• Written by: Scott Gifford (Intern)

COFA and Medicaid



Half a century ago, the United States promised special rights to our friends of the Compact Free Association. Collectively, the COFA nations consist of the Federated States of Micronesia, the Republic of the Marshall Islands and Palau. Now, Congress plans to further follow through on promises made to migrants from the COFA nations years ago.


Decades ago, in exchange for military access and weapons testing rights, the United States reached an agreement with the COFA nations. Among these include certain rights and benefits for residents who migrate to the United States, including access to Medicaid.


Regrettably, the United States did not entirely follow through on the agreement. What has been identified as a drafting error by experts in a 1996 welfare reform package, left many Marshallese and other islanders without healthcare coverage. The effects on the COFA community have been extensive as many migrants remain uncovered due to not having access to medicaid. Meanwhile, the ongoing pandemic has only worsened and further highlighted the issue.


Bettina Mok, Executive Director of The Legal Clinic, discussed how deeply the COFA community has been affected by the inability to access Medicaid. Bettina commented, “COFA residents in Hawai'i have struggled far too long without the right to Medicaid coverage. When we talk about systemic injustices, this is a clear example of one that has had devastating impacts on an already marginalized population. It took a worldwide pandemic, and unfortunately many lives lost too soon, to underscore how lack of access to affordable healthcare for some, should in fact be a concern for all.”


However, we are happy to announce that recently Congress has agreed to a deal to restore access to Medicaid for migrants from COFA nations. The accord was included in the coronavirus relief package that passed Congress in late December. The agreement reinstates the promises that the United States made with COFA residents and has been years in the making.


Our friends at We Are Oceania, an organization that represents and supports Microneisians who reside in Hawai’i, were delighted to hear the news. Josie Howard, the Program Director at WAO said this, “The Restoration of Medicaid for COFA citizens means restoration of HOPE in the relationship through the COFA treaty between United States and our COFA Nations. It also means "Welcome and Aloha" to the many of us who are living in America. As a Non-Profit empowering the Micronesian community to navigate success in Hawaii, we are very grateful and proud of being part of the Hawaii Team to fight for the restoration of Medicaid.”


Bettina added, “We applaud the tireless COFA advocates and Hawaii's congressional delegation for their efforts to restore this important benefit. It is long overdue."


Josie also applauded the community efforts stating, “This is a classic example of a vibrant community working together to reach a common goal.” She added, “This is the beginning of the victories for many injustices in this relationship. Most importantly, the continuation of learning from one another for a brighter future of Hawai'i. “



Senator Schatz (D-HI) and Senator Hirono (D-HI) have worked diligently, along with dedicated members of the Oceanic community, to see the restoration of healthcare rights enacted. The renewal of Medicaid access represents a significant victory for COFA residents and the community of Hawai’i as a whole.