Entry #6: Understanding COFA

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To understand the complicated situation for Marshallese immigrants living in the United States, one must understand the relationship between the Marshall Islands and the United States. From 1947 until 1986, Marshall Islands was under the administrative control of the United States as part of the United Nations Trust Territory of the Pacific Islands (McElfish et al.). In 1986, a new arrangement was made between several Pacific Island nations, including Marshall Islands, and the United States named the Compact of Free Association (COFA). The COFA gave the Marshall Islands sovereignty; and it allowed, and continues to allow, Marshallese citizens to freely enter, lawfully reside, and work in the United States without Visas or any other legal documents. (McElfish et al.) In exchange “Marshall Islands provides the United States with exclusive military use and control of 2 million square miles of ocean and land. The United States maintains a military installation on Kwajalein Atoll (McElfish et al.).

Image of 2022 Marshellese stamp 


Most health policies affecting COFA migrants living in the United States are made at the federal level: however, many states have different sets of powers and federal policies are followed with a lot of variance from state to state. The first ten years of the COFA arrangement Marshallese living in the US could qualify and receive federal benefits such as Medicaid and Children's Health Insurance Program (CHIP). In 1996, with the passage of so-called “welfare reform” that all changed and COFA migrants could no longer receive these benefits (McElfish et al.).

McElfish, Pearl Anna, et al. “Effect of US Health Policies on Health Care Access for Marshallese Migrants.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358182/. Accessed 28 October 2023.


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