Committee defers Kauai pilot to let Medicaid, supervision and training issues be resolved

A House Committee on Consumer Protection and Commerce hearing on April 2, 2026, on SB847 SD2HD1 ended with lawmakers deferring the bill to a later decision so sponsors can clarify Medicaid reimbursement language and other implementation details.

SB847 would authorize a three-year pilot on Kauai allowing qualified psychologists, under psychiatrist supervision, limited authority to prescribe psychotropic medications for adult patients aged 18 to 65. Proponents said the measure is a targeted response to island workforce shortages; opponents warned it could introduce safety risks without tight limits and oversight.

Supporters, including the Hawaii Mental Health Coalition and the Hawaii Psychological Association, urged action to address long waits for prescribers and limited psychiatric capacity on neighbor islands. "The shortage of psychiatrists on Kawaii is 60% of what is needed for adults and 62% for children and adolescence," said Melissa Pavisk of the Hawaii Mental Health Coalition, citing a University of Hawaii workforce report and a coalition survey. She added that the statewide average wait time to see a psychiatrist or advanced practice prescriber is 3.2 months.

Proponents described training pathways and experience in other states. "We have over a dozen prescribing psychologists in the pipeline," said Dr. Joe Velasquez, who practices in New Mexico, outlining classroom, residency and fellowship components used in states with prescribing psychologists.

Opponents included the Hawaii Medical Association and several psychiatrists who emphasized patient safety, the scope of training differences between psychiatrists and psychologists, and unresolved reimbursement questions. "We recommend a circumscribed formulary of relatively low-risk drugs…and provisional authorization until satisfactory completion of a period of supervision by a psychiatrist," said Dr. James (Jim) Dylan, Kauai branch medical director for the Department of Health, emphasizing in-person care and measurable evaluation.

A central implementation question at the hearing was whether Medicaid would reimburse prescriptions written by psychologists under the pilot. Committee members and witnesses noted mixed experiences in other states. Committee discussion cited Illinois as an example where Medicaid/Medicare reimbursement rules limited access despite provider authorization; witnesses from New Mexico disputed that this outcome is universal. Committee members requested specific statutory language to enable reimbursement and signaled they would return the bill for decision only after that issue is resolved.

Other details the committee pressed for included: a narrowly defined formulary limited to lower-risk medications (for example, selective serotonin reuptake inhibitors for anxiety and depression); a psychiatry member on the credentialing body; defined supervision and malpractice responsibilities; an in-person (not telehealth-only) component for the pilot; and clarity about how many Hawaii psychologists already meet the proposed master's-level psychopharmacology requirements (witnesses said none were identified on Kauai).

The committee did not vote on SB847. Instead, the chair said the committee intends to pass the bill later "but I think we need to get some more information on especially the Medicaid language needed to allow Medicaid reimbursements," and deferred the measure for further work.

Next steps: Sponsors and interested parties were asked to provide model language and examples from other states to clarify reimbursement pathways and to flesh out training, supervision and evaluation details before the committee takes the measure up again.