Hawaii to cover palliative care through Medicaid

Dr. Helen Kao, right, palliative care doctor and a medical director at Lumina Hospice & Palliative Care, adjusts 89-year-old Anne Cotton’s oxygen during a check-up in Cotton’s apartment in 2021 in Corvallis, Ore. Lumina and other hospices that serve Benton County, Ore., are grappling with pandemic-fueled staff shortages, which have forced them at times to turn away new patients or delay their enrollment — as it did with Cotton. “It’s devastating,” Dr. Kao said. (Alisha Jucevic/The New York Times)

Hawaii has become the first state in the U.S. to cover community palliative care services through Medicaid, according to Gov. Josh Green.

The U.S. Centers for Medicare and Medicaid Services has approved a new state plan amendment, which provides coverage for community palliative care in nonhospital settings through the Hawaii Department of Human Services’ Med-QUEST Division.


Coverage goes into effect immediately, according to the news release from the governor’s office.

Palliative care is specialized medical care for people of all ages living with a serious illness such as cancer or heart failure, according to the National Institute on Aging, with the goal of providing relief from the symptoms and stress of the illness while improving quality of life for the patient and family. Hawaii’s Medicaid program is called Med-QUEST.

“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 Green in a news release. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaii continues to lead the nation in innovations in health and health care.”

Med-QUEST will actively engage with the many stakeholders and community members to work through the details needed to fully implement the coverage.

DHS first issued public notice in October 2022 of its intention to submit the state plan amendment to CMS, seeking to expand coverage to nonhospital, community settings.

The benefits were to include care plan development, clinical services provided through an interdisciplinary team, comprehensive management, and care coordination and communication.

“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 in the release.

AARP Hawaii, a nonprofit that advocates for people ages 50 and older, with about 150,000 members in the state, welcomed the news.

“AARP Hawaii congratulates Hawaii’s Med-Quest to be the first Medicaid program in the country to cover community-based palliative care service,” said Audrey Suga-Nakagawa, AARP Hawaii Advocacy Director, in a statement. “We support improved access to palliative care services and commend the governor, the Department of Human Serv­ices and the Centers for Medicare and Medicaid Serv­ices for proposing and approving the State Plan amendment which now removes barriers to the appropriate management of pain and suffering regardless of patient setting (i.e. hospital, nursing home or residence). We look forward to seeing Hawaii lead the way for other states that are exploring different sources to pay for community-based palliative care.”

State leaders expect the amendment to pave the way for other states exploring how to pay for interdisciplinary, community palliative care.

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