House Standing Committee on Finance

Aloha. We are convening the Committee on Finance for our 10am agenda. It's Friday, February 272026. We're in Conference Room 308 live in person and on Zoom. Some quick refreshers. If you are on Zoom, please stay muted until you're called upon. And we do stick to a two minute time limit per testify.

We'll give a little bit of flexibility should you be extremely compelling, you know, that kind of thing.

But otherwise, if you, if you can for the most part stand on your testimony unless there's something really critical you need to explain, or if you are going to testify and you have provided written testimony, please try your best to just summarize or provide additional context instead of reading it directly.

But other than that, I think we're good to go. We can get started. We're going to open up with HB816 HD1 relating to emergency response.

First up we have the Department of Health with comments.

Good morning, Chair, vice chair, Committee Members, Garrett Hall, Chief of Emergency Medical Services and Injury Prevention for the Department of Health. We stand on our written testimony and here to answer any questions you may have.

Thank you. We have Kylie Swan in support on Zoom. Not present. That's everyone who indicated they would be joining us, Members. Also testimony and support from Council Member Kagiwata from the Hawaii County Council and two other individuals.

Okay, Members, any questions on this measure? Seeing none, we're going to move on to HB 1535 HD1 related relating to automated external defibrillators.

We have the Department of Health with comments.

Good morning, Chair, vice chair, Committee Members, Garrrett Hall, Chief of EMS at the Department of Health. We stand on our written testimony as submitted in here to answer any questions.

Thank you. Department of Taxation with comments.

Good morning.

Thank you. Tax foundation of Hawaii with comments on zoom.

Good morning, Chair, Vice Chair, Members of the Committee, Tom Yamachika for Tax Foundation. For the reasons stated in our testimony, we think it's a lot more efficient for this to be handled outside the tax system. We have subsidy programs such as High Energy.

This could be handled, you know, much similarly to that with I think a greater impact and more accountability. Have to answer any questions. Thank you very much.

Thank you. If we have Kylie Swan and support on Zoom still not present, that's everyone indicating they'd be joining us. Also support from one organization and one individual. zero, is there anybody else in the room wishing to testify? Anybody on Zoom?

Okay, Members, any questions on this measure? Seeing none. We're going to move on to the next item, HB 1537 HD1 relating to mental health.

Department of Health and support.

Good morning, Chair, Vice Chair and Committee Members. My name is Kaylee Okuaro. I'm the administrator for the Child and Adolescent Mental Health Division. We stand in our written testimony in support of this measure and I'm available to answer any questions. Thank you.

Thank you. We have the Hawaii State LGBTQ Commission in support on Zoom.

Good. Good morning. Happy aloha Friday. Michael Golojuch Jr. Vice Chair of the Hawaii State LGBTQ+ Commission. He him pronouns. We stand in strong support of this measure. You have our testimony in front of you. The couple things we do want you to know.

Earlier this year, the Lemke Institute, which tracks genocides around the world, issued a warning that the United States is in the early stages of a genocide for the transgender community. What is it?

Since the attacks on Mahu, transgender non conforming communities have began last year, we have seen the suicide rates quadruple for this community just in the last eight months, bringing it close to home.

In the last this year alone that we've lost three keiki that we know of, the need for access to mental health care is now, well, years ago, but the now is now more than ever.

As already as you have in our testimony, you heard from others, we know you're probably not going to amend this Bill to include the protected classes that we requested in our testimony.

But we do request, if you, if you won't do that, that you at least include the list of protected classes found in our testimony in the Committee report.

So when this program hopefully goes forward and gets funded, that the those charge of the program know that they definitely need to take special consideration for these classes to end the special needs. So we encourage you to pass this Bill. We hope you amend it, but if not, put it in the Committee report.

So moving forward, thank you and we available for any questions. Mahalo.

Thank you Hawaii Substance Abuse Coalition and support.

Good morning, Chair, Vice Chair, distinguished Members, I'm Alan Johnson with the Hawaii Substance Abuse Coalition. We now see that mental health diagnosable anxiety and depression is just out of sight, up to 40%. It's just unbelievable what's happening in schools.

And as providers with boots on the ground, we know that because we have substance abuse programs in the schools, the high schools and middle schools, and we see that many of them are coping by using substance abuse, alcohol and tobacco. And the issue is that we have this robust substance abuse program in schools and high schools.

