Hawaiʻi improving services, rights for disabled on Medicaid as mandated by federal law

Hawai‘i has joined the rest of the nation in implementing sweeping changes mandated by federal law that enable residents with disabilities and older adults on Medicaid to live and participate fully in their communities.

As of March 17, 2023, all states were required to be compliant with the “Medicaid Home and Community-Based Services” settings regulation that was established in 2014. The changes are expected to impact more than one million people nationally, according to the Centers for Medicare and Medicaid Services.

Home and Community-Based Services provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual or developmental disabilities, physical disabilities and/or mental illnesses.

“The regulations protect each person’s rights and uphold the value of person-centered processes that make sure people are making their own choices and control the decisions in their lives — a right most people take for granted,” said Dr. Kenneth Fink, Director of the Hawai‘i Department of Health. “This includes being treated with privacy, dignity and respect; freedom from coercion and restraint; deciding what and when to eat; having visitors, and having the protections of a lease or other legally enforceable residency agreement.”

The state’s Developmental Disabilities Division operates Hawai‘i’s Medicaid waiver for individuals with intellectual and developmental disabilities. The division has been preparing to meet this compliance deadline despite the challenges of the pandemic.

It marks the beginning of a new phase of implementation of the rule, requiring ongoing evaluation, monitoring and public engagement.

“It is not enough to simply be living in the community; we need to make sure participants in our program with intellectual and developmental disabilities are fully integrated into the fabric of our community,” said Mary Brogan, administrator of the Developmental Disabilities Division since 2014. “We need to take our transformation to the next level so everyone we serve has access to the life they choose, and we are committed to continuously improving our services.”

About 3,500 participants benefit from the services provided through the division.

“Person-centered planning allows my son to live and work fully integrated into his community, which is the life he wants,” said Debbie Kobayakawa, a parent of an adult child who receives services from the Department of Health. “The whole point of these services is to provide individuals with the life they want,” Kobayakawa said.

The waiver program has positive impacts on Hawai‘i, both in supporting better outcomes for people with significant disabilities, and the economic effect in the community. The State has agreements with more than 50 agencies providing services such as personal assistance, employment supports and adult day programs. These agencies employ thousands of people statewide, according to a Department of Health press release.

Hawai’i is investing resources to address the direct-care workforce crisis, essential to ensuring people have access to the services they need, especially on the neighbor islands.

For example, because low wages make it very hard to recruit and retain the professionals who provide critical services, many states increased payment rates during the pandemic and targeted those increases to apply to wages for direct-support professionals.

“Our goal is to ensure the timely provision of quality services that truly make a difference in people’s lives,” Dr. Fink said.