Honorable Robert Bunda

President of the Senate

Twenty-Second State Legislature

Regular Session of 2003

State of Hawaii

Sir:

Your Committees on Human Services and Health, to which was referred H.C.R. No. 203 entitled:

beg leave to report as follows:

The purpose of this measure is to provide additional resources for Hawaii's hospitals in caring for the uninsured by requesting the Departments of Human Services (DHS) and Health (DOH), with the assistance of Hawaii's congressional delegation, to restore the Disproportionate Share of Hospital payments for compensation for care provided to the uninsured.

Testimony in support of this measure was submitted by the Hawaii Government Employees Association (HGEA); the Healthcare Association of Hawaii; Hawaii Health Systems Corporation; and the Queen's Medical Center. The Blueprint for Change and Hawaii Psychiatric Medical Association supported this measure and proposed amendments. The Department of Human Services supported the intent of this measure.

Your Committees find that health care providers, who routinely and frequently provide care to thousands of uninsured patients annually in Hawaii, have suffered significant adverse impacts resulting from the elimination of the Disproportionate Share of Hospital (DSH) payments under the State's federally-approved Medicaid waiver. The federal Medicaid statute requires DSH payments unless a state obtains a waiver through a Section 1115 Demonstration Project, such as QUEST. Hawaii is one of four states (the other three being Arizona, Oregon, and Tennessee) that obtained such a waiver, resulting in the elimination of DSH payments in 1994. Since that time, Arizona, Oregon, and Tennessee have successfully obtained DSH or DSH-like payments, leaving Hawaii as the only state that does not receive DSH or DSH-like payments.

Your Committees further find that Hawaii's uninsured population has increased from just below 6% in 1995, to 10% in 2001. It is estimated that if Hawaii were still receiving DSH payments, the total DSH money Hawaii would have received in fiscal year 2002-2003 would be about $98 million.

Your Committees believe that immediate action is needed to aggressively advocate for the restoration of DSH (or DSH-like) payments for compensation for care provided to the uninsured by the federal Centers for Medicare and Medicaid Services (CMS).

Your Committees further find that access to appropriate mental health services is an important part of the safety net of programs for Hawaii's citizens that deserves further study.

Accordingly, your Committee has amended this measure by:

As affirmed by the records of votes of the members of your Committees on Human Services and Health that are attached to this report, your Committees concur with the intent and purpose of H.C.R. No. 203, as amended herein, and recommend its adoption in the form attached hereto as H.C.R. No. 203, S.D. 1.