Saturday, October 24, 2009

Micronesian plan extends as state explores options

By Helen Altonn

Honolulu Star-Bulletin, Oct 23, 2009

A temporary restraining order halting the state from switching Pacific islanders to a health plan without dialysis or chemotherapy coverage has been extended pending completion of a rule-making process.

When that will be is not known.

"We're working on it," said state Human Services Director Lillian Koller.

The process involves a number of reviews of the proposed plan, public notice and public hearings.

The Department of Human Services expected the new plan to save about $30 million out of $42 million it is required to cut from its budget over the next two years.

Asked how the department plans to achieve that savings now, Human Services spokeswoman Toni Schwartz said "meeting after meeting" is being held to discuss alternatives.

Senior Staff Attorney Elizabeth M. Dunne of Lawyers for Equal Justice, which sought the restraining order, told state lawmakers it is in effect until the department complies with the state law governing rule-making. "We're prepared if necessary to go forward with a legal challenge."

The restraining order was granted Sept. 1 and extended Sept. 30 by U.S. District Judge J. Michael Seabright.

Dunne updated four legislative committees Wednesday at an informational briefing on the situation regarding Compact of Free Association migrants. The 1986 compact allows migrants from the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau to travel freely and live in the United States.

Facing a critical revenue shortage, the Human Services Department planned to transfer noncitizens with less than five years' residency on Sept. 1 from comprehensive state-funded

medical assistance to a "Basic Health Hawaii" plan. Pregnant women and children were excluded.

The plan's limited benefits did not include coverage for life-sustaining dialysis or chemotherapy, which caused an uproar.

About 7,500 Pacific islanders would be affected by the plan. About 100 are on dialysis and 150 receive chemotherapy, said House Human Services Chairman John Mizuno (D, Kalihi).

The islanders received federally funded Medicaid benefits until Congress eliminated them in 1996. The state continued comprehensive benefits, costing about $100 million a year, with no federal assistance until 2003. It has since received less than $11 million a year.

The State Department says the treaty does not provide health coverage, but it is "an obligation of the U.S.," said state Sen. J. Kalani English (D, East Maui-Lanai-Molokai).

"It's not just health care; it's housing and everything else," added English, chairman of the Committee on Transportation, International and Intergovernmental Affairs and president of the Pacific Island Legislators.

Leaders of the Federated States of Micronesia and Marshall Islands are working with Hawaii's congressional delegation to seek restoration of Medicaid benefits for compact migrants, he said.

Hawaii U.S. Rep. Neil Abercrombie inserted such a provision in the House health reform legislation, and U.S. Sens. Daniel Inouye and Daniel Akaka are pursuing similar language in the Senate reform bill.

Dr. Neal Palafox, Family Medicine and Community Health chairman at the University of Hawaii John A. Burns School of Medicine, said the state "should be proactive" rather than wait for federal help. He said an "impact committee" is

needed to look at the financial and social implications of alternative solutions.

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