House Standing Committee on Human Services & Homelessness

Aloha and good morning. We are convening the Committee on Human Services and Homelessness Thursday, February 5, 2026 at 9:30am in Conference Room 329. Aloha, amapalo, noka, hele. And first up on our agenda is HB 1972 relating to taxation. This establishes a family caregiver tax credit for non paid family caregivers.

And first up we have the Department of Taxation.

Good morning Chair, Vice Chair, Members of the Committee, I'm Robert Avila. I'm Blue Tax. The Department stands on its written testimony providing comments. I'm here to answer any questions you have. Thank you.

And next up we have AARP Hawaii.

Good morning Sheriff Martin, Members of the Committee, I'm Audrey Suga Nakagawa from AARP and AARP stands as strong support of this particular bill. We really appreciate you hearing this bill as the Legislature well know that our 260,000 family caregivers are truly the backbone of a long term care system.

And without them we would not be able to keep up with the aging population and their needs that they have so that they can all remain at home and not be in very expensive nursing homes or type of cares. The families do it day in and day out. They're not asking for a whole lot.

But having this very modest tax credit, non refundable tax credit would really make a big difference to them. We know the cost of caregiving is so high, the average caregiver is spending over $7,200 out of their own pocket. And that's just probably the beginning.

So having this, just this $3,000 tax credit would be very helpful for them in providing the kind of financial relief. And just to illustrate what the cost of care is like, if you were to send a mom to a daycare center you know about maybe it would be about 90 to $100 a day.

So you think about the cost of that every single day for 20 days, 20 working days, that quickly adds up. We know home care services go from 30 to $50 an hour. And so even if you had 23 hours a day, that quickly adds up very well.

In terms of home modification, I recently got a quote from my own home because I needed to expand the doorway and also change my tub into a walk in shower. And I was quoted a $1,500 and that was when with me going to Home Depot and picking up some of the things myself.

So the cost of caregiving me is really expensive. And having this tax credit would really be very helpful to Canadian families. As we poll and listen to our Members. We also attend many and host many of these caregiver events. We hear from our people that caregiving is very expensive. Physically taxing.

They do it because they love their loved ones and having this would definitely be a great help. So thank you very much for consideration of this measure.

Thank you very much. Is the Executive Office of Beijing here on zoom?

Yes. Aloha Chair. Can you hear me? Okay? Okay. My name is Christina Valenzuela. I'm with the Executive Office on Aging. I'm testifying on behalf of our Director, Caroline Kadirao. EOA appreciates the intent and supports the intent behind this measure to lessen some of the financial pressures for caregivers. And we offer comments.

The measure would allow for a tax credit for caregivers who spend about 26% of their income on caregiver expenses. And the measure asks for a nominal tax credit of 3,000 to support the first 1,000 Care Caregiver Tax filers. We thank you for the opportunity to.

Thank you. Thank you very much. Do we have in support Hawaii Public Health Institute?

Aloha Chair, Vice chair, Members of the Committee, I'm Chris Caulfield from the Hawaii Public Health Institute. We're in support of this measure. As you've already heard, There are over 154,000 caregivers in the state of Kauai. Estimated $2.6 billion worth of care if they were compensated at market rates. It's 144 million hours of unpaid care in our state.

About 60% of our family caregivers are employed full or part time. Approximately 16% of adults in our state expect to provide care within the next two years. The financial strain of caregiving is significant and we have an aging population. This makes perfect financial sense when you look at the outcomes and the benefits.

It makes it easier for caregivers to maintain employment, maintain economic and financial viability in a state with such a high cost of living when the Legislature is doing everything it can to look at affordability.

Caregiver credits also from a public health perspective, uplift community based care options that help families keep loved ones at home when that's the best option for their loved ones. So we're in support of this measure. We'd love to see you moving forward. Thank you so much.

Thank you very much. Next up, we have Alzheimer's association of Hawaii in support. Not present, we have Children's Hawaii Children's Action Network speech.

In person. Aloha Chair Martin, Vice Chair Olds and. Members in the Committee. I'm Nicole Wu from Hawaii Children's Action Network speaks. We work a lot with parents around. The state and they are struggling with. Childcare and taking care of their children. But we're also finding a lot of them are the sandwich generation.

They are also taking care of their parents and it's one of the reasons that families are having trouble affording to live here. So that's a big reason about why we are supporting this bill.

We feel that it will help stabilize Keiki and their families as well, also reduce the strain on our long term care system if families are better able to keep their loved ones at home. So please pass this bill. Thank you.

Thank you very much. Next up, we have Tax foundation of Hawaii on zoom.

Good morning Chair Members Tom Yamachika from Tax Foundation of Hawaii. We have some technical concerns with the bill largely duplicating those that the Department of Tax has raised. Also the we wanted to point out that there is already a credit for dependent care expenses necessary for gainful employment.

And one I think of the challenges is going to have to be to specify where that credit ends and this one begins or vice versa. Thank you. I'll be available for questions.

Thank you very much. We also had testimony in support from, from, in writing from the Disability Communication Access Board, Hawai' I Family Caregiver Coalition, Chamber of Commerce, Hawaii, Hawaii Primary Care association and a couple dozen individuals. Is there anyone else wishing to testify on this measure? Seeing none Members, are there any questions?

I have a question for dotex. So. As has been discussed, there is another existing tax credit that is actually going to be the subject of a few measures down the agenda. And how can we make sure that we don't duplicate. Can we have it be a situation where they can choose whichever one gives them the greater benefit?

That's certainly so as opposed to having something like this one trumps this one. But to have it be like they can pick and choose one that provides the greater credit.

Sure. So the taxpayer is certainly free to claim any tax credit in the code to the furthest extent allowed. One of the recommendations we generally have for any tax credit measure is that it includes a provision that says for any costs that are claimed under this credit, those costs cannot be claimed under another credit.

So that's to prevent a bit of that double dipping, as it were, in terms of certification. It can be difficult for dotax to administer that in terms of figuring out our specific cost that was spent for one credit, not spent on another.

So that's also why one of our other recommendations is generally to have a third party certify the credits to let us know.

You couldn't just have a system where you can pick or choose. You can't apply for both.

In terms of a system, it's difficult because you're basically just looking at their tax return and seeing what credit they're seeing, how many credits they're claiming. Some credits you actually specify what credit is. Other times you're just claiming an amount of credit.

So it can be tough to figure out specifically what credit is being claimed unless the taxpayer is audited, for example, which of course doesn't happen all the time. Doesn't happen in overwhelming majority cases.

So that's why we simply want to put that in the law that they can double dip on a credit to allow us to have that if it comes out later.

So, yeah. Thank you very much, Members. Any other questions? Seeing none. We'll move on to our next measure. Thank you. HB 1975, which repeals the sunset for the state rent supplement program for Kukuna. First up, we have Hawai' I Public Housing Authority in person.

Good morning, Chair Martin, Vice Chair Olds. Members of the Committee, my name is Ben Park. I'm with the Hawaii Public Housing Authority. We have our written testimony in front of you. Just throwing out a couple of quick bits. If you are wondering what the appropriation. Or how many kupuna will cover. Cover about 280 kuna if they're at.

The $500 limit and approximately 350 at 400. Thank you for the opportunity to testify.

Thank you very much. Next up we have AARP.

Good morning. Audrey Suga Nakaga from AARP and we also strongly support this particular measure. We've always consistently supported the state rental supplemental program. We know that it's very vital to keeping any of our kaputa who are at risk of being evicted. If you see my testimony, I do have a statistics.

According to the Statistical European Analysis of Status available in the United States Bureau, close to 387 older adults age 65 and older are expected to be evicted in 2026. And more than 1100 older adults are expected to experience homelessness. So, you know, this particular program is very important to help keep them from being evicted and becoming homeless.

So I greatly urge you to please pass this bill. Thank you.

Thank you very much. Next up we have Catholic Charities Hawaii.

Aloha Chair, Vice Chair and Members of the Committee. I'm Betty Lou Larson for Catholic Charities Hawaii, you have a written testimony and we'd just like to comment that right now There are about 600 households on this Program, this special red supplement for Kupuna program.

And so we want them to continue obviously because they literally cannot find other housing that they afford. And I want to give you an example that's in our testimony. But it really is the face of the people.

Most of the clients that Catholic Cherry serves in our housing assistance program, it's very difficult for us to find housing for because they just can't afford the rents, even the affordable rents. So this 67 year old man was living in a container until he had to vacate it. Then he was serving his daughters living in his car.

Finally he got into an affordable senior housing project. Great. Except he was paying over 80% of. His income for rent. So he was very determined to stay there. But we were able to help him with the rent supplement and now he has an affordable rent.

He not only can afford his rent, but maybe save a little bit for those emergencies or those extras that he needs in his life. And so many of our clients are like that. Thank God the affordable rent was targeted people at 30% of the AMI or below.

So it was only like it was like $885 or something like that. So the 500 made just all the difference. So we have other seniors like that who could utilize affordable senior housing with this kind of subsidy. So we thank you for listening and we really appreciate your support of this bill.

Thank you very much. We have these activities can youing on.

Good morning, Chair, Vice Chair. Oh, go ahead. Okay. Good morning Chair, Vice Chair, Members of the Committee, Christina Valenzuela with the Executive Office on Aging testifying on behalf of Caroline Cuty Rao, our Director. We stand on our written testimony supporting the intent of this measure and offer comments.

We feel that making this program progress permanent will continue to help limited income older adults who may be at risk of eviction provide some stable housing. Thank you for the opportunity to testify.

Thank you very much. We also had written testimony and support from leading age Pacific west and one individual. Is there anyone else who wishes to testify on this measure? Are there any questions? I will just comment.

Comment that I had a constituent that an elderly constituent in his late 70s who was recently evicted and is known at Kalhale as a temporary measure because the affordable housing exceeded his income even though he is a state retiree and worked for the DOT for 35 years.

