LEJ seeks to  ensure access to critical medical services for residents under the compact of free association

Hawaii has faced pressure to reduce the state’s expenses since 2009. In response, the Department of Human Services cut critical health services for new immigrant residents of Hawai`i, and residents present under the Compact of Free Association (COFA). Both immigrant groups represent some of the most marginalized people in our society. LEJ has been involved in ongoing advocacy surrounding these cuts, seeking to restore medical benefits for some of Hawai`i’s most needy low income individuals.

History:

In September of 2009, DHS eliminated the Hawaii Immigrant Health Initiative, a state program providing critical medical coverage for legal immigrants present in the United States for fewer than five years. At the same time DHS also eliminated all residents present in Hawaii under the Compact of Free Association from QUEST, the state’s Medicaid coverage plan that assists the low income population in Hawaii with their health care needs. All of these recipients were transferred to a new program known as Basic Health Hawai`i (BHH) which severely restricted health coverage. LEJ with pro bono partners brought the case of Sounds v. Koller in federal court to stop the health care cuts. On September 1, 2009 Federal Judge Michael Seabright issues a TRO enjoining from the state from proceeding with the transfer of COFA migrants and recent legal immigrants from QUEST to the BHH program.

In January, 2010, the state held public hearings over possible regulations to recreate the BHH program for COFA migrants and new legal immigrants. In May 2010, DHS again announced the implemented Basic Health Hawaii, a new separate medical program for both groups that provides very limited medical coverage. They also announced a cap on the BHH program that would permit an enrollment of only 7,000 individuals. For years, Hawaii DHS has provided access to critical medical services to these groups. Hawaii receives almost $30 million annually from the Federal Government in COFA impact funds to offset any state expenditures related to serving COFA residents. Now, COFA residents and immigrants are left with limited medical coverage that does not provide for their basic health needs, or are unable to enroll in any program because of capped enrollment.

Legal Challenges

Korab v. Koller

LEJ believes the decision to selectively single out certain minority groups for disparate access to critical medical services is unconstitutional, as it discriminates based on national origin and alienage in violation of the Equal Protection Clause of the Fourteenth Amendment. Additionally, Basic Health Hawaii forces individuals with disabilities to seek institutionalized treatment, a violation of the Americans with Disabilities Act.  LEJ has filed a class action lawsuit against the Department of Human Services, seeking immediate injunctive relief and restoration of these critical services.

(Photo from Star-Bulletin, Craig T. Kojima)