Basic Health Hawaii Begins July 1; Provides Free Health Insurance for COFA Migrants, Other Legal Aliens

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BY TONI SWARTZ FOR THE DEPARTMENT OF HUMAN SERVICES The Department of Human Services (DHS) officially launched Basic Health Hawai‘i (BHH) on July 1, DHS Director Lillian Koller says. This fully State-funded program will provide free medical insurance for adult, non-pregnant legal aliens who do not qualify for the federally funded Medicaid program.

Among those eligible to enroll in BHH are more than 7,500 low-income adults who migrated to Hawaii from Micronesia, the Marshall Islands and Palau under the Compacts of Free Association (COFA) with the U.S. government. These migrants currently receive Medicaid-like health insurance from DHS.


Also eligible to enroll in BHH are low-income legal alien adults from non-COFA nations who have lived in America for less than five years. These individuals are not eligible for Medicaid and the State currently provides no health insurance for them.

Health plans administering BHH are AlohaCare, HMSA and Kaiser.

“When we announced plans last summer for BHH, some COFA migrants and their advocates were concerned that the program did not cover kidney dialysis and chemotherapy,” Koller said. “This revised version of BHH addresses those issues. While benefits are less in BHH than in our comprehensive Medicaid programs, this lingering economic downturn makes it untenable for the State to continue shouldering a federal responsibility.”

Hawaii spends more than $120 million in State funds each year on services for COFA migrants. In return, the U.S. Department of the Interior only provides Hawaii with about $11 million to partially cover the costs.

“Hawaii taxpayers have generously provided health care and other social services to COFA migrants for many years,” Koller said, “even though this is clearly a 100 percent federal responsibility because the U.S. government used their island nations for nuclear weapons testing during the 1940s and 1950s.

“The State of Hawaii undeniably should receive full federal reimbursement for all the services we provide to COFA migrants, yet we only receive about ten cents on the dollar,” Koller said. “Unfortunately, Congress continues to ignore our State’s repeated requests for relief.”

BHH will save State taxpayers an estimated $8 million annually because COFA migrants will transfer from Medicaid-like coverage to less comprehensive coverage.

DHS originally planned to transfer COFA migrants into BHH in September 2009, but this action was put on hold by a federal court challenge that was later withdrawn. The implementation of BHH on July 1 is in compliance with state and federal requirements.

BHH will cover four medications monthly – including brand-name chemotherapy drugs – along with 12 outpatient doctor visits, ten hospital days, six mental health visits, three procedures and emergency medical and dental care. Clients who require kidney dialysis will also receive these treatments for free as part of emergency service coverage.

Congress in 1996 changed federal law to make most non-U.S. citizens – including COFA migrants – ineligible for Medicaid and other federally funded services, except for emergency services. Because there was no longer any federally funded services for these non-U.S. citizens, Hawaii has shouldered the cost of providing Medicaid-like coverage to COFA migrants since the mid-1990s using only State tax dollars.

“Fortunately, Congress restored federal funding for some of these non-U.S. citizens – pregnant women and children – in 2009 through the Children’s Health Insurance Program Reauthorization Act,” Koller points out. “Unfortunately, Hawaii has had to continue using only State tax dollars to cover non-pregnant adult COFA migrants.”

COFA migrants, health providers who work with the COFA community and others who have questions about BHH can call DHS Customer Service toll-free at 1-800-316-8005 or one of the BHH health plans.

Interpreter services are available for non-English speakers.


For more information, contact:

DHS Public Information Officer Toni Schwartz

Phone: 586-4882