Hawaii this summer is poised to roll out palliative care coverage via Medicaid.

In May, a State Plan Amendment (SPA) that allows coverage of palliative care through Med-QUEST, the state’s Medicaid program, was approved by the U.S. Centers for Medicare & Medicaid Services (CMS). While more than 15 states have established Medicaid palliative programs, Hawaii is the first to request and receive SPA approval through Medicaid’s process for adding new benefits.

The CMS-approved policy document adds community-based palliative care as a preventive service. It defines palliative care and the required services, details the composition of the palliative care team, establishes a payment methodology and sets quality reporting standards, according to a statement by the Office of Hawaii.

“The implications are huge,” Jeannette Koijane, executive director of Kōkua Mau, a coalition of supporters from hospitals, education, consumers, insurance, long-term care and hospices dedicated to improving care for people with serious illness, told Palliative Care News. “As an organization, we are really excited and we see that a change like this could make palliative care services available to the Medicaid population that has not had access to them before.”

The push for palliative care

According to Koijane, the SPA is the result of collaboration and community involvement over the last 10 years.

“[Hawaii] is a small place, so everybody knows each other. At various times, there has been leadership that stood up to help advance palliative care,” Koijane said. “This benefit was in no means created in a vacuum.” 

A decade ago, Koijane said Kōkua Mau visited HMSA, an independent licensee of the Blue Cross and Blue Shield Association, to talk to their leadership about a different issue and ended up discussing the development of a palliative care benefit instead.

HMSA then began a pilot program called Supportive Care, which is a 90-day benefit for people who are at the end of their life. It worked like a hospice but was limited, Koijane said.

HMSA also built upon another plan, started by a smaller company called UHA Health Insurance, to create Concurrent Care, which is essentially palliative care, Koijane said.

“Those two agencies, the private company and this huge HMSA, started the ball rolling,” Koijane said.

The ball continued to roll. Koijane said many people have played a crucial part in the development of the SPA, especially Judy Moore Peterson, Med-QUEST division administrator for the State of Hawaii’s Department of Human Services (DHS); Joy Soares, policy analyst, Med-QUEST Division, Hawaii Department of Human Services; and Torrie Fields, founder and CEO of TFAnalytics, a total cost of care and population health management company.

Kōkua Mau has continually supported Med-QUEST’s efforts throughout the process, including hosting two online virtual palliative care conferences designed to inform the community and gather valuable feedback about what was needed in the program.

“We helped set up a whole bunch of focus groups so they could get feedback from providers, from the hospices, from kids, from people that do pediatric palliative care,” Koijane said. “And we are part of the group sounding board.”

Kōkua Mau also created a Palliative Care Awareness Committee to better understand palliative care in Hawaii and how to educate both providers and the public. The organization has provided resources for professionals such as the Referral Toolkit for Providers, and its website now directs users to Hawaiian locations where palliative care is being offered, along with information on inpatient, outpatient and community-based programs that currently exist.

“We’ve tried to create better pages for families and patients that are more interactive and help them to be more comfortable with palliative care,” Koijane said. 

Now that the SPA is approved, Kōkua Mau will work with Med-QUEST to put on a webinar series to explain the benefit to providers and the public.

Stand by for take-off

Before that can happen however, Kōkua Mau and other care organizations are waiting for clarity about the palliative care benefit from Med-QUEST, which will come in a memo this August.

“Hawaii has a managed care situation for Med-QUEST members, so there’s five health plans that provide care to Medicaid members. What will happen is that Med-QUEST will send a memo to them that outlines the benefit and how it’s going to work,” Koijane said.

Once the memo is distributed, Koijane expects a question-and-answer period will follow.

In the meantime, Koijane is hopeful about the impact this new palliative care benefit will have. Not only is the CMS approved plan a vital step toward establishing a statewide mandate for managed care organizations and insurers in Hawaii to offer palliative benefits, but it may also be a road map for other states to explore new ways to pay for interdisciplinary, community-based palliative care.

“I think that we’re honored and a little scared about what’s coming. But people want to get going. The agencies that currently provide palliative care are really excited,” Koijane said. “We’ll see how it’s structured and if other entities, like federally qualified health centers or hospitals with strong outpatient care, will be taking it on.”

With the SPA changes about to take effect, Kōkua Mau is currently thinking about how to best message palliative care, and ensure they can reach both providers and the Med-QUEST population about the new benefit.

“Palliative care is crucial.” Koijane said. “We feel that this is very much our responsibility, our Kuleana, to make this work.”