The communities of Molokaʻi and Lānaʻi have $2 million coming their way. It's specifically to tackle a huge transportation issue that's been getting in the way of residents' health care.
“I think the first kind of overwhelming feedback we received is gratitude that the state is bothering to look into the daily lives of residents on Molokaʻi and Lānaʻi understand the unique circumstances they are in with accessing health care and trying to do something about it,” said Lorrin Kim, chief of the Department of Health's Office of Planning, Policy and Program Development.
He's referring to the Essential Rural Medical Air Transport program, a line item in this year’s state budget for a two-year pilot project.
It's a first-of-its-kind initiative.
“The most important feature of this project is that the department is a fiscal intermediary,” Kim said. “We will not actually be running this. We are relying on the community, some hui in the community to step up and say, 'This is what my island needs, and this is how we propose to use these funds.' So we are helping to brainstorm.”
Kim stresses it's a bottom-up planning process.
“It's got to come from that community who lives and breathes their daily existence there, they'll be able to identify the solutions that work for them much better than I can for my seat here in downtown Honolulu,” he explained.
Officials just held a meeting on Lānaʻi to hear residents' needs and priorities for the program. They'll hold a similar session on Molokaʻi later this year.
Residents have expressed a preference to bring more providers to Molokaʻi and Lānaʻi — an option officials are looking into. But the health care facilities on these rural islands just aren't set up for many specialized needs – and equipment is a costly investment.
Take giving birth on Lānaʻi, for example.
“When we were discussing this project with the federally qualified health center, the executive director basically said, 'You can't be born on Lānaʻi, whether you're Med-QUEST or HMSA,' and just hearing those words was such a shock to me,” Kim told HPR.
Kim said mothers on Lānaʻi have to routinely fly off-island for all deliveries — often at a big out-of-pocket expense.
“Giving birth is kind of a human right, and if you can't do that on the island you wish to live your life on, that's, that's something I hope we can at least take a little bit of the financial sting out of,” Kim said.
From data provided to the DOH, 83% of Molokaʻi residents say they experience delays in access to health care, while 77% of Lānaʻi residents say they have suffered delays. They cite airline delays as the number one cause, followed by the need to travel off-island for care and availability of appointments.
State Sen. Lynn DeCoite of Molokaʻi said she understands firsthand the frustrations that come with Mokulele Airlines’ flight delays.
“My focus has always been, I believe that Molokaʻi, Lānaʻi, all the rural areas — deserve the same resources that Honolulu gets,” she said. “So we shouldn't be treated differently... everything else should take a backseat to the health, safety and well-being of those islands that have fallen in a monopoly of a single airline carrier.”
This pilot project is similar to a bill proposed by state Rep. Mahina Poepoe this past legislative session that died in the Senate. DeCoite said she and Poepoe have worked together to try to address the ongoing issues.
“We endure this on a weekly basis," DeCoite said. "I've lived through this for the past three and a half years, trying to come to some kind of solution, in this case, the long waits at the airports, the delays, the lack of communication, and then the cancelations.”
After gathering more community feedback, Kim said the Department of Health will release a request for proposals by early next year.
That RFP will be for entities on both Molokaʻi and Lānaʻi to run the program. Kim said funding could be used for a wide range of expenses, like hiring a coordinator, renting an office space or purchasing computer equipment — along with shouldering the cost of chartered flights or seats on a commercial airline.
Those bidding on the RFP would likely be a nonprofit or health care coordinator. In theory, it could also be a direct air carrier.
DeCoite is concerned Mokulele might bid for the project, so she's looking into how the RFP might target smaller charter operations instead.
But Kim said one thing is certain – competition will be essential to the project.
“The RFP we issue will be very clear that there must be more than one airline engaged. This is not intended to be a windfall for any one air carrier,” he said.
