About 50,000 Hawaiʻi residents have accumulated a total of $91 million in medical debt, but a new state program could help absolve lower-income residents of those unpaid bills.
The state’s high cost of living continues to be one of the highest priority issues for both residents and policymakers, and it can quickly become a dire situation with sudden and often expensive medical treatment.
According to a 2025 Holomua Collective survey of 3,200 residents, 70% of them worry about not being able to pay their monthly bills.
That’s what makes unpaid medical bills different from other kinds of debt, said Matthew Prellberg. He’s the policy and communications director for the Holomua Collaborative, a nonprofit related to the Holomua Collective, which focuses on helping make Hawaiʻi more affordable for working families.
“You don't choose to get sick. You don't choose to get injured. You don't choose to have a medical emergency strike, and often when you are … you don't know what the costs are going to be up front,” Prellberg said. “You just pay the bill as it needs to happen.”
He spoke Thursday at a bill signing ceremony at the state Capitol for Senate Bill 3025, which requires the state Office of Wellness and Resilience to create and oversee a medical debt acquisition and forgiveness program.
Residents who qualify will be in households earning up to 400% of the federal poverty level or make less than $100,000 annually and have medical debt that’s at least 5% of their income.
As medical debt piles up, it requires residents, especially those in lower-income households, to choose between more pressing needs and the consequences of increasing debt.
“And as some families in our state that do not have health insurance, they often have to choose between … getting healthcare or … paying their rent,” Prellberg said.
Gov. Josh Green, a former emergency room doctor, also said people who may need medical treatment might hesitate to get it because of the anticipated costs.
“I spent a lot of years in the emergency department seeing people, and many, many times people ask me, ‘Do I really have to have that test? Because I know it's gonna be expensive. Do I have to have a CAT scan of the head after a car accident?’” Green said. “ I understood what they were saying, that the risk of having a bleed (internally) versus not being able to pay for their child's preschool. That was a real question.”
The state is allocating $500,000 for the program, which advocates for the program say is a significant return on investment. The money to start the program must be spent by June 30, 2028.
Similar programs in other states have already forgiven millions of dollars in medical debt.
