Senate defers resolution urging Medicaid waiver eligibility changes for people with developmental disabilities

The Hawaii State Senate committees on Commerce and Consumer Protection and Health on April 1 deferred Senate Concurrent Resolution 226 and its companion SR 201, which urge changes to Medicaid 1915(c) home- and community-based services (HCBS) waiver eligibility for people with intellectual and developmental disabilities.

Supporters said the resolutions seek to fix gaps that keep some people with developmental disabilities from accessing waiver services. The committees recessed the measure to allow stakeholders and agencies to work on a more comprehensive bill during the interim.

Why it matters: The Medicaid 1915(c) HCBS waiver is a primary door to state-funded home- and community-based services for people with intellectual and developmental disabilities (IDD). Testimony at the hearing indicated differences between agency administrative rules and an internal memo that the Department of Health issued; advocates said those differences leave some people without services unless rule changes are made.

Advocates from the Hawaii State Council on Developmental Disabilities and disability-rights groups told senators they have been working with the Developmental Disabilities Division (DDD) and the Department of Health for months. Dansha Bartolos, executive director of the Hawaii State Council on Developmental Disabilities, asked staff member Chase Silver to present the council's concerns, saying the council and DDD have been engaged for about a year to correct wrongly written eligibility rules. Silver said a memo from the DDD director fixes some problems—particularly for certain neuromuscular and spinal-cord conditions—but that the administrative rules themselves remain incorrect and need formal correction.

Lewis Erczyk of the Hawaii Disability Rights Center said the memo has helped some people but does not resolve coordination problems between mental-health services and developmental-disability services. "If someone has a mental-health issue, DD sends them to AMHD. And if someone has a DD issue, AMHD sends them back," Erczyk said, describing a pattern of referral and counter-referral that he said limits access.

Several testimony givers pressed senators on whether the resolution is necessary if the DDD memo already addresses some eligibility gaps. Committee members repeatedly noted that the memo was described as a temporary fix "until they are able to fix the rules," and that a resolution urging rule changes directed at the Department of Human Services (the state Medicaid agency that submits waivers to CMS) could keep momentum while a statutory or rule-change solution is drafted.

Committee action and next steps: The committee chair said the resolution would be deferred to allow interim work on a more comprehensive measure. Committee members urged the parties to use the extra time to produce bill language that would more directly fix the discrepancies in DDD eligibility rules and to resolve coordination issues between DDD and adult mental-health services (AMHD).

Speakers repeated that the memo from the DDD director remains in effect only until administrative rules are formally amended; advocates said the unresolved part of the problem centers on people with co-occurring mental-health diagnoses rather than the neuromuscular items the memo addresses.

The committee did not take a recorded roll-call vote on the deferral; the chair announced the item was deferred and urged interim work toward a comprehensive bill.