And so we're trying to get him some of his supplement so that he can afford affordable housing. So I definitely see the importance.

All right, moving on to our next measure, HB 1706, which expands the services Eligible for Medicaid prospective payment system reimbursement to include services furnished by a federally qualified health center or rural health clinic and provided by medication health professionals under the clinical supervision of a licensed mental health professional.

So this is to expand who can provide those mental health services to people that are still in training. And first up, we have the Office of Hawaiian Affairs in person.

Aloha Kakahiaka Chair, Vice Chair and Members of the Committee, Makena Woodward, on behalf of the Office of Hawaiian Affairs, we'll. Stand on our written testimony and support this morning and I'm available for questions. Thank you very much for weighing in.

Department of Human Services.

Aloha Chair, Vice Chair, Members of the Committee, Meredith Nichols here for DHS. I want to you have a written testimony. We do appreciate the bill's intent to address the shortage of mental health professionals to promote mental health equity and expand training opportunities for early career mental health professionals.

Currently unlicensed mental health professionals cannot directly bill Medicare or Medicaid. Also currently the Hawaii Medicaid state plan generally limits coverage for services, including PPS coverage in the FQHCs and the Rural health centers to services provided by licensed professionals. But DHS is willing to submit a state plan amendment to request something from CMS to do this.

We do caution there's very limited precedent in current regulations for that kind of requested flexibility. And again, we will follow the intent of this Bill.

And I'll be here for any questions. Thank you very much. Meredith. We also had written testimony with comments from the Hawaii Medical association. And. Support from one individual. Is there anyone else wishing to testify on this measure? Members, are there any questions? Go ahead. Thank you, Chair.

Happy birthday. Thank you for dhs. Hi, good morning. Thank you for the comments. And I acknowledge we're trying to create all kinds of pathways. But you mentioned in your letter CMS state plan amendments request to the circumstances. But caution, there's a limited precedence in the current regulation. I get it. Like what's our shot?

Do we have a shot at making this adjustment?

It's really difficult to say. I, I hate to say no, I hate to say never because I'm a hopeful person. But also I appreciate that you also need real talk and real idea and it doesn't seem like it would be something that would pass in this current Administration, but it's not impossible.

Sure. Then let me ask this. What is the measures when we're applying for an exception? How is that valued? And I'm asking because I'm from the neighbor is and we have incredible problems when it comes to healthcare professionals. And oftentimes these rules are based in very urban settings and not rural settings.

So if you could share maybe some of the value systems that are given that they're looking at an exception.

Values for looking at the exceptions, they typically go back to their code of fit, federal regulations and their interpretation of law.

But what I will say, and especially for our rural, for rural members and our rural population, the rural health transformation grant that's being run out of the governor's office does provide a lot of hope and hopeful pathways to do things that recognize the special needs in our rural areas.

We don't have enough providers we could use more, obviously. And there are some really good and exciting pathways forward that I think we'll see coming out of that initiative. So I'm hopeful there.

And then to that point of braiding our rural transformative health care grant with basically expanding the definition. Right. Is that kind of half a step to accessing that rural transformative healthcare monies?

It's, you know, it's possible. You know, I can't speak specifically to rural Health Transformation grant, but I do see a lot of possibility in moving the state forward in new directions through that. Okay. Through that grant. Okay, thank you so much.

Yep, go ahead.

Oh, sorry, DHS. I have questions. Thank you. Hawaii is a trauma informed state and the Legislature is very interested in providing mental health services to more of our residents. But we also want to pass good bills. So my question is, without prior approval from CMS, if this bill were passed, would there be any benefit to it?

We would not be able to move forward without approval from cms. We're very regulated and CMS does require approval before we move forward in the path.

So my follow up question to that is how long is that process to submit an amended plan so that CMS could possibly provide approval?

Yeah, there's no specific time frame. Typically CMS holds themselves to a standard of once we gather, craft the amendment, they will give themselves up to 90 days to respond to us. But that response is typically a question and then we will answer and then, and then go back and then they have some amount of time to respond.

So sometimes it can go quickly when there's an easy path forward and other times when it's more challenging, then it can be a lot. All right, thank you.

Okay, so moving on to our next. Measure.

This is HB 1706 and nope, we just did that line 2007 which is increasing the applicable percentage of the employment related expenses used to calculate the household and dependent care services tax credit so the existing tax credit, as opposed to the new one that we just discussed, allowing people to take full advantage of what is in the law.

So first up, we have Department of Taxation. Still with us? No. With comments, we have Indivisible Hawaii. Please come up to the podium. We can't hear you from back there. The microphones are set up to just be over.

Morning, Chair, Vice Chair, Members of Committee. My name is Yonghee Overlee, representing Indivisible Hawaii. Members of Indivisible Hawaii fully and strongly support this measure. And we're written on. We stand on our written testimony.

Hello. Thank you very much from AAUW Hawaii.

Good morning, Chair, Vice Chair and community Members. I'm Jean Evans with AAUW Hawaii. We stands strongly on our written testimony. Thank you. Thank you very much.

Next up, we have AARP Hawaii.

I'm Audrey Suga Nakagawa from AARP and we also stand our testimony in strong support of this particular bill. We find this bill to be complementary of the caregiver tax credit. It allows families to choose one or the other depending on the category and the type of filing that they have.

So we really do support for this and I'm glad that DOTAX did clarify that there's a way to keep it separate so that they can choose one or the other and that they don't double dip. So thank you very much. We do support this bill.

Thank you very much. Next up, we have Hui Children's Action Network Speak.

Happy birthday, Chair Martin. And hello, Vice Chair and Members of the committees again. I'm Nicole Wu from Hawaii Children's Action Network Speaks and we support this bill. We all know how much child care costs.

It's at least 13,000 a year for Pre K at this time, which is just a crushing amount of tuition for parents who are working hard to make ends meet.

The Child Independent Care Tax Credit, which is kind of what we call it, was started in 1977, but it hasn't kept up with inflation or the skyrocketing cost of childcare. So three years ago, wisely, this body and the Governor raised the amount that could be claimed because it had been way too low.

But part of the language of the original bill didn't make it into the bill that finally passed conference. And so there's still a cap. If your family makes more than $50,000 a year, you can only claim 15,15% of your care expenses in the tax credit. So let's say your Pre K is 10,000.

You can only claim 1,500. And that's just not enough relief for families who are being squeezed. One thing about who would really be helped by this tax credit, it is the Alice families, because the very low income families already qualify for subsidies that the state provides.

But it's the Alice families who just don't make enough to qualify for the subsidies. But we still know they're struggling to make ends meet. They're the ones who are really going to be helped.

So if you look at my testimony, I have a table that kind of shows a few different families, some minimum wage, some Alice, it shows what their current tax credit is and then what it would be if you were to pass this change.

And so, you know, again, for the kind of median household income, single parent with two children or a married couple with two kids who are at the Alice level, their tax credit would go from 3,000 to 10,000, which, you know, really, as I know some of you are working parents, that makes a huge difference.

So that's why we support this bill and we're going to come back every year to try to get this passed. Thank you. Thank you very much.

I hope I don't see you next. Year on this bill. All right, Tax foundation of Hawaii on Zoom.

Good morning, Chair, Members of the Committee, Tom Yamachika from the Tax Foundation of Hawaii. I'm sorry, I can't start my camera. We have submitted some written comments. We'll send our testimony available for questions. Thank you very much.

Thank you very much. We also had testimony in writing and support from Hawaii County Council, District 2, Hawaii State Democratic Women's Caucus, Oahu Youth Action Board, Hawaii Appleseed center and about over 40 individuals. So a lot of interest in this measure which has been a work for multiple years now.

Okay, Members, are there any questions of our testifiers? No, I also do not have questions. So we will move on to HB 1546 which establishes the three year health coverage Continuity Program within the Department of Human Services in consultation with DCCA to assist individuals who lose Medicaid health insurance coverage.

And first up, we have the Department of Human Services.

Aloha again. Chair, Vice Chair, Members of the Committee on DHS, you have our testimony. Meredith Nichols, on behalf of DHS, we appreciate the intent of this bill. We are experiencing with all of you the deep concern that comes from what's happening on the national front that will very likely impact the amount of uninsured people in our community.

We know that the lack of or the fact that the expanded tax credits didn't get extended on the federal marketplace makes it much more unaffordable for our community Members, about 24,000 of them, to seek insurance through that vehicle. These are typically people who aren't eligible for Medicaid anyway. Maybe they make a little bit too much money.

They get their health insurance there. If they're not able to afford it there, what happens? What's their option? And then also there's a combined concern with Medicaid itself. So beginning In January of 2027, there's the community engagement and work requirements that will be in effect.

This means that for a certain portion of our population they will be subject to work requirements. This is going to be think of just able bodied adults, people between 19 and 64 though that population will be required to prove that they're working or engaging in the community at least 80 hours a month.

We know that this is going to be problematic. We know that demonstrating that you're meeting the requirements will be problematic. And so we very much appreciate the intent of this bill. Trying to find pathways towards solutions as people become uninsured. What can the State of Hawaii do to help? So you have our full testimony, but.

I just wanted to share that background here.

Thank you very much. We also have the Office of the Attorney General. Are they here on Zoom in person?

Good morning, Chair and Members of the Committee, Martha him on behalf of the Department of the Attorney General. So we provided comments on the bill regarding the appropriation issue and we are available, or I am available for any. Questions that the Committee may have this morning. Thank you. Thank you very much.

We also have. Okay, I think that's. Oh, DCCA. Thank you.

Good morning. Chair, Vice Chairman for the Committee, Justin Chu for the Insurance Division. DCCA stands on its written testimony, providing copies.

Also in person, we have Catholic Charities Hawaii. Catholic Charities Hawaii.

