Med-QUEST Division (Hawaii’s Medicaid program) submitted an application to renew its 1115 Demonstration waiver to the Centers for Medicare and Medicaid Services (CMS) on Jan. 17, and division leaders discussed the request at the 2024 Hawaii State of Reform Health Policy Conference in January.
Hawaii has had a 1115 waiver since 1994, and renews it every five years. The active 1115 waiver period ends on July 31, and a new one will need to be in place by Aug. 1. Dr. Judy Mohr Peterson, Med-QUEST administrator, said Hawaii is one of the healthiest states in the country, but there is room for improvement.
“We have really serious disparities in our state—particularly for individuals who live in rural areas, by the very nature of (that)—individuals who are on Medicaid because they are low-income,” Mohr Peterson said. “So poverty (and) financial struggles (exist). And Native Hawaiian/Pacific Islanders have far more health disparities than any other community.”
Individuals within these differing demographics are the focal point of the 1115 waiver renewal request, according to Mohr Peterson.
“In the last year-and-a-half—more or less—CMS has come out with many new opportunities that they never had offered before, and so this is our opportunity to take advantage of that,” Mohr Peterson said. “And we will be incorporating many items that, prior to this waiver time period, had not been available to us.”
Expanding on health-related social needs through the waiver renewal will assist with expanding community integration services, like providing a full continuum of housing-related services such as rental assistance, Mohr Peterson said. She noted that the division will focus on adding behavioral health integration support through contingency management.
A primary aspect of the initial waiver renewal—Native Hawaiian traditional healing services—was provisionally removed. Dr. Ranjani Starr, Med-QUEST health analytics and informatics administrator, discussed the division’s decision to remove the services from the new waiver renewal request.
“Med-QUEST had initially developed a section which included six different types of Native Hawaiian healing practices,” Starr said. “We had thought of this as a health equity strategy to offer culturally-based practices to address health outcomes that are particularly prevalent among Native Hawaiian and other Pacific Islander populations.”
During the public comment period for these services, Med-QUEST received notices from many people who were in support of this section, while others had deep-seated concerns, Starr said. MedQUEST incorporated the feedback from the comments, and decided to drop the initiative, at least for now. Starr said she hopes to better support the concerns raised in the public comment period, and Med-QUEST may reapply for those services during the waiver negotiation period.
Meredith Nichols, assistant administrator and deputy Medicaid director at Med-QUEST, discussed the continuity of health coverage for keiki (children), because the waiver is crucial for their development and school readiness.
“We would like to invest some time and effort into seeing what we can do to take away that burden of what we call ‘churn,’” Nichols said. “That really isn’t helpful to anybody.”
Nichols said CMS has already approved the continuous coverage for youth concept in other states’ waivers.
“Primarily, we want to do continuous coverage for keiki (up) to six years (old),” Nichols said. “We’re asking for the permission to say, ‘Once they’re eligible, they’re eligible until they’re six years old,’ (and) let them have this continuity of coverage.”
Med-QUEST instated continuous eligibility for children on Medicaid last year. Nichols said the waiver renewal request also seeks two-year continuous eligibility for youth ages seven to 19 to create better stabilization.