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SB2087
THE SENATE
S.B. NO.
2087
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
relating
to health insurance
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
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The
legislature finds that access to preventive services, telehealth, and urgent
care improves health outcomes and helps in reducing long-term health care
costs.
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Portable coverage options,
including those that allow for employer contributions, support workforce
stability without imposing additional regulatory burdens for employers.
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Recent changes to Medicaid eligibility and
redetermination processes made at the federal level will cause a significant
number of residents of the State to lose their Medicaid health insurance
coverage.
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The legislature further finds
that many of those who will lose Medicaid coverage lack access to
employer-sponsored health insurance or other health insurance options during
periods of transition between health insurance plans.
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Furthermore, commercial health insurance
plans are often cost-prohibitive for individuals who experience temporary or
intermittent gaps in health insurance coverage.
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The legislature also finds that, due to
federal rule changes effective on January 1, 2026, low-premium bronze and
catastrophic health insurance plans, when paired with health savings accounts,
may offer an affordable and flexible coverage option for individuals who no
longer qualify for Medicaid but cannot afford comprehensive health plans.
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The legislature additionally finds that
targeted, time-limited interventions can help to prevent disruptions in care
while preserving the protections of the Prepaid Health Care Act for full-time
workers.
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Accordingly, the purpose of this Act is to:
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(1)
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Establish
a three-year health coverage continuity pilot program within the department of human
services, in consultation with the department of commerce and consumer affairs,
to assist individuals who have lost Medicaid health insurance coverage and lack
access to other health insurance options;
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(2)
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Authorize
the department of human services to contract with a nonprofit health insurer or
community-based organization to operate the pilot program, under certain
circumstances; and
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(3)
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Authorize
the department of human services to:
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(A)
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Issue
premium subsidies or vouchers; and
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(B)
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Accept
employer contributions, under certain circumstances.
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SECTION 2.
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(a)
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There shall be established a
three-year health coverage continuity pilot program to be administered by the
department of human services in consultation with the department of commerce
and consumer affairs.
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The purpose of the
pilot program shall be to provide health insurance coverage to individuals who
have lost medicaid coverage and do not qualify for employer-sponsored insurance
or federal premium subsidies under the Affordable Care Act or any successor
federal program to mirror 2026 federal rules allowing health savings accounts
to pair with bronze level or catastrophic health insurance plans.
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(b)
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The department shall:
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(1)
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Target
individuals who have lost medicaid coverage and do not qualify for
employer-sponsored health insurance or federal premium subsidies under the
Affordable Care Act or any successor federal program, including but not limited
to:
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(A)
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Seasonal
or agricultural workers;
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(B)
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Independent
contractors and freelancers;
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(C)
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Underemployed
adults; and
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(D)
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Community
college or university students without other health insurance coverage;
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(2)
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Establish
eligibility criteria and an application process for enrollment in the pilot
program; and
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(3)
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Provide
low premium bronze level or catastrophic health insurance plans approved by the
insurance commissioner; provided that the health plans:
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(A)
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Qualify
as high deductible health plans under federal law;
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(B)
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Allow
an individual to make tax-deductible contributions to a health savings account
in accordance with federal law; and
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(C)
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Provide coverage for preventive care health
visits, urgent care services, telehealth services, and generic prescription
drugs, including essential health benefits as defined under federal or state
law.
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(c)
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Direct payment agreements for routine primary care services between a
patient and a licensed provider:
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(1)
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Shall
not be considered insurance; and
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(2)
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May
be used in combination with coverage offered under this program, to the extent
permitted under federal health savings account rules.
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(d)
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The
department may contract with a nonprofit health insurer or community-based
organization to administer or operate the pilot program; provided that the
department shall allow the operator to access state-backed reinsurance or risk
stabilization support during the pilot program.
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The department shall promote collaboration between the operator of the
pilot program and local health systems, federally qualified health centers, and
safety-net providers in the State to implement the pilot program.
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(e)
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The
department may:
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(1)
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Issue
premium subsidies or vouchers to eligible individuals enrolled in the pilot
program; and
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(2)
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Accept
employer contributions for eligible individuals enrolled in the pilot program;
provided
that any subsidy, voucher, or contribution shall be portable and shall follow
the individual without imposing compliance or administrative obligations on the
State or an employer.
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(f)
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The
department shall use funding from general appropriations for the implementation
of the pilot program.
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The department
shall apply for any federal subsidies, matching funds, or waivers, including
but not limited to waivers under section 1332 of the Affordable Care Act, and
section 1115 of the Social Security Act of 1935, as applicable, to carry out
the pilot program.
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(g)
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The department shall adopt rules pursuant to chapter 91 necessary
for the purposes of the pilot program.
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(h)
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The
department shall submit a report to the legislature no later than twenty days
prior to the convening of the 2027, 2028, and 2029 regular sessions that
includes the following:
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(1)
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Enrollment
data;
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(2)
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Health
outcomes;
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(3)
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Fiscal
impact;
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(4)
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Program
sustainability; and
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(5)
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Proposed
legislation.
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(i)
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The pilot program shall cease to exist on June 30, 2029.
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(j)
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For the purpose of this Act:
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"Affordable Care Act" means the federal
Patient Protection and Affordable Care Act, public law 111-148, as amended.
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"Department" means the department
of human services.
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SECTION 3.
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This Act shall take effect upon its approval
and shall be repealed on June 30, 2029.
INTRODUCED BY:
_____________________________
Report Title:
DHS;
DCCA; Health Coverage Continuity Pilot Program; Bronze Level; Catastrophic
Plan; Subsidies; Waivers; Vouchers; Employer Contributions; Portability; Reports
Description:
Establishes a three-year Health Coverage Continuity Pilot
Program within the Department of Human Services, in consultation with the
Department of Commerce and Consumer Affairs, to assist individuals who have lost
Medicaid health insurance coverage and lack access to other health insurance
options.
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Authorizes the Department of
Human Services to contract with a nonprofit health insurer or community-based
organization to operate the Pilot Program; provided that the Department shall allow
the operator to access state-backed reinsurance or risk stabilization support
for the operator of the Pilot Program.
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Authorizes the Department of Human Services
to: (1) Issue premium subsidies or vouchers; and (2) Accept employer
contributions; provided that the benefit shall be portable and follow the
individual without imposing compliance or administrative obligations on the
State or an employer.
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Requires reports
to the Legislature.
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Repeals 6/30/2029.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.