Aloha Chair and Vice Chair, Members of. The Committee, I'm Betty Lou Larson with Catholic Charities Hawaii. And we really want to thank you for being proactive on this crisis that's emerging. This is the year we have to act in order to have something in place and started by the time the numbers start growing. Right now.

We have that time. We really appreciate you looking at this bill so seriously. You know, we have a huge number of Medicaid recipients, over 429,000 in Hawaii. And I'm not sure if the Department even knows how many will be at risk with these new regulations going next year, but we know that many will.

Many of the clients that we serve who are homeless or other situations, even Kupuna, might be at risk for this who are not yet 65. But, you know, it's very difficult for them to find a job, et cetera. Maybe they have health conditions, but not considered disabled yet. And so looking at this now is so important.

We have our written testimony, but we really want to thank you and work. Together on this issue.

Thank you very much. We have on Zoom. Do we have the University of Hawaii? Please go ahead.

Aloha chair, vice chair and Members of the Committee. I am Farah Marie Gomes, Associate Vice President for Student Affairs with the University of Hawaii System. I'm here today on behalf of our Vice President for Academic Strategy, Debbie Halbert. We have provided written testimony and we're happy to stand on that testimony. I appreciate you hearing this bill today.

My mahalo. Thank you very much.

And then in person we have Yong Overlee as an individual.

I have to vote that again. Our Chair, Vice Chair, Members of Committee. I'm here to testify in support of this measure. But I also wanted to let you know that Indivisible Hawaii Healthcare team has also submitted written test testimony and support.

A little information about Indivisible Hawaii is we have 14 chapter nonprofit organization here that spreads entire state, including much of the rural Hawaii. And healthcare coverage is already difficult in rural Hawaii, as you all know. So this is going to devastate us. Thank you for listening.

Thank you very much. We also had written comments from the Department of Labor and Industrial Relations, written support from the Hawaii Academy of Family Physicians, Hawaii alliance of Nonprofit Organizations, Hawai'i Primary Care Association, Indivisible Hawaii, as we just heard, the Hawai'i Medical association. And then another a couple dozen letters of support from individuals.

Is there anyone wishing to ask questions of our testifiers? Please go ahead. Thank you, Chair. DHS, please.

Thanks again for your letter. And I recognize that this is a. Private program. And we talked about the. Rural Transformative Health Care Grant and I. Understand that some of the guardrails for. That program is it would have to be something new. Would this pilot program fall into that understanding of a new program?

It's a very interesting idea. I can't comment on that. But. And I hadn't thought of that, but I think that's a very interesting idea. Mahalo for that. I like that. Okay. Yeah. Thank you.

Other questions, Members? Okay, I have questions. So I was very interested in this measure has already moved and started to move in the Senate and they made some amendments to something that is along the lines of what it started with.

But I was very interested in your testimony about your existing premium assistance program for immigrants that don't qualify. Basically that is just giving them subsidies that the Federal Government does not give them to enroll in the ACA plans. Is that correct? That's correct. We've had that program for a long time now.

And your cost per person, you said, is about $1,300 annually. Annually, right. And so but yet they are getting full health insurance as opposed to just emergency health insurance and some help with primary care. They're getting the full arraign.

Yes.

So I can speak to that. I'd ike to just if you could compare the cost effectiveness of that and if we could expand that versus what is already moving with the amendments on this bill. Because I think I'd like to keep two options moving.

Sure. So that program that's currently running, there are some criteria involved and it's a combination of of payer of health insurance that involves the Federal Government on the Affordable Care act side of the marketplace. So what happens is say an immigrant who hasn't yet met that five year bar.

So they're not eligible for Medicaid until you meet that five year bar. But they have historically been eligible to go to the marketplace and leverage advanced premium tax credits. So so then that individual would go to the marketplace, purchase a silver level plan.

And this current program is very specific to leveraging and I'm going to say words that will mean nothing to anybody but me probably, but a silver 94% actuarial value plan, which is basically the plan that leverages the most subsidy on the marketplace. It gives you really good coverage. The premium is low and it gives you that 94%.

It gives you something called CSR. It stands for cost share reduction. So it's a very rich plan for people to get. And then the way the state, through DHS and Med Quest has been partnering with that is saying, hey, because you typically would have been eligible for Medicaid, you're operating at a poverty level that's Medicaid eligible.

When you enroll in that Silver 94 plan, Kaiser and HMSA, those are the two insurance folks that Hawaii has on the marketplace. They will send us a list of their people who signed up for that silver 94 plan.

We get the list, we run it through our Medicaid, our system, to make sure the reason that person Wasn't eligible for MedQuest is because due to citizenship. Right. Otherwise, let's bring them to Med Quest because they're eligible. Right. So we identify the population and then MedQuest wraps around and just pays any remaining premium for that person.

So the reason it's more affordable is because the Federal Government is still picking up the lion's share of support and we're just coming around and making it whole. So that's why it's difficult to compare. And it operates a little differently than I think what the bill imagines.

Is that something the groups that we're talking about targeting, would they also be eligible for getting the lion's share through the ACA federal subsidies and then having the state supplemented, or is there something about them that would make them not eligible?

There's nothing about them that would make them not eligible. But I think the work on deck for all of us collaboratively is to think about how who gets subsidy and what that subsidy looks like. The other complication is for MedQuest, we're open all the time. There's no such thing as an open enrollment period.

People can apply any day of the month, year long. This is not true for the marketplace. On the marketplace, there's a distinct open enrollment period and that happens between November 15th and January 15th.

Fifteenth.

And after that you're locked out for the rest of the year. You don't have access to going to the marketplace except for a few, they call them on special enrollment periods. They're circumstances where you had a life change. So maybe now that life change says, zero, this is new for you, you can come to the marketplace.

So one of the good things for us to think about leveraging is one of the life change events is loss of Medicaid. So we may be able to leverage. When people lose Medicaid, they have a certain amount of time to then go enroll on the marketplace.

And if they enroll on the marketplace and choose that kind of plan, then this, the framework for what I just described, could potentially work. But that discussion, I know, is all in the works, but I think there are pathways we can think about.

And so we appreciate this bill in that it provides opportunity to have the discussion and then work those details out.

Okay, thank you very much. I appreciate it. All right, Members, moving on to our next measure, HB2010, which establishes a surcharge on taxable income exceeding a million dollars to provide funds for Medicaid. Next up, we have Department of Taxation.

Good morning. Chair, Vice Chairman of the Committee, Robert Avila, DOTAX. We stand on our written testimony as submitted. I'm here to answer any questions you. Have and apologies for missing the error between committees. That's totally fine. Thank you.

Thank you. All right, next up, we have Department on Human Services.

Aloha Chair, Vice Chair, Members of the Committee, Meredith Nichols, Department of Human Services. And we'll stand on our written testimony. Thank you very much.

We have the Hawaii Public Health Institute in person.

Aloha, Chair, Vice Chair, Members of the Committee. I'm Chris Coffin from the Hawaii Public Health Institute. We're in support of this measure. This. We're facing just dramatic federal funding cuts, dramatic budget cuts that you're all very aware of HR1, that was enacted in 2025. Right.

It's projected that could trim federal support for Medicaid by as much as 1.5 billion for our state. This proposal would generate $71 million a year in projected revenue to help shore up spending gaps at a time when we need, we really need that revenue. We believe this is an equitable revenue generation approach.

In 2022, there were only about 1800 residential tax returns that reported an AGI of over a million dollars. And this is also part of a national movement.

California, for example, as we note in our testimony, funds major behavioral health investments through the Mental Health Services act, which finance which is financed by 1% tax on personal income over a million dollars. Massachusetts does something very similar. They actually have a 4% surtax on income over a million dollars.

And one of the big concerns that we've heard in talking about this in the community with some of our partners is this idea of tax flight or wealth flight.

If we enact higher earner income taxes or surtaxes on high incomes, and this has actually been heavily studied using IRS data, those Analyses have shown that that's basically mythological, that you'd have to. An increase of 10% in the state's top tax rate equates to about a 1% decrease in the proportion of millionaires in the state.

So we believe this is a matter of equity. It's really about who deserves to live in Hawaii. Who do we really care about? This Committee has consistently supported expanding access to care services and essential social services for those who are most vulnerable in our state.

And really, to enact that vision, we need to generate revenue that matches that rhetoric. So we support this measure and we hope that you'll move it forward. Thank you very much.

Next up, we have the Hawaii Appleseed Center for Law and Justice.

Chair, Vice Chair, Members of the Committee. My name is Devin Thomas testifying on behalf of Hawaii Appleseed in support of this bill for many of the same reasons that were already outlined by Chris.

But we just want to emphasize the point that our Medicaid program, our state Medicaid program is going to require hundreds of millions of dollars in funding potentially to plug the gaps that are being left by the Federal Government.

And this is the best way to pay for priorities that we need, right, Is to tax folks who can afford to pay more. And Massachusetts is a great example of this because they have a 4% surtax that's double what's being proposed here.

And what they actually found is that between 2022 and 2024, the number of millionaires increased by a third there and the wealth increased by over a third, too. So rather than causing people to leave the state, it actually didn't have, you know, it didn't have the effect that opponents were same.

And for this reason, we strongly urge the Committee to. To support a Bill like this which, you know, puts the burden on folks who can't afford to take more of the burden. Thank you.

Next up, we have Hawaii Children's Action Network Speak.

Aloha. Again, Chair, Vice Chair and Members of the Committee, Hawai'i Children's Action Network Speaks is also very concerned about the Medicaid program. According to the Department of Human Services, more than half of our KK rely on that program programs. This is an essential lifeline for them.

I think many of you have heard me talk before about how our tax system at the state and local level taxes people at the low end at a higher rate than people at the high end.

So, for example, families here who make less than $22,000 a year pay 14% of their income in state and local taxes, while the top 1% pays about 10%. So that's 4 percentage points less for the richest people in Hawaii than the poorest.

