Hawaii has become the first state in the U.S. to gain federal approval to include community palliative care — specialized, “wrap-around” medical care for serious illnesses outside of a hospital — through Medicaid. This sensible and forward-thinking initiative has promise to relieve some pressure on hospital and nursing home overcrowding. It can also strengthen the state’s health-care system by establishing alternative care pathways for low-income beneficiaries, with procedures for reporting and monitoring.
The U.S. Centers for Medicare and Medicaid Services approved the state’s plan amendment, effective immediately. Coverage for palliative care, typically provided in cases of complex and life-threatening illnesses such as cancer and heart disease, will now be available for all recipients of Hawaii’s Medicaid health coverage, known as Med-QUEST.
This compassionate and potentially cost-saving advancement is a benefit to the state and its residents, and positions Hawaii to be a leader in establishing this alternative access to services for those in need.
Palliative care provides relief from pain, discomfort and stress associated with illness, and it can be combined with curative treatments — increasing a recipient’s quality of life. It differs from hospice care, which is provided as a patient nears the end of life.
Until this transition was approved, low-income patients with serious illness faced a gap in the availability of care, and were vulnerable to suffering if unable or ineligible to receive hospital treatment, Med-QUEST administrator Judy Mohr Peterson stated.
Gov. Josh Green announced Wednesday that “Med-QUEST is the first Medicaid program in the country to get this benefit approved,” and said creating an acceptable plan amendment took “several years” of work. The state Department of Human Services (DHS) first issued public notice of its intention to submit the state plan amendment in October 2022.
Benefits include “specialized services that address physical, intellectual, emotional, social and other needs throughout the continuum of care,” said DHS Director Ryan Yamane, with an interdisciplinary team to coordinate individual care plans and medical services.
It’s likely that service providers will need to add health care workers to grow this sector of care, because of the team service required, and that could be a positive for the economy. “Details of implementation” are still being worked out by Med-QUEST, according to the governor’s statement.
While this new coverage isn’t expected to change overall expenditures much, it should allow for more staffing and longer treatment periods by providing services outside of an expensive hospital setting — while also better serving the needs of patients who prefer to receive medical care at home or with family.
Availability applies to Med-QUEST recipients of all ages, who currently make up about 1 in 3 residents of the state. Med-QUEST subsidized health insurance covers about half of Hawaii youth ages 18 and under, according to the state.
The service coverage will be especially welcome by Hawaii’s aging population, as about 3 in 5 nursing home residents and 1 in 7 Medicare beneficiaries also receive Medicaid.
AARP Hawaii, a nonprofit that advocates for people ages 50 and older, lauded the expanded access to care, recognizing its benefits to seniors. The Med-QUEST expansion “removes barriers to the appropriate management of pain and suffering regardless of patient setting (i.e. hospital, nursing home or residence),” stated Audrey Suga-Nakagawa, AARP Hawaii advocacy director.
It’s another step forward in advancing Hawaii’s status as a health-care and quality-of-life trendsetter.
