Hawai’i’s New Managed Medicaid Benefit for Community-Based Palliative Care

Hawai’i is actively pursuing a Medicaid benefit for community-based palliative care (as part of an 1115 CMS waiver) thanks to the grassroots efforts of C-TAC members Kokua Mau and Hui Pohala working with the Hawai’i Department of Health Services Med-QUEST Division (MQD) and with the financial support from the Stupski Foundation.   

This is an exciting opportunity as a statewide effort in California resulted in palliative care services being required across that state, which has helped set up the community-based palliative care (CBPC) system there. The Hawaii approach, using a waiver, may be a way for other states to expand access to CBPC in their states. 

Simply put, this waiver would require that the Hawaii Medicaid program offer CBPC services to those with serious illness enrolled in Medicaid. Since it would be state-wide, that would require expanding CBPC programs on all islands and in both urban and rural areas.  

The HI CBPC benefit would cover: 

• Advance care planning 
• Comprehensive assessment 
• Plan of care 
• Care coordination 
• Expert pain and symptom management 
• Medical social services 
• Mental health services 
• 24/7 telephonic specialized palliative care support 

The goal is to deliver a set of defined services, policies, and payment that would allow the program to support increased access to high-quality palliative care to Hawai’i’s most vulnerable seriously ill population. The benefit will allow a new capitated payment providers can bill Medicaid as part of a 1115 waiver demonstration or as part of Hawaii State Plan Amendment. That monthly payment would cover an interdisciplinary team to deliver services currently not reimbursable in the fee-for-service payment system. 

National Impact 
Votive Health, along with C-TAC, CAPC and other national stakeholders have been supporting this grassroot efforts. Federal policy change has also helped. C-TAC’s policy and advocacy efforts make such advancements in serious illness care delivery and quality possible. Votive Health’s CEO Torrie Fields outlined how C-TAC has served as a catalyst for the implementation of the Hawai’i benefit. 

“C-TAC’s advocacy efforts have been critical.  In partnership with the Blue Cross Blue Shield Association and other C-TAC health plan members, the Centers for Medicare and Medicaid Services (CMS) established revenue codes in 2014 and associated professional billing codes in 2016 for non-hospice palliative care services. Since then, private payers have been piloting these codes to reimburse for community-based palliative care. Now, Hawai’i is taking the step to use these codes to create the nation’s first community-based palliative care benefit for Managed Medicaid.” Torrie Fields, MPH, C-TAC Strategic Advisor

State Convenings 
Bridging traditionally siloed health and social systems through community-based services is a central policy priority for C-TAC. C-TAC will be leading conversations with other state coalitions on this topic via its state coalition meetings. At these monthly meetings, coalitions share information and help advance programs like this. If you have an active state coalition or are interested in forming one in your state, please considering joining the Workgroup. For more information, please contact Sarah Park (spark@thectac.org).