And this bill would kind of get a little closer by adding 2% to the fraction of the top 1% who have more than a million dollars in income in Hawaii. We did put higher tax rates on people at the top in 2009 and 2007.

And we didn't see a huge flight away from Hawaii because people live here because it's a beautiful place. I like the food here. So there's a lot of reasons to keep for, you know, wealthy people, they will decide to stay here because this is such a wonderful place to live.

They're getting very big tax cuts at the federal level. It's estimated about $43,000 a year in federal tax cuts to the top 1% here in Hawaii. So it seems like they can definitely afford to pay more, especially when our lowest income families, Medicaid recipients are going to be facing such huge crises in the next year or two.

Thank you. Please pass this Bill.

Thank you very much.

Next up, we have indivisible Hawaii.

Chair and vice chair Members of Committee. It's me again. Individual Hawaii is in strong support of this measure. The court pretty much said what I wanted to say is that we already have regressive tax system and with. Tax. Cuts, federal tax cuts, that one big beautiful bill will provide millionaires goods definitely avoid this. Thank you.

Thank you very much. On Zoom, we have Tax foundation of Hawaii.

Tom, we are not hearing you. I don't know if you're speaking. If he comes on, we'll let him speak.

But we also had testimony and support from Chamber of Sustainable Commerce, Oahu Youth Action Board, Hawai'i Women's Caucus, the Hawai'i Tax Fairness Coalition, the Democratic Party of Hawaii, opposition from the Grassroots Institute of Hawaii, and then support from some 40 individuals members. Are there any questions for our classifiers? I have a question. Chair.

Thank you for DOTAX. Yes, this may seem like an odd question, and I'll probably catch some flat for it, but I'm going to ask it any. We all know that the cost of living is high. So a million dollars here in Hawaii does not go as far as a million dollars in other states.

So taking that into consideration, what would be the equivalent here for what's like a million dollars in Massachusetts or in California? Because, and I ask because for people that I don't make anywhere near a million dollars, but for people who do, I am aware that they still have struggles trying to make ends meet here in Hawaii.

So I'm trying to figure out like, what would be like, an appropriate amount for like the riches to be taxed because perhaps a million is still low. And I. So I'm just trying to explore that.

Yeah, it's a difficult question to answer. In my capacity as a Member of DOTAX. We're here to administer the tax law. I would say the question you asked is more around, you know, economic policy and what the appropriate amount would be. You know, with.

With respect, I would defer to your judgment on that, perhaps consulting economists at UH or other data. But what we're here to do is just tell you whether or not this can be administered and how to do so to accommodate what you all desire. All right. Sorry. No, no, no.

I didn't know who to ask.

But I will say, just to reiterate one of the points in our comments, which perhaps speaks to your question. One of the things we did want to note, page two of our testimony. Our second point was just.

It's a minor thing, but we noticed in this bill that it refers to the surcharge being imposed on the taxable income of every taxpayer filing a return under this chapter. But the sections it's quoting are really speaking to the individual income tax, whereas under this chapter you also have things like the corporate income tax.

So I think just clarifying whether you want this surcharge to be applied to non individual taxpayers as well would be helpful who also generate incomes. Thank you.

Thank you. That's very helpful information. Appreciate it.

Members, any other questions, come back.

Sorry. Also in your testimony, your first point about making the suggestion to do a set dollar appropriation because you can't keep the revenue separate, do you have a suggested amount for that based on previous tax years?

Like if the 2% surcharge would have been, you know, in the last three or four years, that we can get an idea of what that dollar amount might be set at or how much would be raised in general.

So I don't have that number offhand, but I can certainly look for that number for you.

Okay. Yeah, I'm just going to finance after. I think that would be helpful for the Committee then to see those numbers to see like what we're talking about in light of imposing the tax versus the impact it would be doing for the losses that we're kind of looking at seeing.

So just to make sure I'm understanding correctly, you're asking if this tax had been applied last year, for example, what would.

Or maybe over the last couple years. Because that would give us an idea, right? If your suggestion is to set a dollar amount to be transferred, it would give us a better idea of what that dollar amount should be understood. Sounds good. Thank you.

Yeah. So this really isn't a human services bill. It's super. It's really not connected to Medicaid in any way. But I'm so we don't usually get to talk about these things in this Committee, but I'm very interested. So is it accurate?

One of our previous testifiers said that there's about 1800 people in our state that would be impacted by these tax. Is that an accurate number?

I'm not sure off the top of my head what that number is for people who would be impacted, but I would just like to mention that the way that the tax system is set up and the way that this bill is worded is you're looking at the taxpayers taxable income which could be less than the gross income.

It has to be deductions applied to their gross income, which could be from wages, bonuses, rents, interest, royalties. They apply some deductions, they get to this number. And then the bill as written is saying that's where the surcharge would be applied.

So just because the reason that's related to what you're asking is just because a taxpayer has that amount of gross income doesn't necessarily mean that it's gonna get applied to that. It would be after deduction. So. I see.

So we don't know how many people would actually be impacted. And also, have you folks looked at all about mobility? Right.

It's one thing to say that people stay in California where they're making that money, as opposed to saying people will stay in Hawaii, where they're quite likely not making their money in Hawaii, just happen to be living here. Do you folks have data, anything that can kind of shed accurate light on these arguments either side? Right.

I know anecdotally, I have seen multiple people move their domicile, their tax domicile away from Hawaii due to legislation that didn't even pass. Right. And we lost their tax income without even passing a bill, just by hearing bills. So do you have data?

Regrettably, I don't think we do. I think what you're asking is, if this tax is imposed, is there data to show how taxpayers would respond to these changes? Right. That's difficult to like, do we know.

Where people make their money? If they are over a million dollars of taxable income, do we know, like, when they've made it in this state versus when they just happen to be here?

Not necessarily. The way that the Hawaii tax is really imposed is it's limited to what a taxpayer's income source to Hawaii is. So it's not like we know, zero, which portion of your income is in California, or we would only be able to know what portion is in Hawaii.

So to expand on your point, it wouldn't just be about people physically moving to another state, but also where are they trying to establish their income as arising from? You could be in California and still have income in Hawaii and vice versa.

So they only pay tax on the income that's made in Hawaii?

For the most part, yes. Under Hawaii. Yeah. Hawaii can only tax what's sourced in Hawaii.

Thank you for clarifying.

Thank you very much.

Moving on to our next measure, HB 1668, which requires requires the Department of Human Services to allow a full income disregard for individuals with disabilities who are between the ages of 16 and 64 when determining eligibility for Medicaid. First up, we have the Hawai'i State Council on Developmental Disabilities.

Hi. Daintry Bartoldus Executive Director for the Hawaii State Council on Developmental Disabilities. And we stand in strong support of this measure. It took us 16 years to get. A bill passed to have an earned. Income disregard called Cal's Law. For the past five years, we've been. Trying to implement that, and we've come. Across a few hiccups.

I'd like to ask Jay to give a few highlights from our testimony to. Carry off with the Council.

Chair, Committee Members. My name is Jay Silver, also with the Hawaii State Council on Developmental Disabilities on a personal and professional note. So this bill builds on Cal's Law. Cal was my brother. He, we were born and raised here. He went to Akahi Elementary School. He was much smarter than I'll ever be. And he went to Iolani.

He went to the University of Hawaii. And he passed away in 2012. He passed away thinking he was never going to be allowed to work because he had spinal muscular atrophy. He required Medicaid just to get out of bed in the morning. And that's the choice that we're asking people to make.

So we just wanted to highlight that this is a great step forward for that. We did, as my boss mentioned, make good steps so people can work. But this would make people be able to work any job without having to worry about their income. Thank you so much.

Thank you very much. Appreciate it. Next up, Department of Human Services.

Aloha Chair, Vice Chair, Members of the Committee, DHS stands on our written testimony.

And we're also very pleased to share that this bill, we have already done the work that this bill is asking us to do that we, we had a meeting with all of our partners who you just heard from, and we're so grateful to them for their really good input and, and push and, you know, now we're there.

So we were able to, after that meeting, come together at DHS MedQuest. We went ahead, drafted the amendment, we put it in and we've already had our meetings with C cms. They've signaled verbally over the on our phone call that they don't see any problem with this.

So we've requested for effective date of January 1, 2026 which is typical for CMS. They can go retroactive to make this coverage. So we're happy to share with you today that we absolutely agree with what our DD Council has shared and happy to have done this work. Thank you very much.

Next up, we have in person, Janelle.

Good morning, Chair, Vice Chair, Members of the Committee, thank you for allowing me to be here today. My name is Janelle Fiesta and I'll be sharing my story in support of HB 1668. I was born and raised in Honolulu, Hawaii, and I live with a rare neuromuscular condition called spinal muscular atrophy.

I was diagnosed at a year old and since then I have lost most of the motor function in my body. The prognosis for people with my condition isn't the greatest, but I am here today and I will be celebrating my 30th birthday in a couple of days.

Just like anyone else in this room, I have goals, meaningful relationships and dreams for a better future. Because of my disability, I utilize a power wheelchair and rely on daily caregiving assistance for nearly every aspect of my life. Getting out of bed, using the bathroom, bathing, dressing and getting to work all require help.

The support I receive is not optional. It is what allows me to live independently and safely. Medicaid, known as MedQuest Interstate, makes my life possible. Through it, I receive caregiving services that allow me to live at home, stay healthy and participate in the community. I'm deeply grateful for the support that I do receive.

I'd like to share that I am proud of my career as an Equal Employment Opportunity Specialist, a role which I have recently earned after working as an assistant for several years. I work hard, serve our customers and continue to grow professionally. I love the work that I do and the fact that I'm able to serve others.

However, employer based insurance does not cover the caregiving services that I need to live and my income alone could never cover the cost of the daily care that I require. Right now. Medicaid eligibility rules force people with disabilities into an impossible choice. Limit our income and our ambitions or risk losing the health care that keeps us alive.

