SB298 appropriates state general funds for fiscal years 2025-2026 and 2026-2027 to increase Medicaid funding for in-home services administered by the Department of Human Services. The bill’s findings explain that many kupuna and people with disabilities prefer to age in place, and that in-home supports such as personal care, homemaker services, and private duty nursing are essential to making that possible. It also states that these services are generally less costly than institutional care and that reimbursement rates have not kept pace with rising labor and operating costs.
The bill relies heavily on a 2022 Milliman rate study and later cost data to argue that current reimbursement levels are too low to sustain provider participation. It concludes that funding should be raised to the study’s high scenario to better reflect wage pressure in Hawaii’s labor market and to improve access for Medicaid clients. The measure is an appropriation bill only; it does not directly rewrite provider licensing or Medicaid eligibility rules, but it directs the Department of Human Services to use the new funds to support in-home service reimbursement, with the expectation of increased federal matching funds as well.
Impact
If enacted, SB298 would increase appropriations from the state general fund for Medicaid in-home services and channel those funds through the Department of Human Services. The practical effect would be to support higher reimbursement rates for home- and community-based care providers, including personal assistance, homemaker/companion/chore, and private duty nursing services. This could improve provider participation and access to care for Medicaid recipients, especially kupuna and people with disabilities seeking to remain at home, while also leveraging additional federal Medicaid matching dollars.
Sentiment
The bill appears to have received favorable treatment in committee, passing the Senate Health and Human Services Committee 5-0 with amendments and the Senate Ways and Means Committee 13-0 without amendment. The findings and committee outcomes suggest broad support for strengthening in-home care funding and addressing workforce and cost pressures in the home care sector. No opposing testimony or recorded dissent is included in the provided materials.
Contention
The main policy tension is fiscal: the bill proposes additional state spending to raise Medicaid in-home service reimbursement, which some may view as a budget commitment, even though the measure argues that federal matching funds will amplify the benefit. Another point of concern is whether the “high scenario” from the 2022 Milliman study is the appropriate benchmark, since providers’ actual costs have reportedly risen beyond that model and the data are now several years old. The bill also highlights access-to-care concerns for providers like Kokua Healthcare that say current reimbursement is too low to serve Medicaid clients, indicating that provider sustainability and client access are the central issues.
A resolution to direct the Clerk of the House of Representatives to only present to the Governor enrolled House bills finally passed by both houses of the One Hundred Third Legislature.
Relating to nonsubstantive additions to, revisions of, and corrections in enacted codes, to the nonsubstantive codification or disposition of various laws omitted from enacted codes, and to conforming codifications enacted by the 88th Legislature to other Acts of that legislature.