Hawaii stakeholders show support for 1115 waiver during public forum


Hannah Saunders


The Hawaii Med-QUEST Advisory Health Committee received positive feedback from the public at their second public forum on its upcoming 1115 demonstration waiver extension request. The current demonstration expires on July 31st, 2024, and the state is seeking a five-year extension, which includes several new initiatives. 

Judy Mohr Peterson, division administrator for Med-QUEST, explained several of the waiver extension initiatives, including community integration service (CIS) benefits. CIS benefits that are currently active include outreach, pre-tenancy support, tenancy sustaining support, traditional case management, and limited rental and utility assistance. 

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“In the last year, CMS [Centers for Medicare and Medicaid Services] has newly approved—for the very first time ever—up to six months of rental assistance. They’ve never done that. They swore up and down that they would never pay for it, and never cover it, but they approved it. Because they approved it, we’re going to ask for it.” 

— Peterson

In addition to requesting up to six months of rental assistance for qualifying members, Med-QUEST is seeking approval for help with setting up utilities and up to six months of utility assistance. 

The waiver extension request also proposes adding contingency management, which is an evidence-based practice for addressing substance use disorder (SUD)—a priority for Med-QUEST. 

“We have more substance use deaths than car accidents, and we also know that contingency management is an evidence-based practice that is highly effective for behavioral interventions that help treat SUD, especially for those who are suffering from addiction, such as meth,” Peterson said. 

Contingency management services include motivational incentives to advance substance use disorder goals, such as cash equivalence for negative drug tests. Peterson said that if approved, Med-QUEST will pilot the program with the intention of building it out. 

Pre-release services for the justice-involved population is another new initiative Hawaii is requesting, which CMS has already approved in California and Washington. 

“Medicaid is not allowed to have active eligibility for jails and prisons,” Peterson said. “This is a brand new opportunity for us, and we’re taking a look at it.” 

Med-QUEST is seeking Medicaid coverage up to 90-days prior to release from state prisons, local jails, and youth correctional facilities. This initiative would also provide case management and care coordination services, clinical consultation services, labs and radiology services, and a 30-day supply of medications. Following release, Med-QUEST would be responsible for continuing to provide access to services, including case management and medication assisted treatment.

Kat Brady, coordinator for the Community Alliance on Prisons, expressed her full support for the inclusion of these services. 

“We think it’s really important, because people who’ve been inside for a long time, many have no connection to the community, and to find a care provider would be really daunting,” Brady said. 

Brady noted the importance of providing a seamless continuity of services post-release, like the proposal for the 30-day supply of medication. 

“To include medication is really [important], I can’t stress that enough. I talk with a lot of service providers, and they tell me that people come out with nothing, and yet they had prescriptions while they were in prison. Then they come out and they have no idea what to do, who to see, and how to continue. I really can’t stress enough how important that is.” 

— Brady

Since some individuals may also be hesitant to access traditional western healing services, Med-QUEST is seeking coverage for traditional Native Hawaiian healing services. These services would not be limited to individuals who identify as Native Hawaiian, but available to anyone who requires it. 

“Native Hawaiian traditional healing practices are really key to Hawaii and health, not just for Native Hawaiians, but for all people who live here, and that is really integral to our health system in general,” Peterson said. 

Peterson explained how all Native Hawaiian healing practices would not be implemented at once. If approved, Med-QUEST would initially introduce lomilomi, a practice of massage of physiotherapy; hula, a traditional form of dance that increases mindfulness, physical movement, and social interaction; and ho’oponopono, a peacemaking practice that is intended to restore and maintain healthy relationships.

Other traditional Hawaiian healing practices include ‘ai pono, or the practice of holistic nutrition therapy; Lā’au lapa’au, the practice of herbalist healing; and Hāpai hānau, Native Hawaiian birthing practices and midwifery. 

Med-QUEST is proposing to have traditional Native Hawaiian healing services delivered by Native Hawaiian healing providers that are recognized by any Kupuna Council, which falls under Papa Ola Lōkahi, or the Traditional Healing Office.

Kia’i Lee, traditional healing coordinator for Papa Ola Lōkahi, said there was an error in the extension request’s traditional healing section pertaining to Native healing. 

“Unfortunately, there is misinformation there when it’s stating that Papa Ola Lōkahi trains and certifies its Native Hawaiian traditional healers. That is not true. That is not our responsibility to train and certify. All we do under the state law is convene the Kupuna Councils,” Lee said.

Lee explained how the Kupuna Councils are attached to Native health systems and federally-qualified health centers, and that each council has their own process for recognizing or certifying traditional Native Hawaiian healers. Lee said that in order to be recognized or certified, individuals need to receive training in four traditional Native Hawaiian healing practices, which include lomilomi and ho’oponopono. 

He acknowledged how it will take some time for Native Hawaiian healing practitioners to meet the expectations of the plan and incorporate additional practices. Peterson said the information in that section will be corrected. 

Med-QUEST is accepting public comment until Nov. 16th, and will incorporate feedback into the final demonstration request, which is due to CMS by Feb. 1st, 2024.