This choice should not even exist. Wanting to work, to grow and plan for a future should never be a liability for people like me. Medicaid is not just a temporary benefit. It is a lifelong support and with the right policies, it can work alongside employment instead of against it. HB 1668 offers this opportunity.

It allows people with disabilities to work, contribute and build stable futures without fear. It sends a powerful message that our state values inclusion, independence and dignity. I hope you will see 1668 not just as a simple policy change, but as a reflection of Hawaii's values of Mamama and Kuliana.

It is an investment in people like me and in a future where everyone is supported, valued and given the chance to thrive in a place that we call home. Thank you for your time, your consideration and your commitment to our community.

Thank you very much. Next up, we have Kylie Swan.

Good morning Chair, Vice Chair, Committee Members. My name is Kylie Swan. I'm a person with developmental disability. Niggas, Medicaid services. Medicaid helps me with support. I need to live and work in the community. Without these services, it will be very hard for me to keep my job and stay independent.

Right now I have to be careful not earn too much money. If I make too much, I'll lose my Medicaid. That makes it scary to work more hours or take a better job. This bill will let people like me to work and earn more money without losing Medicaid services.

I want to work, I want to grow, I want to become independent. But I also need my support. Please pass this Bill so people with disability do not have choice between working and keeping service. We need. They can listen to my testimony and please let me know if you have any question you have. Thank you.

Allow me to testify.

Thank you very much. Next up, we have on Zoom the Hawaii Disability Rights Center.

Yes, good morning. Thank you, Representative Marten. I'm Louis Erteschik. I'm the Director of the Disability Rights Center. We were very involved with the passage of Cal's law. And don't get me wrong, we were grateful when it happened. It was really hailed as a wonderful achievement because it allowed allowed people to earn money and keep their Medicaid benefits.

But what's happened is that I think time has shown that Cal's law had some limitations because it pegged the ability to disregard the money to a percentage of the poverty level. And so what we've seen in the last few years is that, and Janelle is a shining example of that.

So you have people who are working and now they have opportunities to get promoted, to earn more money, advance their career. And so that 138% of the poverty level cap is essentially keeping them down. So it makes perfect sense to, to basically eliminate the cap.

And frankly, I'm delighted to see Meredith and DHS indicate that they're in support and that they're moving ahead with the CMS waiver process. So we'd love to keep this bill going. So thank you very much. We really appreciate it.

Thank you very much. Next up, we have on Zoom an individual, Iris Xiao. Is she there? Go ahead, Iris.

You having trouble with our system? Because Tom Yamachika couldn't speak together. Okay. How do we know if it's our side?

So it's not on our side. They're just not responding right now.

Okay. All right. We also had in support another handful of individuals Members. Are there any questions? Go ahead.

Hey, Gantry, real quick. You know, last session we passed the savings cap for individuals with disabilities. And I see this kind of working hand in glove. Is that the kind of goal is this?

Yes. Yeah. So I really want to thank Department of Human Services. Meredith, we've talked about it, and it's an earned income disregard as well as an asset, which is great. So. Yes.

And then with raising the cap of their ability to save.

Correct. So we have the asset level, which will be removed. And then we also passed the able savings account. So you can even save more money now. So those two going in? Yes, we're going down the right pathway. Okay, great. Really excited about it. Thank you. Thanks.

Go ahead.

I have a question for Janelle. My question is, I think you can stay there. My question is. So you're on Medicaid, but you have a full time job.

Correct.

How do you do you forego your salary.

From the current job that I'm at? I'm nearing a cap level where I'm getting dangerously close to not meeting eligibility requirements anymore. If I were to be given a raise or a bonus, I could risk losing my Medicaid just because I don't meet the eligibility rules anymore.

Okay. You'll be eligible under the new change?

That's the hope, sir.

Thank you. Thank you so much. Good luck.

I would just like to thank our testifiers for making the effort to come in in person. It's really, really useful. Good thing I didn't wear mascara today. Thank you.

Okay, moving on to our next measure. It's HB 2009, which extends child care subsidies to disabled parents with guardians. Iris, are you able to testify? It's not too late. Yes, go ahead.

Okay. Sorry about this.

She's pulling it up.

Yeah. Aloha Chair. Vice Chair. My name Iris. Thank you for letting me share my testimony. I am writing in support of HB 1668. I live in Oahu. I am a self advocate with the Self Advocacy Advisory Council.

This bill is important to me because without the Medicaid disregard right now, working and making money makes me feel uncertain and it feels unfair.

I would really like to work a job so that I could be more a part of the community and can earn my own money as someone with disabilities, I often need more support to help me work. If I were to work, it would matter how much money I made.

If the Medicaid income disregard were passed, I would feel more secure and I would be determined to earn money to support myself and have a more positive perspective on life. I am in support of HB 1668. Thank you for listening and for your time. Iris, Elle, thank you very much.

Iris, thank you for being with us today. Okay, so we're back to HB2009, which is the subsidies for disabled parents or guardians. And first up, we have in person the Hawaii State Council on Developmental Disabilities.

Thank you, Chair, Vice Chairs, Committee Members. My name is Daintry Bartoldus, Executive Director for the Hawaii State Council on Development of Disabilities. We are in strong support of HB 2009. Parents with disabilities are often assumed to be able to provide full care even when their disability makes that impossible. That leads to families losing needed supports.

HB2009 basis services on actual caregiver capacity, not assumptions, allows child care help regardless of the work status and prevents Medicaid cuts based on unrealistic family expectations. This keeps families stable and children safe. Thank you for this opportunity to testify.

Thank you very much. Next up, we have the Department of Human Services, Meredith somebody.

Good morning. Chair Marten, Vice Chair, all Members of the Committee, I'm Stacy Tonovichi of the Child Care Subsidy Program. I'm CAFE Director of Money. We're happy to stand on our written testimony and we are available. Thank you.

Thank you very much. Next up, we have in person Invisible Voice.

This is my last one. I'm going to just build on again. My name is Yonghee Overlee, representing Indivisible Hawaii. We are in strong support of HB 2009 to provide child care subsidies to disabled persons regardless of their employment status.

I feel like this is building on the testimonies we heard in the last major because it seems like things are pounding on top of each other. And I'm thinking of my cousins who both had polio, my cousin and his wife. But they were all parents. Proud parent, uncle, son.

So I'm personally supporting this major and on behalf of Indonesia, Thank you very much.

Next up, we have Hawaii Disability Rights Center. Not here. zero, I'm so sorry.

Aloha Kakou. I'm Ann Chipchase for Hawaii Disability Rights Center, where I was at. I'll get right to the footing. The law that we are attempting to ask you that you modify currently does, among a few other things, create disability. And as Hawaii Disability Rights and We can't allow him.

We have to stand up and say no, this is not right. I have in my testimony examples of how this happened. I have almost lived it myself and I took care of my dying mother. I was not senior at that point, nowhere near as senior as I am now.

But attempting to give her a bath, I almost killed both of us. That was the last time I tried to give her a bath, that's for sure. Anyway, we stand against this and therefore we have to ask please pass this bill. Mahalo.

Thank you very much. Next up we have Hawaii Children's Action Network speaks.

Aloha again. Chair, Vice Chair, Members of the Committee, this is my second to last one just for keeping count. Hawaii Children's Action Network is dedicated to the well being of Keiki and their families, especially access to affordable child care. It is one of our core missions. And currently the child care subsidies which I mentioned in prior testimony.

A lot. Of them are there's a barrier, there's employment status in order to qualify for these child care subsidies. And we know that some disabled parents and guardians cannot partake in traditional employment. But they still need child care in order to take care of their house, go through their therapies, participate in the community.

So this bill recognizes their very unique kind of caregiving needs and provides a more holistic way of assessing the needs of families in Keiki. And it ensures that our children who have parents with disabilities are still able to have safe and nurturing child care experiences. So we support this bill.

Thank you very much. We have also in person Kylie Swan.

Good morning Chair, Vice Chair, Committee Members. My name is Kylie Swan. I'm a strong supporters bill because I live with my mom in E beach. She teach me how to become more independent and she lived with me for a very very long time.

I'm so grateful for her cuz she helps me how to catch the bus in the community, how to ride a. Train in the community, how to budget. How to go grocery shopping. So I'm so proud of her, my mom. So I'm so grateful for her. So please pass this bill. Thank you for listening to my testimony.

Please leave me any question you may have. Thankful allow me to testify.

Thank you very much Kylie. And then on Zoom do we have Ian Sealy? Go ahead.

Yes, I am here. Thank you so much for, for giving me this opportunity. I am, I want to thank the Chair, Vice Chair and Members for, for this wonderful wonderful opportunity. My, my name is Ian Seeley. I'm in testifying in strong support of HB2009, my household is in the exact scenario this bill is trying to fix.

We have two disabled adults raising a disabled child. It's hard. Right now the system operates on a dangerous blind spot. It automatically assumes that because I'm a husband or a father that I can just provide unpaid, round the clock nursing care, ignoring my own disabilities, work obligations, bills, mortgage, whatnot.

And then I need to pause here because I would like to address the department's written testimony from DHS. They told you they cannot assess caregiver capacity because of federal law. And I want to say that this is misleading.

My wife Jennifer submitted late testimony Proving that Section 22 of the department's own form, the 1147 already asks explicitly, caregiver requires assistance question mark. So they already asked the question. It's not against any federal law. The problem right now is that they're allowed to ignore the answer and to deny services.

HB 2009 simply forces them to use the data that they've already collected. So. And that's not even the only misleading claim. So the Department also testified that federal rules prevent them from using child care funds for disabled parents. That is factually false. Federal regulation specifically 45 CFR 98.20, give the state broad flexibility.

Define vulnerable children however they want. They have the power to help right now, but they're simply choosing not to write it into the state plan. So the issue here is that when they ignore the data that they collect already, they create these phantom supports that their support that isn't really possible or even there. The presumption is irresponsible.