There is no mental health program, preventive program in the schools that will deal with families and kids. And the science is there. Providers and subs abuse have evolved in the last 10 years. We now do substance and severely mentally ill for adults and kids. We and subsequent can deal with the alcohol and mental health in one setting.

We have the expertise, but here we're operating silos with no funding for mental health. We're saying this is an opportunity to evolve our state systems. We're in the schools. We've got relationships with the teachers, the kids, and the school counselors. It's the most economical way ever possible to begin for this state.

The science is there to say it's time to evolve mental health, substance abuse, together at one time, we could make a huge difference. We appreciate the opportunity to testify today and, and thank you for your time.

Thank you. We have Hina Mauka in support on Zoom.

Aloha Chair Todd, Vice Chair and Members of the Committee. As we have heard here today, what we are really missing is a coordinated approach between mental health and substance abuse prevention. Adolescence is such a critical window of development when young people experience intense emotional change, social pressure, and brain development. And.

And that's also when anxiety, depression, trauma, and other mental health challenges often first appear. What we need to do is be treating those together. We cannot treat them separately because just as adults, adolescents turn to alcohol, vaping and substances to try to calm their nerves and escape emotional pain.

So it's very important to treat all of these challenges at the same time. HB1537 allows us to integrate that prevention as expressed by other testifiers. We appreciate your time and we thank you for the opportunity to testify.

Thank you. We have Catherine Abellera in support on Zoom.

Aloha. Good morning. Thank you. Chair. Vice Chair Committee Members. My name is Catherine Abellera and I stand strongly in support of this field. And I am a mother of a daughter who lost with death by suicide. Sorry. I just want to show you that my daughter was 28 years old. She was a PhD student at UMass.

But these things didn't start as an adult. They started early on, probably middle school, high school. And there's really limited access to resources. And I think if we have more preventative and more accessible services, I think a lot of this could be addressed early, caught early. And I really, I really hope that you.

That you pass this field. And I am strongly supportive. Thank you for letting me be here.

Thank you. We have Myah Pupilis and support on Zoom.

Oh, hi. Aloha Chair, Vice Chair and Members of the Committee. My name is Myah Pupilis and I'm a student at Kalaheo High School and I'm in strong support of HB1577. As someone who has firsthand, we experienced high schools and middle schools in Hawaii. Our youth is in a mental health crisis.

Over a quarter of middle schoolers have considered suicide. And I have dealt with my peers dealing with those thoughts and I've even had one commit suicide. And I don't think we can afford to wait for a total breakdown of these issues before we offer them any help.

And I think this Bill focuses on the window of ages 10 to 19 and community based early intervention. And I think that addressing the trauma before it turns into substance abuse or long term disabilities is something we need to focus on. And I think this is a proactive investment for Hawaii's future. And please pass HB 1537.

Mahalo for the opportunity to testify.

Thank you. That's everybody who indicated they would be joining us today. Also testimony and support from the State Council on Mental Health, three organizations and five individuals. Is there anybody else in the room wishing to testify? Fine. Anybody on Zoom?

Members, any questions on this measure?

Chair for Department of health, we have Dr. Okuaro.

Yes. Hello.

Hi. Thank you. I just wanted to make sure that we're all on the same page in terms of adolescence. Like, could you let us know exactly what ages that will cover should this bill pass?

Sure. So the Child and Adolescent Mental Health Division, we serve really ages 3 through 21 and except for our first episode psychosis program, which goes through age 24. But we are working closely with our partners who also serve adolescents.

Department of Education, Alcohol and Drug Abuse Division, Family Health Services Division, Office of Youth Services, Injury Prevention Branch, which is the seat of our suicide prevention activities. So it would be in that age range. But I'm proposing a coordinated, or, you know, through 21. And I'm proposing a coordinated approach across the different child serving agencies.

Several people have noted that the system, while I think we provide a lot to support adolescents, it can be sometimes siloed or fragmented because of the way it's organized. So across those adolescent serving agencies, I think we would want to come together to agree on the most impactful programming for adolescents.

I'm sorry. So to clarify, if passed as is, this Bill could cover ages 3 to 21. However, the Department would work with the community agencies to determine what ages would fit into the adolescent needs. Did I get that correct?

Yeah. So when we, when we. Yes, sorry, I know it's. I wasn't very clear. So when we go through the competitive procurement process.

As we start to define scope for community programming, when we do our requests for information, oftentimes we'll learn from the providers who are providing services, you know, what age ranges should be targeted for specific services, for example.

