The U.S. Supreme Court has decided not to take up a case involving whether immigrants from Micronesia should receive state-funded health care coverage, leaving intact a lower court’s decision that determined Hawaii is not required to provide those benefits.

Hawaii’s attorney general, David Louie, and director of human services, Patricia McManaman, announced Monday that the decision “validates the state’s authority to determine the level of health care coverage provided to noncitizens who are ineligible for federal Medicaid.”

The high court’s decision, they say, “also confirms that the state did not discriminate when it exercised that authority in 2010.”

U.S. Supreme Court Washington D.C.

The U.S. Supreme Court building, Washington, D.C.


By “noncitizens,” the state is referring primarily to Micronesian immigrants living in Hawaii and accessing state services. In late September, attorneys for three Micronesians living in Hawaii asked the U.S. Supreme Court to hear their case about being denied health benefits.

“Why should the court take this? The answer is very simple,” attorney Paul Alston told Civil Beat at the time. “People are going to die if they implement Basic Health Hawaii. This is not something that we can simply ignore.”

In 2010, the state designed BHH specifically for migrants from Micronesia. Basic Health Hawaii is a form of health coverage that limits the days of inpatient hospital care, outpatient visits and prescriptions. The plan also does not cover organ transplants or surgeries like heart surgery, and it covers dialysis only as an emergency service.

The plaintiffs in Korab v. McManaman argue that BHH is inadequate for the needs of Micronesians. Many suffer from cancer, diabetes and reproductive abnormalities that have been linked to the effects of U.S. nuclear testing in the Marshall Islands from 1946 to 1958.

On Monday, however, the high court rejected the plaintiffs’ appeal in Korab, leaving intact a 9th Circuit Court of Appeals decision in favor of the state. That decision found the state was not required to provide state-funded medical assistance benefits to noncitizens after the federal Medicaid program excluded them.  

“This decision is important because it confirms that the state’s actions were not discriminatory,” Louie said in a press release. “But it is also important to know that the state intends to continue providing significant assistance to these individuals.”

Gov. Neil Abercrombie stated,“My administration is committed to the principle that all Hawaii residents should have health insurance. The state will strive to ensure that our neediest residents, including noncitizens, have access to quality health care coverage.”

UPDATE: The plaintiffs’ attorneys have previously indicated that they would also pursue the case in state court. Asked to comment on recent developments, attorney Paul Alston singled out Louie’s remarks.

“They are lying about not discriminating — every judge who has reviewed this has found discrimination,” he said in an email to Civil Beat Nov. 9. “They won in the Ninth Circuit only because Congress has plenary power to authorize discrimination against aliens, and the state discriminated against COFA residents in a manner permitted by Congress. There was discrimination. Period.”

Some history: The federal Welfare Reform Act of 1996 eliminated federal health care funding for many noncitizens, including migrants from Palau, the Republic of the Marshall Islands and the Federated States of MicronesiaThe island nations have international treaties known as Compact of Free Association (COFA) with the United States that allows their citizens to live and work in the U.S. In exchange, the U.S. has access to more than 1 million square miles of the Pacific Ocean, which allows the military to establish strategic training and weapons testing facilities on islands like Kwajalein.

Though sufficient federal funds were not available, after 1996 the State of Hawaii continued state-funded medical assistance for COFA residents. But the state later tried to halt funding, saying it was too expensive. The matter has been in the courts since that time and is likely to continue.

According to the state, adult noncitizens “who are not pregnant, and are not aged, blind, or disabled, and who were eligible beneficiaries under the injunction, will continue to receive their current level of benefits until the new programs are implemented. Those beneficiaries will soon receive a notice in the mail explaining the changes, and they should contact the Department of Human Services at the number provided on the notice if they have any questions.”

About the Author