When the state relies on care that physically cannot happen, families just crash and burn. And this is a problem. We end up in the ER or in crisis. And I guarantee you that costs the state 10 times more than just stabilizing the family up front with a minimum wage worker.

Well, the thing is here, we need to do something about it. And HB2009 fixes this problem by replacing assumptions with documentation. Because if the state allows its contractor force unpaid labor on people that isn't caregiving, you know, it's closer to involuntary servitude, which if I recall the 13th amendment abolished in 1865.

So we're simply aligning policy here with the reality. Please pass this bill and thank you for your time.

Thank you very much. We also had testimony in support from around 20 other individuals. Is there anyone else wishing to testify on this measure? Seeing them Members? Are there any questions? I have questions for DHS, please. So I saw in your testimony that the Source of funding that this bill is hoping to use to pay for this.

You said it can't be used. I checked in with and you had suggested perhaps TANF. I checked in with BESD and they said that TANF could be used, but only if people are either working or in training to get a job. So I'm wondering, you know, this is clearly a need.

What source of funding, what bucket can be used?

Thank you for the question, Chair. For our purposes, yes, a lot of our programs do fund eligibility requirements. They do have a population where they are able to serve families with disabilities. That would be our.

What fund our funds. I'm not the TANF administrator. I can check with them. But they do have a contracted program where they support families with disabilities. And I can get you more information on that for our program. In our testimony, we did suggest that we would go state general funds to support this measure.

That would be our ask.

Okay, thank you very much, Chair. Also for DHS, also in your written testimony, it states that if this bill were to move forward, that the Department would need more time and resources to implement this measure. And I'm.

If you could just expand on how much more time is needed and in addition to state funding, what other resources the Department believes is needed to implement this. Sure. Thank you.

Initially, yes, it would be a great lift for us. We would need to draft up our Hawaii Administrative booths in support of this measure.

That itself has been challenging for this subsidy program. That would be one. Our payment and eligibility system would need to be enhanced as well. That would be another ask. Those would be pretty much the two big gifts for us. And in addition to that, it's just training for our staff, which, you know, we do have support there.

So thankful for that. Learning a variation of a program that would be considered and then just resource materials because it's our program offices that are tasked with completing all of these informational pamphlets, flyers, things to help the community understand what we're striving to achieve.

So those would be. I believe we just did that in our closing section. Family friendly information and outreach material.

Thank you.

If there's no other questions, we'll move on to our next measure, HB2208, which establishes an appropriate funds for the Hawaii Farms and Families program. And first up, we have Department of Human Services.

Good morning, Chair, Vice chair, Members of the Committee. I'm Jeanette Hayes with the SNAP Administrative with the SNAP program. And I'm here on behalf of Director Yamani. We appreciate the intent of this bill and offer a few comments that we do recognize the issue of food security within our state. I think that's a given for us.

I think our concern is our capacity right now to be able to implement this with the focus that we have right now with the HR1 updates as well as our system implementation. We thank you for the opportunity to provide testimony and I'm available for questions out. Thank you very much.

Next up, we have the attorney general's office.

Chairman and he's our youngest sheriff in the Department of the Department has comments about the bill, mainly about section four of the bill. It appropriates public money to provide financial assistance to private entities and it appears to create a grant program.

But it may not have the sufficient standards to guide the Department of Human Services to express the first funds. So we provide a draft standards with our testimony to provide a possible framework for the Committee to consider and we recommend amending the Bill to inclusive sufficient standards. Thank you. I'll be available.

Question thank you very much. And next up we have Hawaii Appleseed.

Good morning, Chair Olds. Sorry, Chair Marten, Vice Chair Olds. Members of the Committee, I'm Daniela Sporo with Hawaii Appleseed. Appleseed has been a strong supporter of Farm to Families for several years now.

We strongly believe that the food bank system is one of the most important systems that we have for fighting hunger in Hawaii and we are very grateful for the support of the Legislature last year in supporting this system. Through this program.

However, we want to highlight that federal cuts and affordability crisis and an uptick in natural disasters have put more pressure than ever on this system, more than we've ever seen before.

Farm to Families not only strengthens Hawaii's food supply chain, but also provide a backup or safety net market for local farmers during times of economic crisis or natural disaster. When these events strike, the emergency food system becomes a lifeline for families seeking food and for farmers seeking markets when tourism plummets.

During the recent federal shutdown, as the state worked toward alleviating the pause in SNAP benefits, federal workers without paychecks, SNAP residents and those struggling to put food on the table were popular, pointed to the food banks and once again those food banks and distribution partners stepped up in institutions that have historically relied almost entirely on charitable contributions.

This bill changes that, ensuring that we're better prepared not if but when the next disaster strikes and supporting our local food economy. Thank you for considering as well.

Thank you very much. Next up we have Hawaii Food Bank.

Aloha and good morning. My name is Aliyah Herman with Hawaii Food Bank. Thank you for the opportunity. I wanted to Start by just briefly acknowledging DHS and the incredible work that they've been doing to make sure that people in Hawaii are continuing to be fed despite everything that is going on in the Federal level.

And we just want to say that we would be eager to work with them in whatever way to help address capacity and streamline the process should this move forward.

Right now we are serving as many people as we did during the peak of the pandemic, twice as many as before, but of course, without the same resources that existed at that time. We also recently released a new food insecurity report that showed that 32% of households in Hawaii are food insecure.

And of that 32%, 2/3 are what we call have very low food security. That means they're not just making different choices about what to eat, but they are actually hungry. They're skipping meals. They are going whole days without eating.

This includes among the food insecure, 34% of children and 45% of of their parents and caretakers who we know skip meals and go without eating so that their children can eat. This is unacceptable in a community like Hawaii where we care for each other. You know, we are also.

So as I mentioned, we're at peak of pandemic levels and this is, you know, we know that these numbers are going to continue to go up. Even before the shutdown, we were on track to do distribute over 25 million pounds of food, which is what we distributed during the peak of the pandemic.

The food banks have, have received considerable cuts of federal food, over $4 million a year statewide. We know SNAP allotments went down in October. You know that SNAP cuts, Medicaid cuts are going to make it that much harder. So, you know, we understand there is a lot going on right now, but this is just something food.

We can't do this alone. We work hard to continue to seek federal funds, to work with our, you know, the philanthropic partners. We are engaging the city and counties. We represent Oahu and Kauai and we work with Maui Food bank and Hawaii island, the food Basket to feed.

But we, you know, as others have mentioned, farm to families really is a way of both investing in our local economy and our local farmers as well as getting this fresh, culturally relevant food to households that don't have access to it otherwise. And I just also want to mention, we do not do this alone.

We provide all the food that we source free of charge to our more than 250 agency partners who are on the ground. Yes, I'll just say, you know, I just want to acknowledge our agency partners we were closely with to meet people where they are in their communities. And I'm here to answer any questions.

Thank you so much.

Thank you very much. Next up we have Hawaii Hunger Action Network.

Hello Chair, Vice Chair, Members of the Committee, My name is Genevieve Mama. I'm here on behalf of the Hawaii Hunger Action Network and we'd like to express Strong support for HB2208. We're a coalition of more than 20 local organizations.

We with the mission to advocate for food security for Hawaii households really just want to echo everything that Aliyah said and echo the urgency from Hawaii Food Bank. We all know that one in three Hawaii residents remain food secure, food insecure and our state has goals to double our local food production by 2030.

Passing this bill is just one step in getting us there by providing that essential funding for local farmers and getting local food to families. So all over your time and please pass HPT which is our right.

Thank you very much. Next up we have Hawaii Farm Bureau.

Morning Chair Marten, Vice Chair Olds, Members of the Committee, I'm Brian Miyamoto here on behalf of the Hawaii Farm Bureau. You have a written testimony in support. I'll just add a few comments. You heard the stats from previous, previous thus farts. I think it's in the bill also. Those are disturbing numbers when we're talking about food insecurity.

But let's put that in context. Those are our family, our friends, our neighbors, our ohana. They talk about federal cuts. Things were bad before the federal cuts. Things are bad now and they'll continue to be bad. The need will always be there.

We acknowledge and we are very appreciative of the the funding that the Legislature provided, half a million dollars per year. This has been a Farm Bureau priority for the past several years. This is extremely important. Again, it's a win win.

It supports our, our friends found in Ohana and me, but also supports the farmers and ranchers, provides another market again, food security. It's a human services issue, but an agriculture issue. Why don't we want to provide those in need the freshest, most nutritious and quite frankly the best tasting food that we can.

The need will not go away. We acknowledge the funding that this legislative body has provided. We need more. We actually would love to see this as just regular budget items. Again, I know time is tough or times are short and money is tough. This should be a no brainer.

We need to fund those that are more most in need and we can also support our farmers and ranchers the same brand. So we really appreciate the support that we've given. One last request from the Hawaii Farm Bureau. We implore you this Committee to ask your colleagues to support and to Fund this. Again, this is.

We need the entire Legislature behind us. Thank you for the opportunity to provide testimony.

Thanks very much. Next up, we have the local food coalition in support, Hawai' I Children's Action, Nagarpur Street. Can I ask everyone to keep it brief because we have one more joint hearing after this.

Yes, I understand. I'll keep it quick. Just to emphasize what Aliyah said. One out of three Keiki here in Hawaii are in households that are food insecure. We know that there are long term effects of child poverty on their achievement and even their earnings at the adults.

So this is a great investment not just to relieve current suffering, but in the development of our children to be productive adults. Thank you. Please pass this bill. Thank you very much.

On zoom we have Maui Food Bank.

Thank you, Chair, Vice Chair, Members of the Committee, my name is Lisa Paulson, the CEO of the Maui Food Bank. I do stand on our radio written testimony with one highlight. This bill would continue to support our efforts to provide fresh produce and protein for Maui County's community.

