Hawaii's Medicaid coverage for palliative care expected to save the state money

by Merrilee Gasser, The Center Square, June 10, 2024

(The Center Square) - A new amendment to include palliative care coverage in Hawaii’s Medicaid plan is expected to save the state money over time, according to the Hawaii Department of Human Services.

DHS spokesperson Amanda Stevens told The Center Square that including palliative care in the state’s Medicaid coverage should lead to people going less frequently to the hospital or the emergency room, which will mean less money spent.

“This new benefit allows Medicaid beneficiaries who are suffering from serious illness, to receive specialized services that address physical, intellectual, emotional, social, and other needs throughout the continuum of care,” said DHS Director Ryan Yamane.

Palliative care provides people living with serious illness specialized care focused on symptomatic relief along with the stress of living with illness, according to Gov. Josh Green, who is a doctor. 

Hawaii is the first state to include palliative care in its Medicaid plan.

“After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” Green said. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”

While there is no cap on the number of patients, people will need to meet clinical criteria to receive the benefit, Stevens told The Center Square.

Stevens said that now that the Centers for Medicare and Medicaid Services has approved palliative care for Hawaii’s Medicaid State Plan, it will not need to be renewed.

Med-QUEST, which administers the state’s Medicaid program, will continue to work with stakeholders and the community to work through the details of its implementation, the governor’s office said.

“Now, fewer people who face serious illness will suffer, because community palliative care is now covered under Medicaid,” said Judy Mohr Peterson, Med-QUEST Division Administrator.

Palliative care is associated with end-of-life care, but differs from hospice care in that patients receiving hospice care are not seeking a cure while those receiving palliative care are looking for ease of symptoms while also typically seeking treatments to cure their illness, according to the U.S. Department of Health and Human Services.

Hawaii’s Medicaid program saw 11,706 fewer enrollments from April 2023 to May 2024 since its unwinding period after COVID-19. Between March 2020 and April 2023, the number of new enrollments increased by 43%, according to DHS. 

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HAWAIʻI IS THE FIRST STATE TO PROVIDE PALLIATIVE CARE COVERAGE

News Release from Office of the Governor, June 3, 2024

HONOLULU – Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.

Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness, with a goal of improving quality of life for both the patient and the family. 

“After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.” 

DHS Director Ryan Yamane shared, “This new benefit allows Medicaid beneficiaries who are suffering from serious illness, to receive specialized services that address physical, intellectual, emotional, social, and other needs throughout the continuum of care.”

“Now, fewer people who face serious illness will suffer, because community palliative care is now covered under Medicaid,” said Judy Mohr Peterson, Med-QUEST Division Administrator.

This monumental SPA is expected to pave the way for other states that are exploring new ways to pay for interdisciplinary, community palliative care.

Although this benefit takes effect immediately, Med-QUEST will actively engage with the many stakeholders/community members who have helped over the years in developing it to work through the details for full implementation.

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SA: Editorial: Care coverage by feds good for Hawaii | Honolulu Star-Advertiser

SA: Hawaii to cover palliative care through Medicaid

HNN: Hawaii becomes first state to provide palliative care coverage through Medicaid (hawaiinewsnow.com)

HN: Hawaii to Cover Palliative Care Via Medicaid - Hospice News