The year-end COVID-19 relief package passed by Congress on Monday (Dec. 21) includes a long overdue change that will provide access to Medicaid coverage for Marshallese adults living in the United States. Marshall Islanders, who have a unique immigration status, were excluded from Medicaid eligibility in a 1996 welfare reform bill passed by Congress.
Arkansas has one of the largest Marshallese populations outside of the islands, with approximately 10–12,000 residing primarily in Northwest Arkansas. Marshall Islanders experience a disproportionately higher incidence of “many chronic diseases, including obesity, cardiovascular disease, diabetes, and infectious diseases, such as Hansen’s disease (leprosy), tuberculosis, and types of hepatitis.”
Until 2018, Marshallese children were subject to a five-year waiting period to access Medicaid coverage in Arkansas until the state joined 32 others in opting to eliminate the waiting period under the federal Children’s Health Insurance Program Reauthorization Act of 2009. Marshallese adults became eligible for subsidies to purchase coverage through the Health Insurance Marketplace in 2014, but continued to be excluded from Medicaid, including expanded coverage under the Affordable Care Act through Arkansas Works.
The United States military used the Marshall Islands as a testing site for nuclear bombs in the 1940s and 1950s, exposing residents near the test sites to radiation and contaminated water and food supplies. Pacific Islanders, including the Marshallese, are covered by the 1986 Compact of Free Association, granting them sovereignty and lawful residence in the United States. Pacific Islanders were promised access to Medicaid as part of those negotiations, but efforts to restore coverage following the 1996 exclusion had been unsuccessful until now.
A Centers for Disease Control and Prevention study released earlier this month showed that Marshallese and Hispanic individuals living in Benton and Washington counties accounted for 64% of COVID-19 cases and 57% of associated deaths in those counties, although they only represented 19% of the population. Just last week, a report in Politico detailed personal stories about how COVID-19 has devastated Marshallese communities.