So I think if we do get an appropriation to provide community based preventive services, we're going to listen to the provider agencies through that RFI process to build scope that's kind of targeted and impactful for the age range that those services are built for.

So without having gone through, through that process, I don't want to say, you know, that we're going to include or exclude any particular group of adolescents. I think what we'll learn through the competitive procurement process is how to tailor services as effectively as possible.

Thank you so much. That was very helpful. Thank you. Thank you.

Members, any additional questions? Seeing none, we're going to move on to HB 1541 HD2 relating to the Department of Health.

We have the Department of Health in support. Thank you. And HGA in opposition.

HGA will stand on its testimony in opposition. Thank you.

That's everyone. That's all the testimony we've received on this measure. Anybody else in the room wishing to testify? Anybody on Zoom?

Additional questions on this measure? Seeing none, we're going to move on to HB 1562 HD1 relating to youth

Mental health, Department of Health and support on zoom.

Good morning, Chair, Vice Chair and Committee Members. I'm Kaylee Okoro. I'm the administrator for the Child and Adolescent Mental Health Division testifying in support on behalf of the Department of Health. We stand on our written testimony and I'm available for questions. Thank you.

I have the Hawaii State LGBTQ+ Commission and support on Zoom.

Aloha again, Michael Golojouch, Jr. Vice Chair of the Hawaii State LGBTQ+ Commission. He him pronouns we stand in strong support of this measure. Like I said earlier, access to mental health is long overdue for our especially. We need to destigmatize it. We need to be able to meet the kids where they're at and it's online.

This would be a great way. We know it's a pilot project, but if our community is left out at the inception, we tend to be forgotten when it comes to talking about Mahu LGBQI plus Cutie Pie community.

We again, we, we realize you probably will not amend this, this bill to it specifically include our community in this, but we do hope you will continue the practice that was started in the previous Committee by listing it in the community Committee report to ensure that when this project is being, if this project should come to fruition, which we hope it does, that we are part of the DNA of this program and so that we are woven into it to making sure that the needs of our community and other minority communities are served because we all, they each have different needs and they need to be looked at it from a different perspective and lens.

So we encourage you to pass this bill. We encourage you to make this happen. And we look forward to this no longer being a pilot project in, in the near future, but a permanent part part of this program. So thank you and available for questions. Mahalo.

Thank you. Hawaii Public Health Institute and support.

Morning Chair and vice chair and Committee Members. I'm Chris Caulfield with the Hawaii Public Health Institute. We're in support of this measure because mental health is essential to public health.

And just to put some data behind the amazing testimony that you've heard today, there one in three public school students in grades six to 12 are facing mental health challenges. Yet less than 25% of those are able to receive care, a number that drops to less than 20% just for high school students.

And there's research that shows that 26% over 26% of students in grades six to eight have seriously considered attempting suicide. Youth or digital natives. This is going to be a digital platform. So we think this makes sense.

We just wanted to note that in some states like Louisiana and Washington, there's already efforts being made around programs like this to ensure that Medicaid programs can provide coverage determination processes to make sure that digital mental health tools are fully incorporated. So we think this is a great idea. We'd love to see it before.

Thank you so much.

Thank you. That's everybody who indicated they would be joining us. Also testimony with comments from the State Procurement office and one organization, as well as support from the State Council on Mental Health, five organizations and two individuals. Is there anybody else in the room wishing to testify?

Anybody on Zoom?

Members, any questions on this measure? Seeing none. We're going to move on to HB 1574 relating to the Healthcare Education Loan Repayment program.

We have the University of Hawaii in support on Zoom. Oh, in person, actually.

Hi, Kelly with the University of Hawaii. I stand on my our testimony and strong support.

Thank you. State Health Planning and Development Agency SHPDA in support.

We stand on our testimony. Chair, Vice Chair and Members, Jack Lewin. And we, we think this has been an extremely successful program. Nearly a thousand participants like to see it continue. It's very important. Thank you.

Thank you. We have Navient Hawaii in support. The Hawaii Affiliate of the American College of Nurse Midwives and support on Zoom.

Aloha. My name is Margaret Reagan. I'm the legislative contact for the Hawaii Affiliate of the American College of Nurse Midwives. We stand on our testimony. I would like to additionally discuss the practice environment for graduates for midwifery graduates. We appreciate the fact that midwives have been named as potential recipients of these loan opportunities post graduation.