As an example, in last fiscal year we purchased£650,000 of locally grown produced food from 29 farmers and ranchers and this generated 1.1 million in revenue for local food producers and 3.55 million for other Maui County food industry businesses. I encourage you to pass this bill and thank you for the opportunity to provide this testimony.

Thank you very much. Next up we have Hawaii Food Industry association on Zoom. Not here. Okay.

We also had testimony and support from the Hawaii Emergency Management Agency, Maui County Council Chair, county of Hawaii of Honolulu, Hawaii Academy of Family Physicians, Ukono, Get Fit Hawaii Maui Food Bank, Malu Aina, Hawaii Health and Harm Reduction Food Basket, Malama, Hawaii and various other non profits. And I'd say over a hundred testimonies and support.

So this is is a measure that has huge community interest and support Members. Are there any questions for our testifiers? Is there anyone else wishing to testify? And please can you keep it to less than a minute? Okay, thank you,

Angela Melody Young testifying on behalf of CARES and strong support.

So the DHS operates the SNAP food stamps benefits for comprehensive provisions for low income families and it does get a federal grant from the Department of Agriculture.

So if you consider an amendment, I'm proposing that it should include an amendment to say seeking federal funds from Department of Agriculture Implement the initiative because there are distributions of funds from the federal level to help with this state level program so that we can ensure farm to table needs for local families. Thank you.

Thank you very much. Members, are there any questions?

Go ahead. Quick question for Farm Bureau, Brian, if it's okay, real quick. This is a brand new program, right? We've been trying to do it, but we're trying to stand it up through dhs. Correct.

Brown, New model Hawaii Farm Bureau. Thank you Representative. Yes, it's. It would be in a new program in Chapter 346. A lot of the work that's been done. It probably heard it Farm to Farm Food Bank bridges on Hawaii island, all privately funded and work with the different food banks, Hawaii Island Food Bank, Hawaii Food bank programs.

This is going to basically put it in the Department and create this program that we will be coming to the Legislature for to ask for continual funding. So we want an official program that would support our those that are most in need and farmers and ranchers across the state.

Follow up question, Brian. Food is a direct link to health, correct?

Absolutely. I eat all the time and I'm pretty sure I'm healthy. It is. And you hear the advocates talk about, I mean this is in line with just General nutrition for cake, right? Being hungry, all you're thinking about is food. You maybe can't concentrate on your schoolwork, on your education or other things.

Again, we want to if at all possible, take that away. This is, this is one of the, the programs, one of the tools along with many others, as you heard, the SNAP program, Double Bucks again, this one's great. It's a win win supports our families and me, but also can support farmers and ranchers.

And you heard Molly, Food bank again creates another market for our farmers and ranchers. A lot of times our off grades will go there also. So again, we think this is a very positive program. Program that supports a wide range of our own people here in Hawaii.

Yeah. Last question, Brian, any stats on food insecurity for our neighbor islands and our rural areas represent.

I don't have the stats but I'm very sure that the different food banks have all those numbers and the other advocates have all those numbers. Again, you hear the third of our students, I mean it's just disturbing. Those numbers need to go down and this is a program that can assist at least addressing that.

We're not going to. The goal would be to eliminate it, eliminate hunger. This will help alleviate some of that.

Yeah, thanks, Brian. I'm trying to draw that nexus between food health and our rural Transformative Health Care grant. And if this might be another new program that could benefit from some of.

Those, it will because it's sourcing local products. You know, less carbon footprint, a lot fresher. It's not spending all that time to get here. You'll know where these products are coming from. Some of those that will receive this are going to know the farmers themselves at farms and ranchers. Again, fresh produce, fresh proteins.

Thanks, Brian. Thanks, Chair. Thank you very much. Okay, moving on to our final measure on this agenda, HB2458 relating to surveillance pricing or SNF. And first up we have DCCA.

Good morning, Chair, Vice Chair, Members of the Committee. My name is Dominic Jenkieri. I'm an enforcement State of Hawaii Office of Consumer Protection. I am missing a front tooth. It's an old hockey injury, so I apologize for that. Working on getting a new one.

The State of Hawaii Office of Consumer Protection appreciates the intent of this bill and generally supports what it's trying to affect. We did offer written testimony with some concerns and proposed amendments as well. OCP stands on its written testimony and is available for question. Thank you very much.

Next up, we have the Chamber of Profits.

Morning, Chair. My name is Robert Singleton and I serve a Chamber of Progress. We are a tech industry association that supports inclusive innovation here. Today, in respectful opposition to HB 2458, it is proposing to ban surveillance pricing on food eligible SNAP and WIC benefit recipients, a category that covers nearly all grocery items.

This bill does risk inadvertently eliminating the personalized deals and discounts that some families help afford groceries. We share the legislature's concern about the food costs and the like. When families are spending over 17% of their household budget on groceries and only one third of households is food insecure, every dollar matters.

Which is why we are precisely concerned about HB2458. Using customer data to personalize deals, discounts and shopping experiences delivers real values to customers, particularly those on tight budgets. Parent who regularly buys baby formula going through a grocery app might receive a timely coupon where the brand she uses goes on sale.

A family that stocks up on rice or children's cereal every month might see a Target promotion when those staples are discounted. These are examples of retailers using customer information to make everyday groceries more affordable. HB2458's definitions put these everyday tools at risk.

The bill defines surveillance pricing as any customized price based in whole or in part on personally identifiable information collected through electronic surveillance technology. This sweep captures not just the price a Shopper pays at checkout.

But the full range of personalized grocery tools consumers have come to depend on coupons can match to past purchases, targeted promotions and personalized loyalty rewards and savings alerts based on shopping history. So I'll defer to testimony in the interest of time. Thank you.

Thank you very much. Next up, we have Department of Human Services.

Good morning, chair, Vice Chair and Committee Jeanette Hayes with Department of Human Services. Thank you for the opportunity to provide testimony. We stand on her testimony and I'm available for questions after.

Next up, we have Hawaii Appleseed.

Good morning, Chair Martin, Vice Chair Olds, Members of the Committee, Daniela Spoto with Hawaii Appleseed. Again, we are in strong support of this bill. Hawaii is already experiencing the highest grocery costs in the entire nation. There's an affordability crisis ultimately resulting in one in three households struggling to afford food, as we've already heard.

And surveillance pricing is a predatory corporate practice that has become rampant across other industries, notably travel and ticketing industries. It has no clinical place in our food industry. Food is a basic need. Some would even argue a right.

And gouging prices based on things like shopping time, demand or personal information is an egregious overreach in an abuse of corporate power that must be stopped before it comes commonplace. Please join other states like New York, California and Maryland in stopping this practice in its tracks before it becomes the norm. Please pass this bill.

We also have testimony and support from Purple Maya foundation and four other individuals. Is there anyone else wishing to testify on this measure?

Hello, Vice Chair, Chair, Vice Chair, Members of the Committee, Chris Caulfield from Hawaii Public Health Institute. I'm sorry that our testimony was submitted late. We just also wanted to add our voice. We're in support of this measure.

Surveillance pricing is when companies use things like where you live, the frequency of your purchases, what you buy, when you buy, what's left in your shopping cart in order to tailor specific prices to a customer. And we've seen, as you just heard from testifiers, we've seen this creeping into our food industry. FCC looked into this.

The federal FCC looked into this recently and found that behaviors ranging from mouse movements to on a webpage to items left in consumer shopping carts can impact prices. The consumer watchdog looked into this, found that Amazon had increased price, was increasing prices over two and a half million times a day.

We are all familiar with dynamic pricing at Uber, where you know a ride will cost $151 minute and five minutes later, five minutes later it'll cost 25.

Think about that with regard to food that's purchased by SNAP recipients where companies are quietly racing raising prices on SNAP recipients, on consumers who are at the most critical times of the month when they're trying to meet basic hunger needs. And that's what we're seeing. That's what we're seeing research showing.

And it's really predatory practices which is said that has a negative impact on the financial viability of people who are hungry. It's weaponizing hunger. It's turning hunger into a profit motive. And it also has an impact on the amount of funding that's available and the efficiency and use of that funding by those users.

So it has an impact at the state level in terms of how we're allocating our resources and how efficient that's being maximized. So we're in support of this bill and we hope that go moving forward. Thank you so much.

Thank you. Is there anyone else wishing to testify? See none Members, are there any questions? Testifiers. Okay. And we are going to move right into decision making. So first up we have HB 1972 relating to taxation and Chair recommends passing this with amendments, technical amendments to remove the aggregate cap. So currently there is no.

I'd like to insert language as recommended by dotax to to give the taxpayers some skin in the game and so say the family caregiver tax credit shall be equal to 75% of the qualified expenses of the eligible taxpayer up to a maximum of 3,000 in any taxable year so that they have motivation to be cost conscious.

And Also insert that HRS Section 23-556 provides the other tax credit and insert a clause for non duplication so that the same expenses cannot be applied to both credits. With that, are there any comments or questions? Vice Chair for the vote voting on.

HB 1972 Chair's recommendation is to pass with amendments. [Roll Call] Chair, your recommendation is adopted.

Thank you very next. Next. HB 1975 related to kupuna housing and this one I would just like to defect the date and include in the Committee report the numbers provided by HPHA needed for their budget and for their two FTEs. With that, are there any comments or questions? Vice Chair for the vote.

Voting on HB 1975 Chair's recommendation is to pass with amendments. Any Members voting no? With reservations?

Okay, next up, HB 1706 relating to mental health.

For this one just some technical amendments needed for clarity and to underscore a particular part as new language, defect the date and then also insert language saying that if this bill is is contingent upon and enforceable only to the extent approved by this if the actions in this bill are approved by the Centers for Medicaid, Medicare and Medicaid Services through a state plan amendment. With that Members, are there any questions or concerns?

Seeing none. Vice Chair for the vote.

