SB 298: DHS; Medicaid; In-Home Services; Appropriation

A BILL FOR AN ACT

RELATING TO HUMAN SERVICES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that most of the State's kupuna would prefer to live in their own homes for as long as they can.  In-home services are key to ensuring kupuna and people with disabilities stay in their own home; these services include helping with activities of daily living such as meal preparation, cleaning, bathing, mobility support, and other forms of personal care.  In a 2021 quantitative research study among Hawaii residents forty-five years of age and older, sixty-five per cent were extremely or very concerned about being able to age in place and eighty-three per cent of those surveyed said it was extremely or very important to them to stay in their homes as they get older.  Helping individuals live in their own home instead of in an institutional nursing facility is also far less costly.

     The legislature further finds that reimbursement rates that do not have medicare rates for equivalent services, such as in-home care services, are reviewed and determined by the department of human services at least every five years.  The last review of home and community‑based reimbursement rates for residential services by the department of human services' med-QUEST division was conducted through a third-party study by the actuarial firm Milliman and reported on December 30, 2022.  The study developed benchmark comparison rates for in-home services, including homemaker/companion/chore, personal care/personal assistance/attendant care, and private duty nursing by registered nurse and licensed practical nurse and modeled three rate scenarios for in-home services--low, medium, and high--under different direct care staff wage and caseload assumptions.  The low scenario includes the lowest wage or highest caseload assumptions to calculate the lowest reimbursement rates, meaning wage assumptions are set at the United States Department of Labor Bureau of Labor Statistics twenty-fifth percentile for specific occupation codes and titles; the medium scenario includes middle wage or caseload assumptions, meaning wage assumptions are set at the fiftieth percentile; and the high scenario includes the highest wages or lowest caseload assumptions to calculate the highest rates, meaning wage assumptions are set at the seventy-fifth percentile.

     The rate studies found there is tremendous wage pressure for direct care workers for home settings, given the highly competitive labor market in the State for similar paying jobs.  For all in-home provider types included in the study, current median direct care wages paid by the operators fell below the United States Department of Labor Bureau of Labor Statistics twenty-fifth percentile for those occupation codes and titles, except for licensed practical nurses who fell just below the fiftieth percentile.

     The legislature additionally finds that the data collected in the Milliman study is now five years old and the cost of providing care has risen substantially.  The legislature notes that data on the actual costs of care provided by Kokua Healthcare's personal assistance services in 2024 had rates exceeding the high scenario listed in the Milliman study.  Kokua Healthcare is unable to provide services to medicaid clients as the reimbursement is too low to cover costs.  Other in-home services providers are facing similar pressure, which impacts access to care for medicaid clients.

     The legislature therefore finds that increasing the reimbursement rates to the high scenario modeled in the Milliman study will best address the significant wage pressure felt by in-home services providers and the rising cost of care and is more likely to make this essential care available to medicaid clients.

     The purpose of this Act is to appropriate funds to increase funding of medicaid in-home services.  The corresponding federal matching funds will also increase, resulting in a larger impact on reimbursement received by service providers.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to increase funding for medicaid in-home services.

     The sums appropriated shall be expended by the department of human services for the purposes of this Act.

     SECTION 3.  This Act shall take effect on July 1, 3000.

Report Title:

DHS; Medicaid; In-Home Services; Appropriation

Description:

Appropriates funds to be expended by the Department of Human Services to increase funding for Medicaid in-home services.  Effective 7/1/3000.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

RELATING TO HUMAN SERVICES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that most of the State's kupuna would prefer to live in their own homes for as long as possible.  In-home services are key to ensuring kupuna and people with disabilities stay in their own homes.  These services include helping with activities of daily living such as meal preparation, cleaning, bathing, mobility support, and other forms of personal care.  In a 2021 quantitative research study among Hawaii residents forty-five years of age and older, sixty‑five per cent were extremely or very concerned about being able to age in place, and eighty-three per cent of those surveyed said it was extremely or very important to them to stay in their homes as they get older.  Helping individuals remain in their own homes instead of in institutional nursing facilities is also far less costly.

     The legislature further finds that reimbursement rates that do not have medicare rates for equivalent services, such as in‑home care services, are reviewed and determined by the department of human services at least every five years.  The last review of home and community‑based reimbursement rates for residential services by the department of human services' med‑QUEST division was conducted through a third-party study by the actuarial firm Milliman, and reported on December 30, 2022.  The study developed benchmark comparison rates for in‑home services, including "homemaker/companion/chore (PA1)", "personal care/personal assistance/attendant care (PA2)", and private duty nursing by a registered nurse or a licensed practical nurse.