In Hawaii there are no residency programs for fellows. There are such programs for nurses. There are such programs for MDs. But for the Hawaii graduates there is not an opportunity to go from school directly into a full scope practice. Hospitals do not hire in Hawaii recent graduates. This is a barrier.

I don't know how it can be addressed through an amendment, but I do want to bring it into to the attention of all who are involved in this loan project because it's a wonderful opportunity and we do have a chronic provider shortage and midwives could be a part of the solution.

They are on all islands and working in all environments. The other barrier though proposed that could be addressed is the requirement of a 30% clientele that is receiving public insurance. That has not been addressed in, in this Bill.

There are a number of private practice midwives across the state who provide care, but for a number of reasons they are not providing it to 30%. So recent graduates potentially could be employed with one of these private practices or even larger institutions such as Kaiser do not accept Medicaid.

So though there may be jobs available, it would prohibit these midwives. We hope you will consider and I'm available for any questions. The final comment, I guess I would say is the fiscal implication of including these midwives is small. We're talking about a few very key providers who potentially are from Hawaii who could stay serve their communities.

So I, I genuinely hope you'll consider this recommendation. Thank you.

We have Ohia Midwifery and Wellness and support on Zoom.

So I have to be careful. Sorry, one moment. My name is Margaret Reagan. I have to be careful because I wear a number of different hats.

I testify on behalf of a private practice, Ohia Midwifery and Wellness, and as the founder of what will hopefully be the first nonprofit licensed freestanding birthing facility on the island of Hawaii, Lehua Community Birth Center.

I am speaking on behalf of all three credentials of midwives as they will all be employed and I currently contract with all three credentials through my private practice at Ohia Midwifery and Wellness.

I stand by our written testimony and the only part that I would like to reiterate is that There are currently 21 locations that are employing APRN CNM's. None of these locations yet are available to of the institutions are available to employ CM LMS as they needed to.

They need to be added to bylaws, but we are actively working on that. A number of these sites potentially could hire Hawaii based students, but it's all in process and it will take years. The CPMs that are working across the state are generally all in private practice and I contract with some of them.

No one is currently able to take Medicaid though the majority of them are capable of hiring a new grad. And so we really hope that you will consider the benefit of some kind of an adjustment to the 30% public insurance requirement of the loan.

I don't know how that could be addressed in this Bill, but I did try to reach out to the Chair to discuss prior to hearing. Thank you for considering our suggestion. Mahalo.

Thank you. That's everyone who indicated they'd be joining us. Also testimony and support from the Office of the Governor, the Office of Hawaiian Affairs and nine other organizations. Is there anybody else in the room wishing to testify? Anybody on Zoom?

Members questions on this measure? Seeing none. We're going to move on to HB 1591 HD1 relating to health care.

We have the University of Hawaii in support on Zoom.

Oh, University of Hawaii stand on support. But I think Laura Reichardt was maybe going to testify.

Oh, we're all supported.

Department of Taxation with comments.

DOTAX stands on our written comments.

Thank you, DCCA Board of Nursing and support. Thank you. Hawaii State Commission on the Status of Women in support.

Yes, good morning everyone. I stand on my written testimony and support. Thank you for your consideration.

Thank you Hawaii Public Health Institute and support.

Chris Caulfield from the Hawaii Public Health Institute. We're very much in support of this measure as well. As you're all very well aware, there's a massive doctor shortage in the state of Hawaii that's grown to over 800 positions.

And on Hawaii island, which is the most acute you have, Hawaii island has to would have to grow its position supply by 43% to meet demand. Maui's just behind that at 35%. And this program, when it was originally evaluated showed that There was a 77% increase in active preceptors, which is phenomenal in terms of its effectiveness.

We're particularly interested in this because it includes social workers and we talk about the doctor shortage and medical professional shortage a lot.

We don't often talk about social workers as much but there was a report that came out from UH's Thompson School of Social Work that showed the demand for healthcare social workers in Hawaii is going to grow by 18% over the next decade, and for specifically, mental health and substance abuse social workers by 22%, which is a big need in our population as well, and one that we often work with at hifi.

So we're in strong support of this, and we we are hopeful that it moves forward this year. Thank you so much.

Thank you. We have Tax foundation of Hawaii with comments on Zoom.

Thank you, Chair, Vice Chair, Members of the Committee, Tom Yamachika from Tax Foundation. We had some very short comments, and we'll stand on those, and we'll be happy to answer any questions.

Thank you. Hawaii Academy of PAs and Support on Zoom.

