Migrants from across Micronesia who travel hundreds of miles to Guam for medical care continue to face challenges accessing care and insurance.
Although Medicaid will be available to citizens of the Federated States of Micronesia, the Marshall Islands, and Palau in January 2021, issues with the application and registration process and other obstacles are preventing coverage.
Diabetes, cancer, heart disease, stroke and obesity are chronic health problems for many Guam residents, said Alex Silverio, who heads the Guam Office of Minority Health at the Department of Public Health and Human Services.
“Particularly hard hit are our brothers and sisters from the Micronesia region,” he said.
Silverio said patients, particularly from other islands in the region, will come to the public health community with manageable conditions that have progressed to the point where they have become life-threatening and require emergency care.
Barriers such as language, transportation, low income and unemployment exacerbate the problems.
When people cannot afford a car or have limited access to a car, the only other option is public transport, which when available can be difficult to use.
To help with this problem, the Mane’lu Micronesian Resource Center One Stop Shop has a vehicle called the Mobile Access to Information Van that operates every Wednesday.
It gives customers a way to get to doctor’s appointments and offices, said Hideichi Mori, project coordinator at the center.
The language barrier for migrants with little or no English can hinder filling out medical forms and communicating with medical staff.
Silverio said that while he appreciates the help of organizations like Mane’lu in providing translations, public health also needs to hire more doctors, nurses and employees who know their patients’ language and culture.
Unemployment is another problem as insurance is usually offered through work.
The only other choices are Medicaid or expensive private insurance.
Even if someone has a job, income can limit their access to care.
“Many of our customers have an income; However, it’s higher than the Medicaid eligibility limit, but it’s not enough to afford private insurance if it’s not provided through her work,” said Jaymi Hainrick, a case officer at the Micronesian Resource Center.
Sam Ilesugam, a community advocate for residents of Yap in the Federated States of Micronesia, where he is from, said Medicaid eligibility has helped.
However, there are problems with the process.
“Even if we apply now, there is a six-month residency permit,” Ilesugam said. This can be deadly for migrants who need urgent medical treatment.
Nedine Songeni, a founder of the organization Neechuumeres: Chuukese Women of Guam, said while her organization and others are making strides to help people apply, the bureaucracy and paperwork involved in registering is a major obstacle.
That’s why some people abandon the process and wait until they need to go to the emergency room, she said.
Kinta Rapun, a 55-year-old Dededo resident of Chuuk, is struggling to get health insurance.
“I really want insurance and I’ve applied to places like Public Health and updated my application and waited a long time. I really need medication for my asthma,” Rapun said.
She lost her job and health insurance when she was laid off in 2021.
Her janitorial job doesn’t provide health insurance, and she doesn’t make enough to afford her own.
She said the Medicaid process was frustrating because of conflicting and confusing application instructions that forced her to make multiple trips.
“A customer is going to apply for Medicaid, and by the time Public Health has processed part of the application, some documents may have passed their deadline,” Mori said.
For example, he said a payslip needs to be submitted within two weeks, and when that part of the application has been processed, it’s three or four weeks later and a new payslip is needed.