Migrants from across Micronesia who travel hundreds of miles to get to Guam for medical care continue to face challenges accessing care and insurance.
Although Medicaid became available to citizens of the Federated States of Micronesia, Marshall Islands, and Palau in January 2021, issues with the application and enrollment process and other barriers prevent care.
Diabetes, cancer, heart disease, stroke and obesity are chronic health problems for many Guam residents, said Alex Silverio, who manages the Guam Office of Minority Health at the Department of public health and social services.
“Our brothers and sisters in the Micronesia region are particularly affected,” he said.
Silverio said patients, especially from other islands in the region, will come to public health with manageable conditions that have developed to the point that they are life-threatening and need emergency care.
Barriers like language, transportation, low income and unemployment compound the problems.
If people cannot afford or have limited access to a car, the only other option is public transport which, when available, can be difficult to use.
To help solve this problem, the one-stop shop at the Micronesian Resource Center in Mane’lu has a vehicle, called the Mobile Information Access Van, which operates every Wednesday.
It gives customers a way to get to medical appointments and offices, said Hideichi Mori, project coordinator at the center.
The language barrier for migrants with limited or no English can hamper filling out medical forms and communicating with health workers.
Silverio said while he appreciated the help of organizations like Mane’lu with translation, public health also needed to recruit more doctors, nurses and staff who know the language and culture of their patients.
Unemployment is another issue, 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 clients have an income; however, it’s over the Medicaid eligibility limit, but it’s not enough to pay for private insurance if it’s not provided by their job,” said Jaymi Hainrick, social worker 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 though we apply now, there is a six-month residency requirement,” Ilesugam said. This can be deadly for migrants who are in urgent need of medical attention.
Nedine Songeni, founder of the organization Neechuumeres: Chuukese Women of Guam, said while her organization and others are making progress in helping people apply, the bureaucracy and paperwork to register is a major hurdle.
That’s why some people drop out of the process and wait until they need to go to the emergency room, she said.
Kinta Rapun, a 55-year-old resident of Dededo in Chuuk, struggles to get health coverage.
“I really want insurance, and I was applying to places like public health and updating my application and I’ve been waiting a long time. I really need medication for my asthma,” Rapun said.
She lost her job and her health insurance when she was made redundant in 2021.
The babysitting job she does doesn’t provide health insurance, and she doesn’t earn enough to pay for hers.
She said the Medicaid process was frustrating due to conflicting and confusing application instructions, requiring her to make multiple trips.
“A client will apply for Medicaid, and by the time public health reviews part of the application, some documents may have passed their deadline,” Mori said.
For example, he said a pay stub must be submitted within two weeks, and when that part of the application has been processed, that’s three or four weeks later and a new pay stub is needed.
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