The Lingle administration vowed yesterday that a new, state-sponsored medical insurance program for legal immigrants will not endanger the lives of Micronesians in Hawai'i who need kidney dialysis or chemo- therapy.

But advocates for the Micronesians filed legal challenges in federal and state courts to stop the new program, Basic Health Hawai'i, which begins today. A rally is also scheduled today at the state Capitol and at least one advocate plans a hunger strike if the legal challenges are unsuccessful.

About 30 members of Micronesians United met with Gov. Linda Lingle's senior policy adviser, Linda Smith, and state Department of Human Services director Lillian Koller for more than an hour yesterday morning to air their concerns about the new insurance program.

The community group tried to persuade the state to postpone the new program in hopes the federal government would increase payments to Hawai'i to recover the cost of providing health insurance to legal immigrants from Micronesia.

Smith and Koller said concerns about dialysis and chemotherapy were caused largely by a misunderstanding over what the new insurance program will cover.

Koller said the state believes it may be eligible for additional federal money that would fund dialysis for Micronesians for another two years.

According to a recent estimate, about 100 Pacific Islanders received dialysis and another 120 to 160 relied on chemotherapy under the former state insurance program.

Koller said Arizona recently signed a consent decree with the federal government that agreed that kidney dialysis should be considered an emergency medical treatment.

The federal government agreed to reimburse Arizona for dialysis provided to legal immigrants there during the past two years, Koller said. She said Hawai'i will file a similar claim, hoping to recoup about $3 million. That would allow continuation of dialysis services for about two years.

While the federal government does not consider chemotherapy an emergency treatment, almost all of the Micronesians who undergo chemotherapy do so as inpatients. That means the costs will be covered by Basic Health Care Hawai'i, Koller said. The Queen's Medical Center, where the vast majority of Micronesians go for chemotherapy, has pledged to continue the service uninterrupted. Smith said state officials were able to identify only two Micronesian patients who received chemotherapy as outpatients.

About 7,500 adult Micronesians live in Hawai'i and are subject to the terms of a Compact of Free Association. Officials estimate that it costs the state about $100 million a year to provide health insurance to Micronesian legal migrants. The new Basic Health Hawai'i plan is expected to shave $15 million a year from those costs.

The Compact of Free Association made between the United States and the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau allows for citizens of those nations to travel freely, work and live in the United States.

But there was no provision in the compact for medical care. The federal government did allow COFA nation citizens to be eligible for Medicaid, but that ended in 1996.

Since then — even though it was not required — Hawai'i continued to provide the same level of medical assistance to the COFA migrants without receiving any money from the federal government. No state except Hawai'i offers medical benefits to citizens of COFA nations.

In 2003, Hawai'i began receiving a partial reimbursement — less than 10 percent — from the federal government for the money Hawai'i spends annually on COFA migrants.

Smith said Hawai'i's congressional delegation is asking Congress to "step up to its responsibility" to reimburse Hawai'i for costs associated with providing assistance to the Micronesians.

Some of those who attended the meeting thanked Smith and Koller for warding off what they said could have been a health care crisis.

But Elma Coleman was taking a wait-and-see approach, and repeatedly asked Smith and Koller to postpone implementing the new health insurance plan and to talk to the leaders of the various Pacific island nations before doing so.

"The new plan still seems very limited for the people," Coleman said.

Masai Kintaro of Palau said Micronesians in Hawai'i have been very nice and very patient, but told Smith it was time for the government to deliver "on the legacy of your nation."

"We are up to here," Kintaro said, raising her hand to her neck. "We call the hospitals, and they don't give us the right medicines, the right services. We are human beings, you know."

Mitauo Anis of Chuuk thanked Smith and Koller through an interpreter.

Before the meeting, Anis, a dialysis patient, said he was afraid he would die in a matter of days if the state insurance program no longer paid for his treatments.

Victor Geminiani, executive director of Lawyers for Equal Justice, said the lawsuits allege that migrants have an equal protection right to health care and that the Lingle administration did not follow proper administrative procedures when converting to the new insurance program.

Advocates, who appeared with state lawmakers at a press conference yesterday afternoon at the state Capitol, said there are also questions about whether migrants would receive transportation to treatment appointments and brand-name prescription drugs under the new program.

Manuel D. Sound, a former lieutenant governor of Chuuk, said he has lived in Hawai'i for seven years and relies on the state's dialysis coverage. He said there is no dialysis treatment available to him back home.

"I got really scared," Sound said of the potential loss of dialysis treatment, which could leave him vulnerable and trigger emergency care at a hospital. "I thought I was going to die."

William Swain, a community organizer who represents people from the Marshall Islands, said he and others would stage a hunger strike at the Capitol if the legal challenges fail and nothing changes. He said his people have been asked by the United States to sacrifice for nuclear and missile defense testing and that the federal government should honor its obligation to migrants.

"I have not asked much. But you have asked that I sacrifice the very life and my existence. You have asked that of my grandparents. You are asking that today of my people, at least with the Marshallese patients that I represent. And you are going to ask me tomorrow because my kids will serve in your military forces," he said.