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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.
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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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