State lawmakers will face the federal impacts on the state’s health care systems and social services when they reconvene next week.
“My top priority is in the face of the Trump administration changes, keeping people on existing benefits, and in existing services,” said Rep. Lisa Marten, House Human Services and Homelessness Committee chair.
She is introducing a bill to create a secure Hawaiʻi benefits hub. It would contain all the information people need to submit to qualify for services that are spread throughout different governmental agencies. It’s an effort to streamline the eligibility screening process.
“It also reduces the burden on our agencies, which have to collect very similar data,” she said. “SNAP, Medicaid, public housing — so that they can check to see if somebody qualifies for their services. It’s especially important right now because of the new community engagement requirements.”
Marten is referring to the new federal work requirements for Supplemental Nutrition Assistance Program recipients.
Recipients between 55 and 64 years old, parents with children over 13 years old, people experiencing homelessness, and youth between 18 and 24 years old transitioning out of foster care are required to work at least 80 hours a month to qualify for SNAP.
Those groups of people were previously exempt from those work requirements. The state Department of Human Services estimates that the change will impact 16,000 people between 55 and 64 years old, and 10,000 families with teenage children.
Similar requirements will also be imposed on Medicaid recipients in 2028. At the same time, required eligibility screenings for Medicaid recipients will increase to twice a year.
“ It's a huge burden on Medicaid, on MedQuest, to double the times that they need to verify people's qualifications. And then that's not even talking about a new system of checking people's work, volunteer, education training hours every month,” Marten said.
“That's an enormous administrative burden, and the purpose of that burden is to knock people off.”
Those changes to Medicaid are something Senate Health and Human Services Committee Chair Sen. Joy San Buenaventura is also looking to address. She explained that coupled with the expiration of the Affordable Care Act premium tax credits, it could result in 6% of the state being uninsured. That’s double the current rate.
“If it gets to be that high, then the question is going to be how we're gonna address the uninsured population,” San Buenaventura said. “The fallout on having that large an amount of uninsured affects, frankly, everybody.”
She explained it would exacerbate the state's physician shortage because doctors will leave if they are forced to take on an uninsured caseload.
That's why she's looking into what it would take for the state to create a basic health care plan — similar to what was implemented in the state in 1989 when the state's uninsured rate was about 6%.
It covered six doctor visits a year and cost about $150 a month for a family — which is now equal to about $600 a month.
State Health Planning and Development Agency Administrator Dr. Jack Lewin was the head of the state Department of Health at the time. He briefed lawmakers on the program last month.
“It's a piecemeal program, but it did work. It did provide great care and because it was focused mainly on prevention and primary care, it actually had great effects on avoiding unnecessary hospitalizations, and it did save a bunch of money,” Lewin said. “So I bring it up to you only because it's something the state did back in the day. And, if we get into desperate straits, it's an opportunity for us to consider again.”
San Buenaventura added that although there is a bill being introduced that would implement a state health insurance plan, she will likely amend it to create a working group to see if it’s a viable program.
Gov. Josh Green has also included $16.5 million in his budget proposal to cover the expired Affordable Care Act subsidies.
San Buenaventura also wanted to address the state’s nearly $400 million stockpile of federal funds for the Temporary Assistance for Needy Families program, which is meant to help low-income families meet their basic needs. She wants that money spent since significant barriers to using those funds have been eliminated.
“I know it can only be used for those families that fall within TANF … which are usually young children, families, poor families with young children, but that's also the same subset that usually interacts with child protective services,” she said.
“I want to see how much of those monies we can use towards getting the Mālama ʻOhana recommendations of getting trauma-informed care, more training for the social workers so that we don't have the problems of what has occurred previously.”
Both the House and Senate majorities have listed protecting the social safety net as their legislative priorities this session.
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