SB877 appropriates state general funds to increase Medicaid funding for in-home services in fiscal year 2026-2027, with the Department of Human Services required to secure the maximum available federal matching funds. The bill is aimed at raising reimbursement rates for home- and community-based services such as homemaker/companion/chore services, personal care, attendant care, and private duty nursing. Its stated policy goal is to help kupuna and people with disabilities remain in their homes longer by making in-home care more financially viable for providers.
The bill’s findings explain that Hawaii’s existing reimbursement benchmarks are based on a 2022 Milliman study and that those data are now outdated because labor and care costs have risen substantially. The measure cites wage pressure in the direct care workforce and notes that some providers are already unable to serve Medicaid clients because reimbursement rates do not cover costs. By directing funding toward the high scenario modeled in the Milliman study, the bill seeks to improve access to essential in-home care and reduce reliance on institutional nursing facilities.
Impact
If enacted, SB877 would increase state spending for Medicaid in-home services and likely raise reimbursement levels for providers serving Medicaid beneficiaries in home and community-based settings. It would not directly amend a large body of substantive human services law, but it would affect DHS/Med-QUEST administration of reimbursement rates and provider payments, while also leveraging federal Medicaid matching funds to amplify the fiscal effect. The bill is an appropriation measure, so its practical impact would be on funding levels, provider participation, and access to in-home care rather than on eligibility rules or benefit structure.
Sentiment
The available legislative history suggests generally favorable sentiment. The Senate Health and Human Services Committee passed the bill with amendments by a 5-0 vote, and the measure advanced to Ways and Means after second reading. The bill’s findings frame the issue as a cost-of-care and access problem affecting seniors, people with disabilities, and Medicaid recipients, which likely contributed to the positive committee reception. No opposing testimony or recorded dissent is included in the provided materials.
Contention
The main policy tension is fiscal: the bill would require additional state general funds, and the final appropriation amount is left blank, indicating unresolved budget considerations. A related point of contention is whether reimbursement should be increased to the high scenario from the Milliman study, which the bill endorses, versus lower benchmark scenarios that would cost less. Providers and advocates appear to support higher rates because current reimbursement is described as insufficient to cover labor and operating costs, while budget-conscious stakeholders may be concerned about the state share of the appropriation and the long-term cost of expanding Medicaid in-home services.
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.