S.B. NO.














relating to health.





     SECTION 1.  The legislature finds that recent budgetary cuts to the medicaid QUEST health care program will result in more stringent eligibility requirements.  Currently, those with incomes below two hundred per cent of the federal poverty level are qualified, but proposed changes due to take effect in April limit qualifying individuals to those with incomes below one hundred thirty-three per cent of the federal poverty level.  This change in program eligibility will disenroll approximately four thousand five hundred adults from QUEST and cause them to become uninsured.  Although the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148) expands the population that will be eligible for medicaid coverage and private insurance, those provisions do not take effect until 2014, leaving many to an uncertain future and causing an increase in the number of uninsured persons in Hawaii's struggling economy.

     The legislature also finds that any change to the medicaid program will disproportionately affect community health centers because of their patient demographics.  Twenty-seven per cent of patients at community health centers, or thirty five thousand consumers, are currently uninsured.  In addition, eighty-five per cent of community health center patients have incomes below two hundred per cent of the federal poverty level, and approximately half of the total patients seen by community health centers are current medicaid enrollees.  The vast majority of newly uninsured health care consumers who will be cut from the QUEST program will either turn to community health centers for their care or seek out emergency department care, which reports show to be seven times more costly to the State than providing basic coverage.  Community health centers are also being increasingly utilized, as seen in the case of Massachusetts; though that State passed landmark legislation in 2006 to make health care required and more accessible.  Between 2005 and 2007, Massachusetts' community health centers saw the total number of patients served increase by fifty thousand individuals.

     Community health centers serve uninsured, low-income patient populations with demographic complexities and co-morbidities, medicaid members, the homeless, and privately insured individuals and families.  Specifically, characteristics of community health centers include the following:

     (1)  Are nonprofit, community-based organizations whose purpose and expertise lie in providing quality, person-centered health care to underserved populations and regions;

     (2)  Provide culturally and linguistically appropriate health care and a broad range of primary care and preventive services;

     (3)  Are located in medically underserved areas where people have limited access to other health care providers because of geographic and socio-economic barriers;

     (4)  Contribute greatly to the economies and livability of the communities they serve; and

     (5)  Are cost-effective providers whose care results in healthier patients and decreased use of emergency, specialty, and in-patient services.

     With less unnecessary emergency room, in-patient, and specialty utilization, community health centers save the health care system $1,262 per year per patient.  That means that in 2009, community health centers in Hawaii saved the State more than $160 million, which was even more than the $128 million saved in 2008.  Thus, the legislature also finds that community health centers are a smart investment that results in healthier communities while saving the State money.

     The purpose of this Act is to provide funding for quality, cost-effective health care through community health centers for Hawaii residents who are uninsured.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $           or so much thereof as may be necessary for fiscal year 2012-2013 to community health centers for the provision of direct health care for the uninsured, which may include primary medical, dental, and behavioral health care; provided that the distribution of funds may be on a "per visit" basis, and may include a per member, per month quality incentive payment, taking into consideration the need on all islands.

     The sum appropriated shall be expended by the department of health for the purposes of this Act.

     SECTION 3.  This Act shall take effect on July 1, 2012.








Report Title:

Health Care; Funding for the Uninsured; Community Health Centers; Appropriation



Appropriates moneys to community health centers for the provision of direct health care for the uninsured, including those who will be disenrolled from the medicaid QUEST program pending eligibility changes in April 2012.




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