Health Access for Immigrants

Hawai`i has faced pressure to reduce the state’s expenses since 2009. In response, the Department of Human Services cut critical health services for new immigrant residents of Hawai`i, and residents present under the Compact of Free Association (COFA). Both immigrant groups represent some of the most marginalized people in our society. LEJ has been involved in ongoing advocacy surrounding these cuts, seeking to restore medical benefits for some of Hawai`i’s most needy low income individuals.

LEJ Executive Director Victor Geminiani is one of the featured interviewees in a documentary produced by UH masters student Keola Diaz about the Micronesian community and Basic Health Hawaii. You can view this documentary below:

You can also click here to view the film in full.

Legal Challenges

Sound v. Koller

LEJ and pro bono partners, Alston Hunt Floyd & Ing, successfully represented COFA residents in bringing a federal class action law suit in September 2009. The case, Sound v. Koller, argued that the implementation of the Basic Health Hawai`i program violated the COFA residents’ due process rights by failing to provide adequate notice to residents and their equal protection rights by basing the state’s action on the alienage of COFA residents. DHS sent letters notifying residents about the reduction in health care provided by the BHH program only 2 weeks before the scheduled implementation date and failed to divulge that the new program would not cover any treatment for dialysis or chemotherapy. While many compact residents speak limited or no English, the notices were printed only in English and, although there was a phone number for those requesting clarifications on coverage or more information on the program, the number was answered by a menu driven recording that only used English to assist callers. The letter did not adequately explain the actions taken by DHS, the right to a fair hearing to contest the transfer to BHH or the options available to COFA residents. Federal District Court Judge Michael Seabright determined that the COFA plaintiffs were likely to succeed on the merits of their due process claim and issued a Temporary Restraining Order restraining the DHS from implementation of the BHH program.

Another case was filed simultaneously in state Circuit Court claiming that the state had violated the HRS Chapter 91 (Hawaii Administrative Procedures Act) by altering the health care program without giving the public adequate notice and an opportunity to comment. The state conceded that it had not properly complied with Chapter 91.

Korab v. Koller

After the earlier due process challenge in Sound v. Koller, Hawai`i DHS held the required public hearings in January, 2010 and announced the new implementation of the Basic Health Hawaii program (BHH) target cuts to health insurance for immigrants in May, 2010. On July 1st the state began the implementation. The Korab v. Koller case challenges the severe cuts in health care provided by this program as a violation of equal protection. Hawai`i Appleseed Center believes the decision to selectively single out certain minority groups for disparate access to critical medical services is unconstitutional, as it discriminates based on national origin and alienage in violation of the Equal Protection Clause of the Fourteenth Amendment. Additionally, Basic Health Hawaii forces individuals with disabilities to seek institutionalized treatment, a violation of the Americans with Disabilities Act. LEJ has filed a class action lawsuit against the Department of Human Services, seeking immediate injunctive relief and restoration of these critical services. In December 2010 Federal District Court Judge Seabright issue a preliminary injunction enjoining the State of Hawai`i from continuing Basic Health Hawai`i, and restoring health services for Micronesian individuals. The State of Hawai`i is appealing this decision to the 9th Circuit. Briefing finished in September 2011. Amicus Briefs from the NAACP, Japanese American Citizens League, and Kokua Kalihi Valley Health Center were filed in September 2011. A panel of 9th Circuit judges heard oral arguments in the case in September 2012. A decision is expected sometime in 2013.

Policy Briefs

In addition to the litigation, LEJ has produced a policy brief and FAQ to provide further information on the barriers Micronesians face daily. Click on the links below to view our reports.