Hi, good morning. We stand on our testimony. We'd like to add that the importance of the preceptor tax credit is ultimately to support healthcare workforce development.

Today PAs have not been included in this preceptor tax credit, but we now have PA students from Hawaii who are attending Hawaii based institutions for PA school and it's important that we support these students so that they can have clinical education experiences in Hawaii and ultimately stay in Hawaii.

Thank you. Kaiser Permanente in support, present. Ohia Midwifery and Ohia Midwifery and the Wellness and Lehua Community Birth Center in support on Zoom.

Aloha. Thank you for this opportunity to testify. I speak on behalf of a private practice and developing birth center. We stand by our testimony.

I want to reiterate that the benefit of consideration of the addition of a clause that has been utilized in SB2491, the landmark Bill that revised statutes regarding health care to use provider neutral language where applicable. We just as the previous testifier for PAs, we wish that midwives could be included.

There was a clause in that massive bill which was midwives license under Chapter 457j. We wish to be included in this opportunity. Even then, we also want to reiterate that there is no midwifery based program in Hawaii. Though There are currently 70 plus midwives serving the community and a number of them available to precept.

All of their students are in remote programs. None of those programs have a 50% Hawaii student base. These programs are very familiar with the medical community.

They include Frontier Nursing and Georgetown University, Thomas Jefferson University and there is a new program starting through the University of Colorado Anschutz that has incredible rural health scholarship programs for both certified nurse midwives and certified midwives who are dedicated to serving their communities. Last year we asked for consideration of this barrier for midwifery preceptors.

It's very difficult for Hawaii based students, number one to enroll in a rural program and then number two to secure a clinical site. The clinical sites currently are Kaiser, Tripler and Queensland. During the government shutdown I was directly in touch with students at Tripler where their ability.

They've been trying to finish their program for years and their clinical experience kept getting interrupted by the shutdown. This student had tried to secure a place in Kaiser, had tried to secure a place in Queens. On any island there are three private practice midwifery groups that also precept students.

So we very much hope that you will consider it. This is very much a social justice issue for the APRN. CNMs and the CMS in Hawaii, there is only one Native Hawaiian provider. And for the CPMs, LMS, that of the 40 licensed providers, there is only one who was born and raised in Hawaii. So.

So we really hope that somehow we can address the need to grow providers from Hawaii and to support them. It's wonderful that this preceptor program is going. It seems to be very effective. I think it's important to understand that the two credentials of the aprn, CNM and the CMLM are advanced practice credentials.

They both act as primary care providers, so already they were in alignment with the first initiative. And it's wonderful that there's consideration of other credentials. Thank you so much.

Thank you. Thank you. Members. That's everybody who indicated they'll be joining us today. Additional testimony from 18 organizations and 16 individuals. Anybody else in the room wishing to testify?

Hi. I'm sorry, I wanted to testify as an individual outside of the, UH testimony. You guys are brilliant. To start the preceptor tax credit.

I'm sorry, can you just state your name for the record.

Sorry, Hollywood.

You guys are brilliant. Starting the preceptor tax credit program five years ago, we've only used half the funds allocated and less every year. And while I'm a physician and I do the physician workforce research, only physicians, nurse practitioners and pharmacists can actually make use of this. And as you've heard, we now have way more programs.

We have occupational therapy, physical therapy. We have two PA programs we're just developing wonderfully in the state. And now we have some rural health transformation money that will pay tuition for these programs and it'll pay for the travel to do work, rural training. So I really encourage you.

It's a cheap way to get these trainings done because it'll only cost. The money's already in there. You know, if we could maximize the preceptor tax credits, I think it would go a long way to training our healthcare teams together like we need to do. Thanks.

Thanks. Thank you. Anybody else in the room? Anybody on Zoom?

Okay, Members, any questions on this measure? Seeing them Moving on to HB 1854, HD1 related to community behavioral health clinics.

We have SHPDA in support, Not present, and HGA in opposition.

HGA stands on its testimony in opposition. It's just limited to the civil service language. Thank you.

Thank you, Members. Also testimony. That's a run to indicate they'd be joining us. Also testimony and support from the Hawaii State Council on Mental Health. Is there anybody else in the room wishing to testify?

Members, any questions?

I thought we are. Did you not receive our written testimony? DOH in support. 1854.

Sorry, I skipped. Oh, I read it wrong. Sorry. Yes, it is you guys. Thank you. Okay. Yeah. Anybody else in the room wishing to testify? Anybody on Zoom?