DOH, hospital budget requests aim to address ‘chronically underfunded’ public health sector


Nicole Pasia


Members of the Hawaii Department of Health (DOH) testified before the Senate Committees on Health and Ways and Means this month, presenting their legislative budget requests for fiscal year 2023. In total DOH is requesting $1.07 billion in budgetary funding, a $10 million increase from FY 2022. 

Hawaii Health Systems Corporation (HHSC), which operates acute and long-term care facilities across the state, also presented its FY 2023 budget requests. HHSC is requesting approximately $753.8 million, an $18.7 million increase from FY 2022. 


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One of HHSC’s top requests, according to president and CEO Linda Rosen, M.D., is funding for a 12% increase in fringe benefits, or additional compensation added onto an employee’s salary or wage. Rosen specified the 12% increase began during the current fiscal year, but the agency has relied on resources such as American Rescue Plan (ARP) funding to absorb costs. To avoid applying for emergency funding once those resources run out, HHSC is looking for budgetary funding to maintain those increases. 

“We would appreciate support in the coming fiscal year to cover that 12% increase,” Rosen told Senate members. 

Personnel costs account for about 70% of HHSC’s total budget. The 12% increase in fringe benefits would come out to about $26.1 million for the state. 

A number of agencies under DOH presented requests that would address workforce shortages, behavioral health and substance abuse programs, and long-term care. Key budget addition requests include: 

  • $3.48 million for additional security services and maintenance of a new forensic building at the Hawaii State Hospital under the Behavioral Health Administration.
  • $3.60 million for the delivery of early intervention services for infants and toddlers up to age three.
  • $1.50 million for the Kupuna Caregiver Program (KCG), which provides financial assistance for those caring for senior relatives at home. KCG has not received additional funding in the last two fiscal years, according to the department’s written testimony. 
  • $627,840 to re-establish the Health Promotion and Education Branch. These positions would focus on community-oriented public health campaigns on suicide prevention, healthy pregnancies, and environmental health.
  • $101,478 to fund three positions that will work with home and community-based services (HCBS programs). HCBS services help divert Medicaid beneficiaries from needing institutionalized care and promote community living.

The department is also requesting a little over $36,000 to “fully cover competitive salaries” for the State Epidemiologist (DOCD Division Chief) and the currently vacant Deputy State Epidemiologist (Deputy DOCD Division Chief). 

Sarah Kemble, M.D., the current state epidemiologist, said she would like to build up an analytic office within the division to conduct in-depth studies on the social and economic factors that impact Hawaii’s vulnerable communities, such as those experiencing homelessness. 

“We’ve had really critical issues with burnout and turnover within our programs,” she said. “It’s been particularly difficult to build epidemiologist positions.” 

To help address epidemiologist shortages in the DOCD Division, legislators questioned whether the Department could utilize the University of Hawaii (UH) as a potential resource for additional staff. Director of Health Elizabeth Char, M.D., said she recently spoke with UH President David Lassner about the possibility, noting that any epidemiologist transfers would have to stay at least six months to a year with the department to be fully apprised of their projects.