Compact of Free Association Migrants (COFA Migrants) who hail from the Federated States of Micronesia, The Republic of the Marshall Islands and the Republic of Palau have a unique relationship with the United States that allows them to freely travel without a visa and with no time restraints. While they are not immigrants, COFA Migrants share many of the same difficulties faced by immigrants in the including access to health insurance. Their unique status has caused unexpected health costs to be borne by the states and territories where they reside which is why it is important to address this issue in comprehensive immigration reform.
Before 1996, COFA migrants enjoyed access to Medicaid through their designation as legally residing non-citizen nationals. Unfortunately, the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996 stripped COFA migrants of their eligibility for most federal benefits, including Medicaid, by unfairly excluding them from the category of “qualified immigrants” for purposes of eligibility. In the aftermath of this decision, some states continued to provide health care to COFA migrants through state and territory funded programs, causing an undue burden to already strained local budgets. As such, it is important that the federal government correct their 1996 error by re-designating COFA migrants as “qualified immigrants” for purposes of Medicaid eligibility. COFA Migrants reside in all states, with the largest concentration being in Hawaii, the territory of Guam, California and Washington.