1012 and the upcoming Medicaid plan amendment , Arkansas will take a significant step in providing equitable care to thousands of COFA migrant children . This is an achievement worthy of celebration , but more work is needed to ensure equitable coverage for lawfully residing COFA migrants . Furthermore , we must continue to pursue appropriate reimbursement for health care providers in Arkansas who are forced to assume the cost of the federal compact agreement . These efforts are important because access to health insurance and quality health care services has both personal and public health consequences .
Finally , many Marshallese COFA migrants argue that the U . S . has an ethical duty to provide access to affordable basic health care benefits , given the legacy of nuclear testing in the RMI and the long-lasting effects on health . 12 The U . S . and Arkansas continue to derive significant military and economic benefits from its relations with the RMI and the Marshallese people . One repeated refrain by Marshallese is that they have been “ good friends to the U . S ..” They continue to provide their land for the Missile Defense base to protect our country , and Marshallese COFA migrants continue to serve and die in the U . S . armed forces at higher per capita rates than our own citizens . 12 Their exclusion from health programs , which were provided when they signed the COFA , is seen by the Marshallese as a betrayal of their sacrificial relationship with the U . S .. 12
References
1 . State of Arkansas . To encourage the Governor to submit a state plan amendment to the Centers for Medicare and Medicaid Services to provide access to coverage for migrant children and pregnant women from the Compact of Free Association Islands . HCR 1012 . Little Rock , AR : Arkansas State Legislature ; 2017 .
2 . Hixson L , Hepler B , Kim M . The Native Hawaiian and Other Pacific Islander population 2010 . Washington , DC : United States Census Bureau ; 2012 .
3 . Central Intelligence Agency . World Factbook : Marshall Islands . 2014 . Available at https :// www . cia . gov / library / publications / the-worldfactbook / geos / rm . html . Accessed 03 / 09 / 2015 .
4 . Barker H . Bravo for the Marshallese : Regaining Control in a Post-Nuclear , Post-Colonial World . Belmont , CA : Cengage Learning ; 2012 .
5 . Pollock N . Health transitions , fast and nasty : exposure to nuclear radiation . Pacific Health Dialog . 2002 ; 9 ( 2 ): 275-282 .
6 . Guyer R . Radioactivity and rights : clashes at Bikini Atoll . Am J Public Health . 2001 ; 91 ( 9 ): 1371-1376 .
7 . Noshkin V , Robison W , Wong K , Brunk J , Eagle R , Jones H . Past and present levels of some radionuclides in fish from Bikini and Enewetak Atolls . Health Phys . 1997 ; 73 ( 1 ): 49-65 .
8 . 108th United States Congress . Compact of Free Association Amendments Act of 2003 . Public Law 188 . Washington , DC : United States Government Printing Office ; 2003 .
9 . Arkansas Department of Education Data Center . Springdale School District Enrollment by Race , 2016-2017 . Little Rock , AR : Arkansas Department of Education ; 2016 .
10 . McElfish P . Unpublished interview with Carmen Chong-Gum . Springdale , AR : Arkansas Marshallese Consulate ; 2013 .
Contact AMS for a complete list of references .
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