     The rate studies found tremendous wage pressure for direct care workers in home settings, given the highly competitive labor market in the State for similar-paying jobs.  For all in‑home provider types included in the study, current median direct care wages paid by the operators fell below the United States Department of Labor Bureau of Labor Statistics twenty‑fifth percentile for those occupation codes and titles, except for licensed practical nurses, who fell just below the fiftieth percentile.

     Accordingly, the purpose of this Act is to make an appropriation to increase funding of medicaid in-home services.  The corresponding federal matching funds will also increase, resulting in a larger impact on reimbursements received by service providers.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to increase funding for medicaid in-home services.

     The sums appropriated shall be expended by the department of human services for the purposes of this Act.

     SECTION 3.  This Act shall take effect on December 31, 2050.

Report Title:

DHS; Medicaid; In-Home Services; Appropriations

Description:

Appropriates funds to be expended by the Department of Human Services to increase funding for Medicaid in-home services.  Effective 12/31/2050.  (SD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

Relating to human services.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that most of the State's kupuna would prefer to live in their own homes for as long as possible.  In-home services are key to ensuring kupuna and people with disabilities stay in their own homes.  These services include helping with activities of daily living such as meal preparation, cleaning, bathing, mobility support, and other forms of personal care.  In a 2021 quantitative research study among Hawaii residents forty-five years of age and older, sixty‑five per cent were extremely or very concerned about being able to age in place, and eighty-three per cent of those surveyed said it was extremely or very important to them to stay in their homes as they get older.  Helping individuals remain in their own homes instead of in institutional nursing facilities is also far less costly.

     The legislature further finds that reimbursement rates that do not have medicare rates for equivalent services, such as in‑home care services, are reviewed and determined by the department of human services at least every five years.  The last review of home and community‑based reimbursement rates for residential services by the department of human services' med‑QUEST division was conducted through a third-party study by the actuarial firm Milliman, and reported on December 30, 2022.  The study developed benchmark comparison rates for in‑home services, including "homemaker/companion/chore (PA1)," "personal care/personal assistance/attendant care (PA2)," and private duty nursing by a registered nurse or a licensed practical nurse.

     The rate studies found tremendous wage pressure for direct care workers in home settings, given the highly competitive labor market in the State for similar-paying jobs.  For all in‑home provider types included in the study, current median direct care wages paid by the operators fell below the United States Department of Labor Bureau of Labor Statistics twenty‑fifth percentile for those occupation codes and titles, except for licensed practical nurses, who fell just below the fiftieth percentile.

     Accordingly, the purpose of this Act is to make an appropriation to increase funding of medicaid in-home services.  The corresponding federal matching funds will also increase, resulting in a larger impact on reimbursements received by service providers.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of          or so much thereof as may be necessary for fiscal year 2025-2026 and the same sum or so much thereof as may be necessary for fiscal year 2026-2027 to increase funding for medicaid in-home services; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure; provided further that the department of human services shall pursue all funding sources known to the State, including private grants, prior to expending any general revenues appropriated pursuant to this Act.

     The sums appropriated shall be expended by the department of human services for the purposes of this Act.

     SECTION 3.  This Act shall take effect on July 1, 2025.

Report Title:

DHS; Medicaid; In-Home Services; Appropriation; Expenditure Ceiling

Description:

Appropriates funds to increase funding for Medicaid in-home services, conditioned on the Department of Human Services obtaining maximum federal matching funds and pursuing all other funding sources.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

STAND. COM. REP. NO.  1905

Honolulu, Hawaii

                , 2025

RE:   S.B. No. 298

      S.D. 1

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

     Your Committee on Finance, to which was referred S.B. No. 298, S.D. 1, H.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO HUMAN SERVICES,"

begs leave to report as follows:

     The purpose of this measure is to appropriate funds to increase funding for Medicaid in-home services.

     Your Committee received testimony in support of this measure from the Executive Office on Aging; Disability and Communication Access Board; AARP Hawai‘i; and AlohaCare.  Your Committee received comments on this measure from the Department of Human Services and State Health Planning and Development Agency.

     As affirmed by the record of votes of the members of your Committee on Finance that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 298, S.D. 1, H.D. 1, and recommends that it pass Third Reading.

Respectfully submitted on behalf of the members of the Committee on Finance,

STAND. COM. REP. NO.  1339

Honolulu, Hawaii

                , 2025

RE:   S.B. No. 298

      S.D. 1

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Madame:

     Your Committee on Human Services & Homelessness, to which was referred S.B. No. 298, S.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO HUMAN SERVICES,"

begs leave to report as follows:

     The purpose of this measure is to appropriate funds to the Department of Human Services to increase funding for Medicaid in-home services.

