Medicaid Restoration for Compact of Free Association Communities


What we do: APIAHF works to educate policymakers and fight for the health care rights of COFA communities.

Compact of Free Association Migrants (COFA Communities) 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 U.S.
In exchange for permitting the U.S. exclusive use and military strategic positioning in the Pacific, the U.S. provides grants to fund education, health care, and infrastructure in these jurisdiction. The Compacts allow COFA citizens to freely travel, live and work in the country without a visa and with no time restraints. Maintaining good relationships with our COFA allies is imperative to our national security.


While they are classified as “non-immigrants” when they enter the U.S., COFA communities share many of the same difficulties faced by immigrants, including access to health insurance. The 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) stripped COFA communities of eligibility for most federal benefits, including Medicaid. Many COFA migrants suffer from chronic diseases and health conditions that can be linked to the medical effects of U.S. nuclear testing in the region.


Congress must correct the 1996 error by restoring Medicaid eligibility to COFA communities.


Organizations Supporting Action on COFA Medicaid


As organizations, businesses and community groups working to remove barriers to healthy living, we urge Congress to fix a legislative oversight that has led to inequitable access to health care for thousands of Pacific Islanders in the United States. Since the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), people residing in…


Impact of Proposed DHS Public Charge Regulation on Citizens of Freely Associated States Under Compacts of Free Association


The United States has international treaty agreements, known as the Compacts of Free Association (COFA), with three Pacific Island nations – the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia. Citizens of these nations, which are known as the Freely Associated States (FAS), are eligible to freely enter…


Health Care for COFA Citizens

Fact Sheet

COFA Citizens And Our National Security Since 1986, the Compacts of Free Association (COFA) have defined the relationship between the United States and the independent governments of the Freely Associated States (FAS) including the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau. Under the Compact, in exchange for…