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Aid
to migrants from Micronesia still falls short
By Vicki Viotti
Advertiser Staff Writer
The federal government's allocation of $10.6
million a year to care for Micronesian migrants in Hawai'i will
soon start to cover some of their healthcare expenses, a burden
formerly shouldered entirely by the state. But officials here expect
that Hawai'i will still fall short by about $5 million this year.
The grant amount for this year was determined
by Congress, but the cost of providing medical care to Micronesians
is rising under new federal agreements, according to the state
Department of Human Services. That may mean
cutbacks in coverage in a few years, said Lillian Koller, director
of the state agency. "We're very grateful to get this assistance,
but we are pointing out the fact that our expenses are much higher," Koller
said. The state's grant plan identifies services provided to migrants
such as education and social services. The entire grant, however,
is allotted to the Department of Human Services. Two medical programs
for migrants are estimated to cost $23 million in the coming fiscal
year. The $10.6 million federal grant, plus $7.3 million that the
state has set aside for the programs still falls $5 million short,
Koller said. The federal grant was authorized by the new compacts
of free association, which Congress signed last fall. The 20-year
agreements allow migration from the Federated States of Micronesia,
Republic of Palau and Republic of the Marshall Islands to U.S.
territories, in exchange for U.S. military access to the region.
The grants are designed to reimburse local governments for the
cost of providing services to the migrants. Hawai'i's grant plan
cites a 2003 census report showing the number of migrants to the
state rose 35 percent in the past six years, to 7,297. It is not
the first time Hawai'i has received federal money to offset migrant
expenses. The state Department of Education, for example, received
two $2 million annual grants appropriated in 2002. But it is the
first aid under the agreements that guarantees minimum allotments
for Hawai'i, Guam, American Samoa and the Commonwealth of the Northern
Mariana Islands. Hawai'i's grant plan directs that the money be
spent on two medical assistance programs run by the Department
of Human Services:
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Hawaii QUEST, a managed-care
program that provides medical and mental health services
through selected health plans and doctors;
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Medicaid Fee for Service
Program, which pays medical providers directly for serving
migrants 65 and older, blind or disabled. Under the federal
grant program, services will be covered to qualified migrants
who became ineligible because of a 1996 law delaying access
for five years after entering the United States.
Micronesians' most prevalent
medical costs are for hypertension, diabetes, pregnancy and respiratory
ailments. But Koller noted that in recent years migrants have
needed more and costlier care upon arrival. "More are coming
over; they're sicker when they come; and they have chronic diseases
that are difficult to manage," she said.
Higher standard One
problem with the way grants were allocated to U.S. territories
affected by migration is that the allocations were based on a
census of the Micronesian population in each location, Koller
said. "The more important thing that doesn't show up in a census
is that we spend more per person than they do elsewhere," she
said. "We're more generous with the benefits compared to the
others. We need a formula that looks at per-capita spent." Koller
said Hawai'i would continue to lobby Congress for more aid, and
predicted that the 2006-2007 state budget would show a reduction
in health services to the migrants. Government-financed healthcare
for U.S. citizens limits membership and type of care offered,
she said; for example, dental coverage is restricted to the most
essential emergency services. However, no change in service to
migrants is expected through the 2005 fiscal year, Koller said.
For 2004, QUEST monthly premium costs are estimated at $180 per
member, and monthly fee-for-service costs at $522.76 per member.
Everyone pays The
impact of high costs is being felt at many clinics that treat
the uninsured. May Akamine, executive director of the Kalihi
Palama Health Center, said Micronesians often turn to emergency-room
care. The clinic patient population of about 17,000 includes
some 1,600 Micronesians, she said, and the clinic is hiring a
fund-raising expert to seek alternative sources of money. "Our
whole philosophy is we want to serve our community the best way
we can," Akamine said. "We really do not to turn anyone away.
If all our providers are full up, we'll refer them elsewhere." Despite
government financing, the healthcare system often absorbs costs,
and sometimes has to curtail services to make up for it, said
Rich Meiers, president of the Hawai'i Healthcare Association,
which represents the state's hospitals. Kapi'olani and Queen's
medical centers are among the hardest hit, Meiers said. "People
are being treated in emergency rooms, for which our hospitals
are not getting reimbursed," he said. "Because we have not been
seeing the reimbursements through the years, it's very frustrating
to our CEOs. "The federal government invited them in here — and
we weren't getting paid for that." The impact of continuing shortages
eventually will fall to the general healthcare consumer. "We're
all going to be affected," said Beth Giesting, executive director
of the Hawai'i Primary Care Association, a nonprofit group that
focuses on health services for needy populations. "It has an
effect on insurance rates. We're all eventually going to pay
for this one way or another."
Reach Vicki Viotti
at vviotti@honoluluadvertiser.com or
525-8053
Article url: http://the.honoluluadvertiser.com/article/2004/Jul/26/ln/ln01a.html
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