February 5, 2021

(Des Moines, Iowa) – The Department of Human Services (DHS) is now providing full Medicaid benefits to all eligible adult citizens of Palau, the Marshall Islands, and the Federated States of Micronesia living in Iowa through treaties known as the Compacts of Free Association (COFA).

The 2021 Consolidated Appropriations Act (CAA) was signed into federal law on December 27, 2020, allowing Medicaid coverage for COFA adults. COFA adults must still meet all other Medicaid eligibility requirements (e.g. income limits and Medicaid program requirements) to be eligible for full Medicaid benefits.

DHS has updated its Medicaid eligibility policies and systems to allow for this federal change in Medicaid coverage. Previous federal legislation caused COFA migrants to be barred from receiving full Medicaid coverage since 1996.

This policy change directly affects COFA adults. This includes all eligible COFA adults living in Iowa who are currently either receiving only limited emergency Medicaid coverage or who applied for ongoing Medicaid, but were denied full Medicaid coverage since the policy changed on December 27, 2020.

The Department estimates between 300 and 400 COFA adults will gain Medicaid eligibility through this policy change.

There is no change to Medicaid eligibility for COFA children (under age 21). In Iowa, COFA children have been eligible for full Medicaid benefits since 2010 based on their immigration status.

DHS will be taking the following actions to ensure Medicaid coverage to COFA adults who are now eligible for full Medicaid benefits:

  • If a COFA adult’s Medicaid application received by the Department during December 2020, and January 2021 was denied full Medicaid coverage due to citizenship/immigration status, the Department will reprocess the application. By the end of February, affected applications will receive a notice in the mail explaining the new decision or requesting any additional information needed by the Department.
  • Medicaid applications filed with the Department through March 31, 2021, for COFA adults who meet all other Medicaid eligibility requirements, will receive coverage needed to help pay for medical bills back to December 2020.
  • For Medicaid applications filed April 1, 2021, and later, COFA adults will be eligible for retroactive Medicaid only if they fall into a category that allows for retroactive coverage (a pregnant or postpartum woman or resident of a nursing facility licensed under Iowa Code Chapter 135c) and meet all other eligibility requirements.

Eligible COFA adults, and other eligible individuals, may apply for Medicaid benefits online through the DHS benefits portal, by downloading a paper application from the Department’s website, or by calling 1-855-889-7985.


For more information

Matt Highland