Voting on HB 1706 Chair's recommendation is to pass with amendments. Any Members voting no? With reservations? Chair, your recommendation is adopted.

Next up, HB 2007 relating to the household independent Care Services Tax Credit. This one I would like to pass with just defecting the date. Any questions or comments?

Voting on HB 2007 Chair's recommendation is to pass with amendments. Any Members voting no? With reservations? Chair, your recommendation is adopted.

Next up, HB 1546 relating to health insurance. This one I would like to defer decision making to next Tuesday. Can someone help me with the date February 10th at 10:30am so that I have more time to work on an alternative viable solution for us to consider as bills move through the House in my Senate.

Next up we have HB210 relating to taxation and I will defer this bill. Not really an appropriate bill for the Human Services Committee. Next up is HB 1668 relating to Medicaid. For this one I'd like to defect the date and otherwise pass it with that amendment only. Members, any questions or comments?

Vice Chair for the vote.

Voting on HB 1668 Chair's recommendation is to pass with amendments. Any Members voting no? Reservations? Chair, your recommendation is adopted.

Thank you very much. Next up we have HB 2009 relating to family caregiver support. This one I see we definitely need to continue this conversation. Clearly DHS will have some work to do in implementing it and we need to clarify our source of funding.

So for now I'd like to adopt the recommendations made by DHS and their testimony making the source of funds General funds and pass it on for further conversation with that amendment. Members, are there any questions or comments? Seeing then Vice Chair for the vote.

Voting on HB2009 Chair's recommendation is to pass with amendments. Any Members voting no? With reservations? Chair, your recommendation is adopted.

Next up we have HB2208 relating to food security and for this one I'd like to adopt the AG's amendments proposing standards for DHS to distribute the grants to food banks and effect the date technical amendments. And those are my recommendations. Any questions or comments? Vice Chair for the vote, please.

Voting on HB2208 shares recommendations to pass with amendments. Any Members voting no? With reservations? Okay, your recommendation is adopted.

Okay. And then the next step, HB2458 relating to surveillance pricing. For this one, I would like to adopt DCCA's recommendations in their testimony, as well as technical amendments and also defecting the date. Members, are there any questions or comments? Okay, Vice Chair for the vote.

Voting on HB2458 Chair's recommendation is to pass with amendments. Any Members voting no? With reservations? Chair, your recommendation Adoption.

Thank you very much. And with that we are adjourned.

Good morning. So we are. This is the Committee on Human Services. And Homelessness and Committee on Health joint hearing Thursday, February 5, 10am or a little bit later. And we have two bills on the agenda. I'm here with Chair Greg Takayama and.

Lisa Martin and we'll start with Our first measure, HB2488, relating to the Disability and Communication Access Board. And we have first up, the Hawai' I State Council on Developmental Disabilities.

Executive Director for the Hawaii State Council on Developmental Disabilities. And we stand in support of this measure for the Disability Communication Access Board. For the details, thank you so much.

Thanks very much. Next up, we have the State Health Planning and Development Agency. Nope, they are in support. And the Disability and Communication Access Board.

Hi, Good morning. First, my name is Christine. I'm just.

And I just want to first say I apologize to the Committee on Health for last week's misunderstanding through the ASL interpreter and misinterpretation of the question that was asked last week. This is one example of. Communication needs. And how to have effective communication in settings like this. I communicate with using asl.

So with an ASL interpreter, spoken English is through the ASL interpreter and it's on the screen right now on video remote interpreter. So when I see the ASL interpreter, your questions or statements are through into another language, second language.

And when I look at the interpreter, I'm looking at ASL and in my mind and interpreting it into English. So your spoken English and the English that I interpret from ASL to English may have been maybe close enough or not close enough. And that's what happened last week. So I apologize for that. So that leads to.

To health care. So health care is so critical for what is the communication needs for individuals who are part of hearing and deafblind. And there are so many different ways of receiving the information from medical to a healthcare facility, the information that they need to convey to patients.

And Gwen, who is our program policy development coordinator and I have here also Justin Pono, communication access specialist.

And on behalf of DCAT, we are more than willing to do this study and gather information for the Legislature to have a better understanding about the communication need that needs to be offered for a patient in medical or health care facility. Thank you. Thank you very much.

Is Kylie Swan still here? He's in support on Zoom. We have Kekai. Not present in support. We also had an additional support in writing from the Hawai'i Disability Rights Center Deaf and Blind Task Force and about 10 individuals. Is there anyone else wishing to testify on this measure seeing none.

Members, are there any questions of our testifiers? Seeing none. We'll move on to our next Measure, which is HB2456 relating to drugs for weight loss, requiring DHS to provide glucagon, like peptide drugs. And first up, we have Department of Human Services, who are no longer here.

This is Ranjani Stare. I'm here online. Thank you. Hi, Chair Martin. Chair Takayama. Yeah. My name is Ranjani Star and I'm the interim deputy Director of the Med Quest Division. I represent the Department of Human Services on this bill today, and the Department stands on its testimony. I'm happy to answer any questions you may have.

Thank you very much. Next up, we have the state Health Planning and Development Agency in support and not here. We also have written testimony and support from the American Diabetes Association, Lose Quality Home Health Care Services, Diabetes Patient Advocacy Coalition, and another three individuals. Is there anyone else wishing to testify on this measure?

Members, are there any questions of our testifiers?

Chair, go ahead. I have a question. Thank you. For DHS, in the testimony provided, it indicated that if this bill were to pass, there would be cost to the state of up to 621 million.

I was hoping you could expand on that and explain to us how that amount was determined and whether and where those funds would come from. Are those state funds or are those costs that can be covered by other financial resources?

Yeah. Thank you for your question. So the Department of Human Services already covers these weight loss medications for any FDA approved indication other than weight loss for obesity.

So if we are expanding coverage of these medications specifically to treat obesity, then what we did was try to estimate, based upon current obesity rates available from the behavioral risk factor surveillance systems and other public health surveys, how many Obese individuals we have in the Medicaid population and what the medications cost today.

Currently we spend a little over $1,000 a month per person for these drugs. That's the current cost of some of these medications. That's the average price across various weight loss medications that we are currently providing for patients, people with other indications other than obesity.

So taking that cost, taking the total number of Members, adult Members with obesity, we were able to try to multiply out to come up with a per annual cost of $621 million. Now, that medication, if we were to cover it, would be covered by the federal Medicaid Agency as well.

So we would have cost sharing for that particular medication. And I think our cost share, the state General funded cost share, would be approximately half that amount. And I can that exact amount for future testimony.

Thank you.

Sure.

Any other questions? I have a question. So you said that they're covered. Like for example, if someone is diabetic or heart disease, it would be covered. But if it's just if their only diagnosis is obesity, then it is not. Is that what you're saying?

Yes, but let me please clarify. Currently, the weight loss medications that we're talking about are approved by FDA for indications other than obesity, including things like cardiovascular risk reduction, fatty liver disease, obstructive sleep apnea, metabolic dysfunction, associated steatohepatitis, but not specifically diabetes. So they are. It does for any FDA approved indication for the drug.

Medicaid agencies are required to cover these medications and we are therefore covering. And we have data from 2024 to show that we have been providing coverage for other conditions besides obesity. Obesity is the one condition where we as a Medicaid agency have the option to choose to cover it.

We are not required to cover it even though the FDA indicates that condition for some of these weight loss medications. Does that help?

Yeah. Thank you very much Members.

Any other questions? Sure. I'm sorry, I have one more follow up question. So am I correct in presuming that there are other medications that is covered by Medicaid for people who have been diagnosed with obesity?

So again, there are several weight loss medications. GLP1s are one type of weight loss medications. There are various types of weight loss medications. They are all technically Fda. When they are FDA indicated for weight loss, then Medicaid agencies have the option to cover them or not cover them for obesity purposes only.

So far the state of Hawaii has not required coverage of these medications for obesity because of the expenditures. There are very few states that have gone forward and covered weight loss medications for obesity.

And of the states that have in the last four or five months, four of those states have rescinded that coverage because the cost started to become astronomically high.

Thank you. Any other questions? Seeing none, we'll move right into decision making. And first up we have HB 2488 relating to the disability and Communication Access score. And for this one, I would recommend passing with just defecting the date. Are there any comments or questions? Vice Chair for the vote.

Voting on HB 2488. Chair's recommendations passed with amendments. [Roll Call] Chair, your recommendation is adopted. Same recommendation for the Committee on Health.

Thank you. Chair. Members voting on House Bill 2488. Chair's recommendation is to pass with amendments. [Roll Call] Chair, your recommendation is adopted.

Thank you very much. Next up, we have HB 2456 relating to drugs for weight loss. For this one I'd like to keep the conversation going.

Delete all references to Medicare Part D which are not part of Medicaid and are federal and condition the access to the prescription on participation in lifestyle change programs that support long term weight loss maintenance. Members, are there any questions or comments?

Chair, just a comment. The cost of covering this type of medication is concerning and I'm cognizant of the budget situation that the state is in. So I'm going to be voting with reservations. Thank you very much.

Any other comments?

I will also be voting.

Okay. Just know that that is fine. I do. My only comment is that there are a lot of costs associated with obesity and so I do see this as cost saving perhaps in the long run in terms of the, you know, the what they have seen with these drugs on the decrease in other obesity associated diseases.

Vice Chair for the vote.

Voting on HB2456. The chair's recommendation is to pass with amendments noting the excused absence of Representative Amato. Any other Members besides Rep. Olds and Rent Hartfield. Voting reservations. Reservations. Any Members voting? No, Chair, your recommendation is adopted. Same recommendation.

Thank you, Chair. Members voting on House Bill 2456. Chair's recommendation is to pass with amendments noting the absence of Member Amato. Reservations by Members Hartsfield, Olds and Garcia. Any other Members voting with reservations? Any voting no, Chair, your recommendation is adopted. Thank you very much. Without your adjournment.