IMPROVED “MEDICAID HOME AND COMMUNITY-BASED SERVICES” FOR HAWAI‘I’S VULNERABLE RESIDENTS

News Release from Hawaii DHS, Mar 22, 2023

HONOLULU, HI – Hawai‘i has joined the rest of the nation in implementing sweeping changes that enable residents with disabilities and older adults to live and participate fully in their communities. As of March 17, 2023, all states were required to be compliant with the “Medicaid Home and Community-Based Services” settings regulation. The changes are expected to impact more than one million people receiving Medicaid HCBS nationally, according to the Centers for Medicare and Medicaid Services.

“The regulations protect each person’s rights and uphold the value of person-centered processes that make sure people are making their own choices and control the decisions in their lives — a right most people take for granted,” said Dr. Kenneth Fink, Director of the Hawai‘i Department of Health (DOH). “This includes being treated with privacy, dignity and respect; freedom from coercion and restraint; deciding what and when to eat; having visitors, and having the protections of a lease or other legally enforceable residency agreement.”

The DOH Developmental Disabilities Division, which operates Hawai‘i’s Medicaid waiver for individuals with intellectual and developmental disabilities, has been preparing to meet this compliance deadline despite the challenges of the pandemic. It marks the beginning of a new phase of implementation of the rule, requiring ongoing evaluation, monitoring, and public engagement.

“It is not enough to simply be living in the community; we need to make sure participants in our program with intellectual and developmental disabilities are fully integrated into the fabric of our community,” said Mary Brogan, Administrator of the DOH Developmental Disabilities Division since 2014. “We need to take our transformation to the next level so everyone we serve has access to the life they choose, and we are committed to continuously improving our services,” Brogan said. “Our entire system, including staff, participants, families and providers have worked tirelessly through the transition period to make the changes needed, and we are incredibly grateful for everyone’s efforts.”

About 3,500 participants benefit from the services provided through the DOH Developmental Disabilities Division.

Debbie Kobayakawa, a parent of an adult child who receives services from DOH, said her son’s services have been game changing. “Person-centered planning allows my son to live and work fully integrated into his community, which is the life he wants. The whole point of these services is to provide individuals with the life they want,” Kobayakawa said.

The waiver program has positive impacts on Hawai‘i, both in supporting better outcomes for people with significant disabilities, and the economic effect in the community. The State has agreements with more than 50 agencies providing services such as personal assistance, employment supports, and adult day programs. These agencies employ thousands of people statewide.

A number of states including Hawai‘i, are investing resources to address the direct-care workforce crisis, essential to ensuring people have access to the services they need, especially on the neighbor islands. For example, because low wages make it very hard to recruit and retain the professionals who provide critical services, during the pandemic, many states  increased payment rates and targeted those increases to apply to wages for direct-support professionals.

“Our goal is to ensure the timely provision of quality services that truly make a difference in people’s lives,” Dr. Fink said. “The support from the Governor and Legislature has been instrumental toward this shared goal.”

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NIH: Since enactment in 1981, the HCBS waiver program has experienced significant growth 

CRCH: 1998 Case: Makin v. State of Hawaii

Reconsidering Makin v Hawaii: "The state had a waiting list of 801 individuals two months before the court's ruling, without any guidance as to when the services were to be provided. 30 The plaintiffs argued that the waiting list violated Medicaid's 'reasonable promptness' requirement, but the court rejected this theory."