Tuesday, April 9, 2019


Representative John Mizuno (D – Kalihi Valley, Kamehameha Heights, Lower Kalihi), Chair of the House Committee on Health, together with fellow lawmakers and stakeholder organizations formed an initial outline of solutions to address the unique needs of Compact of Free Association citizens in Hawaiʻi.
"This is a blueprint for a path in the right direction for both Compact citizens and the state," said Rep. Mizuno. "When Pacific Islanders do well, our entire state benefits."

In 1947, the United Nations granted the United States trusteeship over the Republic of the Marshall Islands, Federated States of Micronesia, and Republic of Palau, also known as the Compact Nations or the Freely Associated States. In exchange for exclusive military use and positioning, citizens from these nations are allowed to freely travel, live, and work in the United States. Those who have immigrated to Hawaiʻi from these independent nations are referred to as the Compact of Free Association (COFA) citizens, and face extreme challenges due to their unique immigration status. Many COFA citizens deal with health conditions that can be linked to effects of U.S. nuclear testing in the nations from which they come.
Lawmakers and stakeholders created the outline following the House Health Committee's legislative briefing on COFA citizens. Participants included Representatives John M. Mizuno, Tom Brower, Richard P. Creagan, Bertrand Kobayashi, and Dale T. Kobayashi, the Department of Health, Department of Education, Queen Emma Clinic, Queen's Medical Center, Pacific Resources for Education and Learning, Project Vision, Dr. Neal Palafox, and Kokua Kalihi Valley.
Rep. Mizuno noted that according to information presented by the Department of Health, the State Department of Health spends $10 million annually in health care costs and the Department of Human Services spends $38 million in human services for COFA citizens.
"We reviewed how state funds were allocated for services to Compact citizens and determined how we can be more efficient with services and prudently spending state resources for the benefit of both our state and Compact citizens," said Rep. Mizuno. "The mission of this briefing was to bring people and agencies together to find consensus and solutions working with all stakeholders. Today we have a blueprint for a system change to lead to a stronger state."
Stakeholders and lawmakers concluded that a trifecta of education, civic engagement, and health care are the core to successful integration of COFA citizens in Hawaiʻi. The blueprint determined by lawmakers and stakeholders following the briefing:
Establishing transitional services and transition centers in Hawaiʻi and Compact of Free Association Nations
To ensure higher assimilation success rates in Hawaiʻi for COFA citizens, the following information and issues need to be presented and addressed prior to departure from their respective nations and and upon arrival in Hawaiʻi: Information about state laws, the education system, and cultural norms in Hawaiʻi and the United States; and those migrating need to aggregate their medical records prior to arrival in Hawaiʻi.
State Departments including the Departments of Health, Human Services, Education, Public Safety, University Systems, and the Department of Economic Development and Tourism must collaborate to efficiently use state resources to serve COFA citizens. Collaboration will result in the dual benefit of reducing government spending while providing more meaningful services.
Continuing The Queen's Medical Center Patient Navigation Services
The Queen's Medical Center and Queen Emma Clinics utilize trained patient navigators to assist both COFA citizens and homeless persons in Hawaiʻi to access health care and resolve barriers that impede their ability to maintain care and treatment. This program is extremely effective in diverting non-emergency services and changing the focus toward preventive health care, which has superior outcomes for needy clients.
Background: In 2016, the Queen's Medical Center lost $10 million and the State of Hawaiʻi lost $90 million (Medicaid funds) for unnecessary emergency room visits by homeless persons.  During the 2018 session the Legislature passed legislation to provide $1 million matched by Queen's Medical Center for a Navigation Services Program.
Utilizing mobile clinics
Mobile clinics are a viable option to provide health care outreach and services to COFA citizens as well as veterans, homeless, and needy persons.
Creating a Compact of Free Association Advisory Body       
Concurrent resolutions are moving through the 2019 Legislature to create this advisory body. This advisory body can act to bridge the gap in communication and understanding between COFA citizens and government officials. The group could act as a data center and clearing house for support services.

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