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Maui Medicaid patients deserve access to same health plans as Oahu patients

Viewpoint

The COVID-19 pandemic has highlighted the importance of accessible health care. However, many beneficiaries of Hawaii’s Medicaid QUEST Integration system — kupuna, people with low incomes, children, pregnant women and individuals who are disabled — are at risk of having their insurance options and access to health care limited by a dangerous administrative decision.

The Department of Human Services decided earlier this year to limit the number of plans providing QUEST Integration insurance on the Neighbor Islands. DHS selected HMSA and UnitedHealthcare as the only two health plans able to offer QUEST insurance on Neighbor Islands, which had previously been served by five plans.

Under the current decision, Oahu QUEST beneficiaries would have access to four health care plans. Does DHS value the health and lives of all the people of Hawaii or just those living on Oahu?

Eliminating AlohaCare and Kaiser Permanente leaves a gaping hole in our health care system and puts a huge strain on our provider networks, which are already stretched to their limits due to a physician shortage. This decision could force 50,000 QUEST beneficiaries to change their insurance plans, and there’s no way all these patients will be able to smoothly transition plans all at the same time. There are bound to be lapses in coverage and for many patients with preexisting conditions, any delay in care could be detrimental to their health.

The Maui County Council has recognized that this decision will cause a massive disruption for patients, health care providers, community health centers and others within the health system. On March 13, the council passed a resolution urging Gov. David Ige to delay the implementation of this decision. The Hawaii island County Council saw fit to do the same.

The decision has been put on hold indefinitely. This measure of uncertainty is one we cannot allow to continue. Our patients deserve to be informed about the future of their health care options.

I have personally witnessed the difficulties that our patients have faced, and the lengths they have had to go through, to access specialty care as members of a rural community. In January, we had a Medicaid patient who was in danger of losing the use of his finger and urgently needed an orthopedic surgeon. We couldn’t find any specialists on Maui who accepted the patient’s health plan and were available to do emergency surgery. The patient had to be flown to the Big Island for care, but the health plan did not respond to requests for travel approval. The patient ended up paying for the emergency travel out of pocket.

The patient’s health plan was one of the two plans that were awarded statewide contracts. Meanwhile, AlohaCare and Kaiser Permanente, two plans that we are in danger of losing on Maui, together have the most robust provider network in the Neighbor Islands. If they are not allowed to continue providing coverage on Maui, we anticipate many more patients will go through what our patient experienced. They will be forced to change to health plans that have smaller provider networks. They will have fewer choices of providers and will likely need to leave Maui for specialty care or go to doctors that are out of their network. If that happens, they may be forced to foot the bill for their costs — and most Medicaid patients don’t have the financial resources to do that.

No one should have to choose between life-saving care and financial ruin, but I worry that is exactly the kind of situation more Neighbor Island residents will face with the current DHS decision.

Council members and state lawmakers have heard our concerns and stepped up to put pressure on Ige and DHS to reevaluate the Medicaid contracts. It is time for DHS to take a step back and reconsider its decision, taking into account all the ramifications of offering fewer plans to Neighbor Island residents. We must do everything we can to protect the health of all of Medicaid beneficiaries, no matter what island they live on.

* Cheryl Vasconcellos is executive director of Hana Health, where she has been working for over 20 years.

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