SB2227 HD1.DOC

PART I

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 mandatory 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 $160,000,000, which was even more than the $128,000,000 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 part 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 part.

PART II

SECTION 3. The legislature finds that the national and global economic crisis that began in the second half of 2008 has caused significant economic problems in numerous industries in the State, including the airline, cruise ship, tourist, and construction industries. Mass layoffs have been reported by an increasing number of Hawaii businesses statewide, from the agricultural sector to the medical-services sector. Difficult economic times and declining tax revenues have resulted in budget cuts for many state services.

The current and impending situation jeopardizes the safety net of basic health needs for Hawaii's residents and families. While all of Hawaii's residents will be affected by the situation, gap group families and families closest to the poverty line will suffer the most.

The purpose of this part is to appropriate moneys to maintain the levels of programs determined to be essential to public health.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $114,467 or so much thereof as may be necessary for fiscal year 2012-2013 for direct respite services.

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

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $3,000,000 or so much thereof as may be necessary for fiscal year 2012-2013 to supplement the cost of direct services of the healthy start program.

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

SECTION 6. There is appropriated out of the general revenues of the State of Hawaii the sum of $285,000 or so much thereof as may be necessary for fiscal year 2012-2013 to provide funding for grants pursuant to chapter 42F, Hawaii Revised Statutes, to provide direct services from the following:

(1) Catholic Charities Hawaii for the Lanakila

Multi-Purpose Senior Center $175,000

(2) Moiliili Community Center for the

Moiliili Senior Center Program $50,000

(3) Waikiki Community Center $60,000

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

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $4,800,000 or so much thereof as may be necessary for fiscal year 2012-2013 for the cost of direct services of the kupuna care program and meals for the elderly receiving kupuna care.

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

SECTION 8. There is appropriated out of the general revenues of the State of Hawaii the sum of $1,400,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the aging and disability resource center.

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

SECTION 9. There is appropriated out of the general revenues of the State of Hawaii the sum of $1,500,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the developmental disabilities medicaid waiver program.

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

SECTION 10. There is appropriated out of the general revenues of the State of Hawaii the sum of $1,500,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct adult mental health services.

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

SECTION 11. There is appropriated out of the general revenues of the State of Hawaii the sum of $150,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the partnerships in community living program.

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

SECTION 12. There is appropriated out of the general revenues of the State of Hawaii the sum of $1,400,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct substance abuse treatment and prevention services for adults and adolescents.

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

SECTION 13. There is appropriated out of the general revenues of the State of Hawaii the sum of $426,722 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the healthy aging partnership program.

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

SECTION 14. There is appropriated out of the general revenues of the State of Hawaii the sum of $332,000 or so much thereof as may be necessary for fiscal year 2012-2013 to provide funding for grants pursuant to chapter 42F, Hawaii Revised Statutes, to the Waianae District Comprehensive Health and Hospital Board, Inc., to support its direct emergency room services.

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

SECTION 15. There is appropriated out of the general revenues of the State of Hawaii the sum of $810,000 or so much thereof as may be necessary for fiscal year 2012-2013 to provide funding for grants pursuant to chapter 42F, Hawaii Revised Statutes, for direct HIV/AIDS related services and to be distributed as follows:

(1) Life Foundation $270,000

(2) Gregory House Programs $270,000

(3) Community Health Outreach Work to

Prevent AIDS $270,000

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

SECTION 16. There is appropriated out of the general revenues of the State of Hawaii the sum of $10,500,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct health care services for individuals who are uninsured and underinsured.

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

SECTION 17. 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:

(1) Increase direct adult and children's oral health services and prevention services;

(2) Increase public awareness of oral health through outreach and education programs; and

(3) Establish and implement an electronic system to track data on children's dental health.

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

SECTION 18. There is appropriated out of the general revenues of the State of Hawaii the sum of $500,000 or so much thereof as may be necessary for fiscal year 2012-2013 to provide funding for grants pursuant to chapter 42F, Hawaii Revised Statutes, to Kokua Kalihi Valley (Comprehensive Family Services) to provide direct services.

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

SECTION 19. There is appropriated out of the general revenues of the State of Hawaii the sum of $180,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services to pregnant women struggling with addiction.

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

SECTION 20. There is appropriated out of the general revenues of the State of Hawaii the sum of $699,557 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the baby S.A.F.E. (substance abuse free environment) program.

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

SECTION 21. There is appropriated out of the general revenues of the State of Hawaii the sum of $110,000 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services related to fetal alcohol spectrum disorders.

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

SECTION 22. There is appropriated out of the general revenues of the State of Hawaii the sum of $546,021 or so much thereof as may be necessary for fiscal year 2012-2013 for direct family planning services.

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

SECTION 23. There is appropriated out of the general revenues of the State of Hawaii the sum of $94,229 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by perinatal health programs.

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

SECTION 24. There is appropriated out of the general revenues of the State of Hawaii the sum of $436,596 or so much thereof as may be necessary for fiscal year 2012-2013 for direct services provided by the preschool developmental screening program.

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

SECTION 25. There is appropriated out of the general revenues of the State of Hawaii the sum of $75,000 or so much thereof as may be necessary for fiscal year 2012-2013 to provide funding for grants pursuant to chapter 42F, Hawaii Revised Statutes, to Planned Parenthood of Hawaii for statewide sexual health education.

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

SECTION 26. There is appropriated out of the general revenues of the State of Hawaii the sum of $35,000 or so much thereof as may be necessary for fiscal year 2012-2013 for the provision of training for trainers and others to prevent and address bullying and cyberbullying and to promote peaceful relations among students and others who are a part of a public or private school community.

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

PART III

SECTION 27. This Act shall take effect on July 1, 2012.

THE SENATE	S.B. NO.	2227
TWENTY-SIXTH LEGISLATURE, 2012		H.D. 1
STATE OF HAWAII