Apr 24, 2023 - News

Marshallese population is vulnerable with Medicaid redetermination

First anticipated Medicaid terminations, by state
Data: Center for Medicare and Medicaid Services; Chart: Tory Lysik/Axios Visuals

Thousands of Pacific Islanders who were granted long-promised Medicaid coverage during the COVID-19 pandemic could lose those benefits this spring in the first wave of eligibility redeterminations.

  • Arkansas, one of the largest Marshallese enclaves in the continental U.S., started Medicaid renewals and recertification this month and will evaluate eligibility for more than 400,000 residents this year.

Why it matters: States are culling their Medicaid rolls and seeking additional restrictions with the end of the COVID emergency, removing guarantees of continuous coverage that reduced health inequities in ways obvious and not so obvious, Axios' Arielle Dreher reports.

  • About 94,000 people from the Marshall Islands, Palau and the Federated States of Micronesia are living in the U.S. As noncitizens, they're guaranteed Medicaid and CHIP benefits under a Reagan-era agreement that gave the U.S. exclusive use and control of sites in those islands for military activity.

Zoom in: An estimated 15,000 Marshallese lived in Arkansas as of 2020, many drawn to the region's food processing plants for work or to join family on the mainland.

  • After their Medicaid coverage was restored, upwards of 4,000 Pacific Islanders and native Hawaiians living in Northwest Arkansas got health coverage from 2020 to 2022.
  • The concern is for individuals who still may qualify for benefits, but could be disenrolled and lost in the administrative churn due to language barriers, erroneous contact information or other factors.

State of play: Notices to Arkansas residents started going out earlier this year asking recipients to update their contact information — the first step of the redetermination process.

  • Michelle Pedro, community health worker and policy director at the Arkansas Coalition for the Marshallese, said her office has been flooded with questions.
  • "We're doing a little bit more outreach than we anticipated," Pedro told Axios.
  • The Medicaid benefits have been a lifeline for those residents, including in Northwest Arkansas, said U.S. Rep. Steve Womack, R-Arkansas.

The bottom line: After 25 years without Medicaid benefits, some Pacific Islanders could fall through the cracks again unless states and health groups find workarounds and new processes through outreach.

This story is a part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

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