Hawaii lawmakers to focus on workforce needs, behavioral health, and Medicaid reimbursement rates during this year’s session


Shane Ersland


Addressing healthcare workforce shortages, behavioral health needs, and increasing Medicaid reimbursement rates will be top priorities for Hawaii lawmakers as they work through the legislative session, which began on Jan. 18th.


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Lawmakers discussed their legislative priorities during the 2023 Hawaii State of Reform Health Policy Conference. Sen. Jarrett Keohokalole said the state’s budget surplus could help address workforce challenges.

“The challenge there is that surpluses don’t last forever,” Keohokalole said. “We need to treat the money like it’s one-time funding. Which means allocating those resources to full-time employee positions, or contracts that we know need to continue in perpetuity [which] are going to be very challenging.”

As the state cannot project what types of revenue streams it will have in the future, lawmakers will need to be responsible about which new systems and programs will be established, Keohokalole said. But there will be opportunities to address workforce needs.

“I’ve talked to healthcare facilities that can’t find janitors because they’re working in the hotels,” Keohokalole said. “How can we do better in the state government to provide incentives for people in this space to stay in this space? And for us to put more people into this type of work so we can actually execute on new embedded systems that were created?”

Rep. John Mizuno is chair of the House Committee on Human Services. He said the committee will work to make Medicaid reimbursement rates equal to Medicare rates.

“Right now, the Medicaid reimbursement is 60% of Medicare,” Mizuno said. “That’s why a lot of physicians or healthcare workers do not want to take Medicaid recipients. This is going to [take] about $30 million in state funds, but we believe it will draw $35 million in federal funds. So instead of the band-aid approach, where we ask for credit or tax exemptions for physicians treating Medicaid, we can cover that by making Medicaid reimbursement equal to Medicare reimbursement.”

While Mizuno expects the initiative to cost a total of $65 million per year, it’s the right thing to do, he said. 

“This will help with our healthcare workforce in the future,” Mizuno said. “Access to healthcare should be a right, and not a privilege for only the rich. Government cannot say this is the way it’s been done for the past 20 years so we’re going to do the same thing. We need revolutionary change for the betterment of all people.”

Rep. Della Au Belatti is chair of the House Committee on Health & Homelessness. She said mental health will be a top priority for the committee.

“When I talk about mental health, [and] the crisis we’re facing coming out of the pandemic, especially amongst youth and everybody who’s feeling a little bit stressed out, we know there is a mental health crisis in the community,” Au Belatti said. “We’ll see some bills addressing that. We’re also going to be seeing follow up on mental health and substance abuse treatment pilot programs we initiated pre-pandemic.”

Au Belatti said there are too many Hawaiians cycling in and out of the criminal justice system. Many of those people suffer from homelessness and mental health issues.

“We know they’re not really criminals, that they’re suffering from mental health and substance abuse issues,” Au Belatti said. “We have a process now trying to divert them from going to jail and going through the involuntary commitment process to get them evaluated quickly. The challenge there is we don’t have enough mental health and substance abuse treatment in the community.”

Au Belatti noted that Honolulu’s Law Enforcement Assisted Diversion program, which is designed to divert low-level offenders from citations or arrests and increase connections to harm reduction-based individualized case management, yielded great results and should be expanded to other areas in Hawaii.

“We need to make sure to ask for money for Big Island, Maui, and Kauai so they can have their own law enforcement diversion system, and then form a statewide system,” Au Belatti said.