     Your Committee received testimony in support of this measure from the State Council on Developmental Disabilities; Executive Office on Aging; Disability and Communication Access Board; AARP Hawai‘i; Hawaii Self-Advocacy Advisory Council; and one individual.  Your Committee received comments on this measure from the Department of Human Services.

     Your Committee finds that the majority of Hawaii's kupuna prefer to age in place, remaining in their own homes rather than transitioning to institutional care.  Additionally, in-home services, such as assistance with daily living activities, are essential in supporting kupuna and individuals with disabilities to maintain their independence while reducing the financial burden associated with nursing facilities.  However, a 2022 actuarial study revealed that Medicaid reimbursement rates for in-home care services are not keeping pace with labor market demands, leading to workforce shortages and wage pressures in the home care industry.  This measure seeks to address these challenges by appropriating funds to increase Medicaid reimbursement rates for in-home services, ensuring that care providers receive adequate compensation and that more kupuna can access the support needed to safely age in their homes.

     Your Committee has amended this measure by:

     (1)  Clarifying certain findings in the preamble related to reimbursement rates for Medicaid in-home services;

     (2)  Changing the effective date to July 1, 3000, to encourage further discussion; and

     (3)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Human Services & Homelessness that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 298, S.D. 1, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 298, S.D. 1, H.D. 1, and be referred to your Committee on Finance.

Respectfully submitted on behalf of the members of the Committee on Human Services & Homelessness,

STAND. COM. REP. NO. 938

Honolulu, Hawaii

RE:    S.B. No. 298

       S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Ways and Means, to which was referred S.B. No. 298, S.D. 1, entitled:

"A BILL FOR AN ACT RELATING TO HUMAN SERVICES,"

begs leave to report as follows:

     The purpose and intent of this measure is to appropriate funds for Medicaid in-home services, which, when matched with federal funds, will fund services for Medicaid recipients to receive care in their own homes.

     Your Committee received written comments in support of this measure from the Disability and Communication Access Board, Hawaii State Council on Developmental Disabilities, AARP Hawaii, and seven individuals.

     Your Committee received written comments on this measure from for Department of Human Services.

     Your Committee finds that the moneys appropriated by this measure and matched by the federal government will allow more Medicaid recipients to continue to live in their homes, as they prefer, instead of moving to more costly community care foster family homes or expanded adult residential care homes.

     As affirmed by the record of votes of the members of your Committee on Ways and Means that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 298, S.D. 1, and recommends that it pass Third Reading.

Respectfully submitted on behalf of the members of the Committee on Ways and Means,

STAND. COM. REP. NO. 565

Honolulu, Hawaii

RE:    S.B. No. 298

       S.D. 1

Honorable Ronald D. Kouchi

President of the Senate

Thirty-Third State Legislature

Regular Session of 2025

State of Hawaii

Sir:

     Your Committee on Health and Human Services, to which was referred S.B. No. 298 entitled:

"A BILL FOR AN ACT RELATING TO HUMAN SERVICES,"

begs leave to report as follows:

     The purpose and intent of this measure is to appropriate funds to increase funding for Medicaid in-home services, conditioned on the Department of Human Services obtaining maximum federal matching funds and pursuing all other funding sources.

     Your Committee received testimony in support of this measure from the State Council on Developmental Disabilities and one individual.

     Your Committee received comments on this measure from the Department of Human Services.

     Your Committee finds that most of the State's kupuna would prefer to live in their own homes for as long as possible, and that in-home services are key to ensuring kupuna and people with disabilities stay in their own homes.  Your Committee further finds that there is tremendous wage pressure for direct care workers in home settings, given the highly competitive labor market in the State for similar-paying jobs.  This measure increases funding of Medicaid in-home services.

     Your Committee has amended this measure by:

     (1)  Deleting language that would have required the Department of Human Services to:

          (A)  Obtain the maximum federal matching funds available for this measure's proposed expenditure; and

          (B)  Pursue all funding sources known to the State, including private grants, prior to expending any general revenues appropriated pursuant to this measure; and

     (2)  Inserting an effective date of December 31, 2050, to encourage further discussion.

     As affirmed by the record of votes of the members of your Committee on Health and Human Services that is attached to this report, your Committee is in accord with the intent and purpose of S.B. No. 298, as amended herein, and recommends that it pass Second Reading in the form attached hereto as S.B. No. 298, S.D. 1, and be referred to your Committee on Ways and Means.

Respectfully submitted on behalf of the members of the Committee on Health and Human Services,