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Members press Hawaii officials on uninsured access after $188.9M award; presenters point to 15% cap
Summary
During a March 6 briefing, committee members asked how people losing coverage will access care under the Rural Health Transformation Program; state officials said many initiatives can serve uninsured people but CMS capped provider payments for uninsured services at 15% of program funds.
Committee members at the March 6 joint informational briefing repeatedly asked how Hawaii's Rural Health Transformation Program (RHTP) will help people expected to lose insurance coverage.
A member said the program's "whole idea" is to help rural communities weather impending coverage losses and asked whether telehealth and other initiatives would be directly accessible to uninsured residents. Lauren Kim of the governor's office and other presenters said many interventions (telehealth, respite services, community outreach, mobile clinics and community paramedicine) are being designed to serve uninsured people where feasible, but that the RHTP includes a specific constraint on direct provider payments for the uninsured: CMS set a 15% cap on provider-payment funds for uninsured services across the program.
Kim and other presenters said that cap prevents the state from allocating a larger share of the first-year award as direct payments to providers for uninsured services; instead, the 15% is distributed across initiatives in components intended to serve uninsured people. "They specifically created this program... and they put on us this specific constraint, 15%," Kim said. Committee members asked for a written explanation of how that 15% will be allocated across initiatives, and the chairs agreed to collect questions and provide written responses.
Members also expressed concern that short timelines in the first (10-month) budget period may complicate rapidly standing up services for people who lose coverage; presenters said sustainability plans and an oversight team are part of the application and will be used to plan for maintenance and long-term access, but that specific allocations and RFP timing will be provided to the committee in writing.
No formal decisions were made at the briefing; members requested follow-up letters on the 15% allocation, RFP timelines and adviser/vendor selection processes.
