SCIENTIFIC ARTICLE Marshallese HCR 1012
Pearl Anna McElfish , PhD , MBA University of Arkansas for Medical Sciences Northwest
Abstract :
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 .” 1 The resolution , put forward by Rep . Jeff Williams and Sen . Lance Eads , had strong bipartisan support from both the House of Representatives and the Senate . The resolution encourages coverage of all lawfully residing children whose families meet other eligibility requirements to receive ARKids First coverage . It is estimated that approximately 2,000 children will benefit from this coverage . This resolution is a significant step in strengthening the health and security of Arkansas and our nation .
Marshallese Community Context
Arkansas has one of the largest populations of Marshallese outside the Republic of the Marshall Islands ( RMI ). 2 The RMI was controlled by the United States ( U . S .) as part of a United Nations Trust Territory of the Pacific Islands from 1947-1986 . 3 From 1946-1958 , the U . S . used the Marshall Islands as a test site for atomic and nuclear weapons . 4 This testing program in the RMI is important in contextualizing the relationships with Marshallese migrants . The equivalent of 7,200 Hiroshimasized bombs were detonated in the RMI , exposing the Marshall Islanders , as well as their water and food resources , to significant levels of radiation . 5-7 Years of weapons testing caused significant destruction of natural resources and significant ongoing health disparities .
The RMI gained its independence in 1986 through the Compact of Free Association ( COFA ), an agreement between the U . S . and the RMI . 8 Through the COFA , the U . S . gained control of a large area of the Pacific Ocean and 10 % of the RMI land mass for strategic military purposes . The RMI is home to the Ronald Reagan Ballistic Missile Defense Test Site , and Marshallese citizens serve in the U . S . military at higher per capita rates than U . S . citizens . As part of the COFA , the U . S . agreed to provide financial compensation to the RMI designed to help build the country ’ s economy and improve the education and health of its citizens . The COFA also permits citizens of the RMI – as well as citizens from the Federated States of Micronesia and the Republic of Palau – to live , work , and study freely in the U . S . without a visa . 8 This agreement created the unique legal status of COFA migrants , distinct from other immigrants who are subject to U . S . Citizenship and Immigration Services administration .
Between 2000 and 2010 , Marshallese migration to Arkansas and other states of the U . S . tripled from 6,700 to 22,434 according to census estimates . 2 The exact number of COFA migrants is difficult to ascertain , because COFA migrants can move freely without a visa and tend to move back and forth between the U . S . and their native countries in the Pacific . The actual number of Marshallese living in the U . S . is estimated to be much higher . Using school enrollment and health department birth record data , it is estimated that ~ 10,000-14,000 live in Arkansas and ~ 40,000 COFA migrants live in the U . S . 2 , 9 , 10
Limited Access to Health Care and Health Insurance
Many Marshallese COFA migrants who come to the U . S . do not have adequate access to health care services or health insurance . According to local needs assessments , approximately 50 % of
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Marshallese living in Arkansas are uninsured . When the COFA was signed in 1986 , COFA migrants were eligible for federal benefits programs , including Medicaid . However , with the passage of the Personal Responsibility and Work Opportunity Reconciliation Act ( PRWORA ) in 1996 , COFA migrants lost Medicaid eligibility because the law only extended coverage to “ qualified aliens ,” which excluded lawfully residing non-immigrants such as COFA migrants . 13 This left state governments the option to continue Medicaid coverage for COFA migrants using only state funds . Only a few states chose to extend coverage at their own cost ; Arkansas did not .
The Children ’ s Health Insurance Program ( CHIP ) was created by the Balanced Budget Act of 1997 as a joint state-federal partnership that provides access to affordable health care for children whose families have modest incomes that would not otherwise qualify them for Medicaid . Some states have opted to add these children directly to Medicaid , and others have created a separate but similar CHIP program . In Arkansas , this program is called ARKids First . CHIP provided access to medical care for millions of children across the U . S ., but the narrow terminology used in the legislation did not include COFA migrant children . In 2009 , the Children ’ s Health Insurance Program Reauthorization Act ( CHIPRA ) included an option for states to extend this coverage to children who are “ lawfully present .” To extend CHIP coverage to COFA migrants as well as other immigrant and migrant children who have been in the U . S . for less than five years , states were required to amend their Medicaid plan with authorization from CMS . Arkansas did not initially amend its plan . But with an enhanced federal match rate implemented in 2015 , Arkansas had the opportunity to take this new coverage option at no cost to the state .
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 .” 1 The res-
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