In late June, Hawaii’s Med-QUEST Healthcare Advisory Committee met to discuss Medicaid redeterminations and the 1115 waiver renewal. Med-QUEST is the state’s Medicaid agency, which launched the Stay Well Stay Covered Campaign prior to the start of redeterminations.
Meredith Nichols, assistant administrator and deputy director of the state’s Med-QUEST division, said that while redeterminations are underway, individuals are applying for health insurance coverage each day, adding that the state is focused on tracking enrollment on a weekly basis.
In March 2020, Med-QUEST saw a climb in enrollment numbers due to the COVID-19 pandemic. Last April, Hawaii began Medicaid disenrollments and had a total of 468,120 beneficiaries on April 10th. By April 17th, the number of beneficiaries dropped to 464,782 due to the termination of members who moved out of Hawaii during the pandemic.
“March of 2020, we had the best unemployment rate in the nation. We were so low—2.2 percent—and then BOOM, the pandemic hits and we’re up to 22.6 percent—worst unemployment rate in the nation because of our tourism-based economy. And now, we’re not quite fully recovered, but in April of 2023 back down to 3.3 percent unemployed.”
— Nichols
As Hawaiians continue to navigate the financial challenges that arose during the pandemic, Nichols said that more individuals have been able to find jobs with employer-sponsored health coverage, which will decrease rates of those on Med-QUEST.
In March, Med-QUEST beneficiaries received a letter from the state that let them know when their renewal month is, and to look out for a pink letter that will be sent a month prior to an individual’s Med-QUEST renewal date.
The committee also discussed key achievements and challenges with the state’s 1115 waiver, which allows states to launch experimental, pilot, and demonstration projects to assist with Medicaid objectives. The waiver has been effective since 1994, and in July of 2019, the Centers for Medicare and Medicaid Services (CMS) approved Hawaii’s 1115 waiver renewal request which will run until July 31st, 2024.
To keep the 1115 waiver and its related services, the state must submit another renewal request to CMS this month, and the next year will focus on community and stakeholder engagement for a five-year plan.
Under the current waiver, beneficiaries who are chronically homeless are provided with supportive housing services, including moving costs, and utility and rent deposits. Additional ongoing services include behavioral health support, and home and community-based services. For the 1115 waiver renewal, the goal is to maintain ongoing services while offering new initiatives which would address health-related social needs among select members.
Judy Mohr Peterson, division administrator for Med-QUEST, said that from now until October, the division will be collecting feedback regarding each initiative, such as who’s eligible for additional services and what those services are, and where services will be provided.
“All of those things have to be thought through and then, what our intention is is to put together our preferences about the guard rails and what it is we want to include, and engage with various, different, interested stakeholders.”
— Peterson
Some new 1115 waiver initiatives the state is looking into fall under medical respite, such as recuperative care, short-term stays, and post-hospitalization. Peterson said she is highly interested in looking into short-term stays and to use those as an opportunity to connect individuals experiencing homelessness to housing.
“This primary focus is just that they stay immediately out of the hospital,” Peterson said.
Other initiatives of interest to Med-QUEST for the next waiver renewal include pre-release services for justice-involved individuals, including case management and medication-assisted treatment. The agency is also looking into traditional healing practices like hula, lomi lomi massages, and ho’oponopono, as well as nutritional supports like medically tailored meals, nutrition education, and counseling.