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Heart Day 2015

Family and Community Health Access

Children do better when the adults in their lives are able to get the health care they need to care for their families, go to work, and contribute to their communities. 

That’s why Children’s Alliance has worked with Washington state’s Micronesian communities to win health and dental coverage for uninsured adults. 

During the Great Recession, state lawmakers severely cut food assistance for immigrant communities. This impacted Washingtonians living in the state due to a diplomatic arrangement between their home countries and the U.S. government. Called a Compact of Free Association (COFA), the agreement allows citizens of three nations in the western Pacific—the Federated States of Micronesia, the Republic of the Marshall Islands and Palau—to live, work and study in the United States. Washington state is home to the third-highest number of COFA migrants in the country.  

Along with Children’s Alliance, community leaders advocated for the full restoration of food assistance, and succeeded in 2015. They then turned their attention to health care coverage. Congress had revoked federal Medicaid benefits from COFA families in the mid-1990s as part of federal welfare reform; while children qualified for Apple Health for Kids, adults and elders in the Marshallese, Micronesian and Palauan communities were uninsured. Many faced chronic health conditions, some of which are connected to the U.S. testing of atomic bombs on the Marshall Islands from 1945 to 1958. Many also work in low-paying jobs that put medical and dental procedures out of reach. 

Governor Inslee and members of the COFA community at bill signing

In response, in 2018 Washington state lawmakers passed Senate Bill 5683, creating COFA Islander Health Care. Lawmakers added a dental coverage program in 2019. These programs allow Washingtonians from COFA nations who are income-eligible for Medicaid to enroll in plans offered on the state’s Health Benefits Exchange, with no out-of-pocket costs.   

These victories were made possible by the leadership of members of Washington’s Marshallese, Palauan and Micronesian communities, as well as by the coordination of the COFA Alliance National Network.  

As the COVID-19 pandemic continues to expose Washingtonians from COFA nations to disproportionate risk of illness and income loss, COFA Islander Health Care will matter more than ever. More information about coverage is available at the Washington State Health Care Authority’s COFA Outreach Toolkit page.