Sunday, August 30, 2009

Star-Bulletin: Health plan faces legal challenge

A shift in coverage for 7,500 noncitizens due to the state's revenue shortfall fuels concerns

In Star-Bulletin, August 29, 2009 (by Helen Altonn)

Lawyers for Equal Justice are considering legal action to delay implementation Tuesday of a new state health plan key legislators say "could be a death sentence" for some residents.

Because of the state's revenue shortage, the state Department of Human Services is transferring about 7,500 noncitizens from comprehensive medical assistance to a "Basic Health Hawaii" plan with limited benefits. Pregnant women and children are excluded.

"It's a good plan for healthy people," said Noda Lojkar, consul general of the government of the Republic of the Marshall Islands.

The Marshallese government, affected residents and organizations such as the American Cancer Society Hawaii Pacific Inc. are protesting the plan because life-sustaining dialysis and chemotherapy services are not covered.

"Basic Health Hawaii will become the first program in Hawaii to kill individuals it is meant to help," George Massengale, a cancer society official, said in a letter to state Rep. John Mizuno (D, Kalihi), House Human Services Committee chairman.

Mizuno and Senate Human Services Chairwoman Suzanne Chun Oakland (D, Kalihi-Liliha) have asked Gov. Linda Lingle either to grandfather in people on dialysis and chemotherapy or delay the plan for six months.

Most of those affected are migrants from Micronesia, the Marshall Islands and Palau who have lived in Hawaii less than five years and are ineligible for federal assistance. Many Filipino noncitizen residents also will be affected, said Mila Medallon-Kaahanui, health care advocate.

Dr. Kenneth Fink, Med-QUEST Division administrator, said he was directed to reduce the budget by $42 million over two years, and he and his staff critically examined all programs. "But to get that kind of money, we had to start looking at reimbursement benefits or eligibility," he said.

The governor said children and pregnant women could not be affected, and the state agency did not want to cut any programs drawing matching federal funds, he said. That left state-funded programs, the biggest of which covers medical benefits to noncitizens who have lived in Hawaii under five years and are ineligible for federal aid, he said.

Human Services Director Lillian Koller said the department is working with dialysis and chemotherapy providers to ensure that critical health care needs will continue.

"That said, it is undeniably a federal — not a state — responsibility to compensate Compacts of Free Association migrants for the extensive harm caused to their islands in the 1940s and 1950s by the U.S. government's nuclear weapons testing program," Koller added in a statement.

Guam has dropped medical coverage for the migrants, and Hawaii is the only state giving them free health insurance, with federal reimbursement at about 10 cents on the dollar, Koller said.

"It is time for the U.S. government to stand up and fulfill its legal and moral obligations" to the so-called COFA migrants, she said. "It is also time for federal officials to fully reimburse Hawaii taxpayers for all we do to improve the lives of COFA migrants."

U.S. Rep. Neil Abercrombie has included an amendment in the House health care reform bill to reinstate Medicaid benefits for compact migrants totaling about $15 million a year.

Fink said the federal government dropped Medicaid coverage for the Pacific islanders in 1996, but Hawaii continued comprehensive state-funded coverage without any federal help until 2003.

The state since has received $10 million to $11 million a year as a share of impact funding, but it has spent more than $100 million a year on that population, Fink said.

Aside from humanitarian issues and federal policy, the state is not going to save any money from the new plan, Dr. Neal Palafox, Family Medicine and Community Health chairman in the John A. Burns School of Medicine, said at a community meeting held by Mizuno on the issues.

Palafox, who spent many years in the Marshall Islands, said the cost simply will be shifted because the new plan covers emergency services. It will be five times more expensive for people to go to emergency rooms for dialysis and chemotherapy and will cause many problems at hospitals, he said.

Victor Geminiani, executive director of Lawyers for Equal Justice, said he had just done a preliminary review of the issues, but he sees "constitutional failures" in the adverse action notice to clients from the Human Services Department about the new plan.

It was printed only in English with a number to call if someone needed help, he said. "People had no clue what it was. They didn't understand."

He also cited questions of equal protection, short notice to clients and lack of outreach to 230 to 260 people expected to lose kidney dialysis and chemotherapy coverage.

Fink said the federal compact with the Freely Associated States says "it's not the intent of Congress that the compact adversely affect any jurisdiction, but that does not appear to be the case."

He said "very difficult decisions" had to be made because of the state's unprecedented economic situation.

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