Lawyers challenge new state health plan

The nonprofit Lawyers for Equal Justice is considering legal action to delay the Sept. 1 implementation of a new state health plan some legislators say "could be a death sentence" for some residents.

Victor Geminiani, executive director of the Hawaii nonprofit LEJ, 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.

The state's revenue shortfall led the state Department of Human Services to transfer some 7,500 non-citizens from comprehensive medical assistance to a "Basic Health Hawaii" plan with limited benefits. Pregnant women and children are excluded.

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.

Rep. John Mizuno (D, Kalihi), House Human Services Committee chair, 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 non-citizen residents also will be affected.

The Med-QUEST Division was directed to cut its budget by $42 million over two years, which led to reductions in reimbursement benefits and eligibility. 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. That left state-funded programs, the biggest of which covers medical benefits to non-citizens who are ineligible for federal aid.

Human Services Director Lillian Koller said the department is working with dialysis and chemotherapy providers to ensure critical 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 said in a statement.

Hawaii is the only state giving COFA migrants 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," 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.