Improving Healthcare Access for COFA Residents

Women wearing a yellow flower crownIsland of Hawaii YMCAThree people smiling at the camera during an event
Kumukahi Health + Wellness Celebrate Micronesia Health Fair in Hilo

Health insurance can be complicated. The Fund for Health Equity aims to bridge the coverage gap in Hawai‘i communities.

In Hilo, local nonprofit Kumukahi Health + Wellness puts on regular Celebrate Micronesia Health Fair events as a way to reach out and support the Micronesian community there. One booth at the events helps to guide people through the Med-QUEST enrollment process in order to get health insurance coverage at no cost, but members of the COFA community often seemed reluctant to participate.

That is, until Rachelle Hanohano, Kumukahi’s director of kokua services, used an HCF Fund for Health Equity grant to hire a Chuukese speaker to translate at these events. Hanohano says she noticed an immediate difference. Attendance was up at an event in January, where Kumukahi also distributed bags of food. “They stayed around and asked questions; they didn’t just take the groceries and leave,” Hanohano says. “I’ve been doing outreach for many years, and it was so exciting to see how the dynamics changed when they talked with someone from their own community.”

Navigating the U.S. health care system can often be confusing, time consuming, and frustrating—and that’s at the best of times. Having to find treatment with all the added hurdles that come with being a recent arrival to the states, such as language barriers, economic challenges, and discrimination, can make it virtually impossible.

Citizens of Micronesia, the Marshall Islands, and Palau are legally entitled to medical care in the United States, thanks to the Compact of Free Association (COFA). Yet many COFA-eligible people living in Hawaiʻi have not signed up for coverage, leaving them without access to the health care they need and deserve. Now 11 organizations supported by Hawai‘i Community Foundation are working with these communities to build lasting connections and equity.

HCF established the Fund for Health Equity in 2021 to distribute $1.2 million in grants over two years, with contributions from the NME Fund, the Taketa ʻOhana Fund, the Stupski Foundation, the Kosasa Family Fund, and the Omidyar Network.

Part of that funding has gone to grassroots organizations within Hawaiʻi’s COFA community to support outreach and education. Other grants have gone to larger nonprofits to hire COFA staff and native language speakers to better reach this community.

“There are language and translation challenges, there’s cultural nuance,” says Chris van Bergeijk, HCF’s former senior vice president and chief impact officer. “People are more likely to trust someone who comes from their community and speaks the same language they do.”

In addition to funding, HCF is also helping COFA-related organizations to build capacity and better coordinate with one another. “It’s so important that they share information and resources, and support each other,” she says.

COFA gives citizens of the three member countries the right to live and work in the U.S., and to receive healthcare benefits and social services. It was established in response to U.S. nuclear testing in the South Pacific, which left many islanders with devastating long-term health problems.

Due to frequent rule changes and bureaucratic inconsistencies, adult members of the COFA community have not always been able to access those benefits. These issues were resolved in 2020, when federal legislation clarified the rights of COFA citizens, but the number of COFA residents who actually signed up remained troublingly small.

The enrollment process for Med-QUEST, Hawaiʻi’s comprehensive Medicaid coverage plan, can be extremely complicated. Many COFA residents don’t know how to navigate the system or what paperwork to bring. Language barriers and lack of transportation to appointments add to the challenge.

Outreach efforts like that of Kumukahi Health + Wellness on Hawaiʻi Island can make all the difference.

“We love supporting programs that are informed and guided by local leaders,” said HCF board of governer member Deborah K. Berger. “These navigators will help communities access services with culturally-specific and sensitive outreach efforts, which help to build stronger, healthier communities.”

To support the Fund for Health Equity, visit