Requires the Executive Office on Aging to develop the framework and scope of work for a proposed study that examines the feasibility, impacts, and costs of different public and private financing options for long-term car, the official text

HOUSE OF REPRESENTATIVES

H.B. NO.

1804

THIRTY-THIRD LEGISLATURE, 2026

H.D. 1

STATE OF HAWAII

S.D. 2

C.D. 1

A BILL FOR AN ACT

RELATING TO LONG-TERM CARE FINANCING.

BE IT
ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION
1.  The legislature finds that Hawaii's senior
population has been growing faster than the national average.  Without a sustainable financing framework for
long-term care, the majority of Hawaii's families will be forced to shoulder
increasingly unsustainable financial burdens.
According to a 2025 report by the kupuna advisory council's long-term
care financing permitted interaction group, the average per-person annual cost
for long‑term support services ranges from approximately $45,500 in a
community care foster family home to more than $200,000 in a skilled nursing
facility, which is already prohibitively expensive for many Hawaii families.  The State must find a way to address long-term
care costs and ensure that long-term care services remain equitable and
available to all of Hawaii's residents.
Accordingly, the legislature believes that it is necessary to obtain a
comprehensive, data‑driven evaluation of feasible financing strategies
for long-term care.

The
legislature also finds that creating a successful long‑term care program
is complicated due to the fragmented nature of the long-term care system; the
multitude of providers and payors; the State's chronic shortage of caregivers;
the high costs of private insurance; and the inherent difficulty in predicting the
extent, duration, and timing of an individual's long-term care needs.  To address these issues, the State must
consider a variety of financing models; examine potential reforms of home- and
community-based services; and implement cost containment strategies that manage
expenditures while improving the quality of care.

However,
the legislature recognizes that it will first be necessary to carefully develop
a framework and scope of work for a thoughtful study of these complex
issues.  To allow for effective planning,
the State must also create a realistic timeline and list of proposed next
actions for selecting and implementing a future long-term care services
financing program.  The legislature
believes that these steps are essential for understanding the impacts of a
future long-term care services financing program and will provide valuable
information necessary for policymakers to select the model or framework of
financing that will work best for Hawaii's residents.

The
legislature further finds that these issues should be addressed by an agency
that has specific experience with and expertise in the unique issues that the
State's kupuna face.  The legislature
notes that statewide planning and oversight functions over kupuna affairs
statutorily reside with the executive office on aging.  Specifically, section 349-3, Hawaii Revised
Statutes, designates the executive office on aging as the "principal
office in state government solely responsible for the performance, development,
and control of programs, policies, and activities on behalf of elders[.]"  Similarly, section 349‑7, Hawaii
Revised Statutes, designates the executive office on aging as "the single
state agency responsible for programs affecting senior citizens of this
State[.]"

Accordingly,
the purpose of this Act is to lay the groundwork for the establishment of a
long-term care financing program by:

(1)  Requiring the executive office on aging to
develop a framework and scope of work for a proposed study that examines the
feasibility, impacts, and costs of different public and private financing
options for long-term care services and supports;

(2)  Authorizing the executive office on aging to
contract with the university of Hawaii to develop the framework and scope of
study; and

(3)  Appropriating funds to the executive office on
aging for these purposes.

SECTION
2.  (a)
The executive office on aging shall develop a framework and scope of
work for a study that:

(1)  Examines the feasibility, impacts, and costs
of different public and private financing options for long-term care services
and supports, including options to pay for those long-term care services and
supports; and

(2)  Determines which long-term care financing
mechanisms have objective, evidence-based merit.

(b)  At a minimum, the framework and scope of work
shall require that the study include:

(1)  Objective, evidence‑based assessments of
each financing option's feasibility, costs, reliability, long-range solvency,
benefits and impacts, and impacts on the populations served, including
assessments of:

(A)  Alternative public and private options and
financing mechanisms for providing long-term care services and supports for
persons who have functional limitations or chronic illnesses and who require
assistance to perform the necessary and routine activities of daily living;

(B)  Options for controlling the cost of services
by funding proactive measures, including efforts to mitigate an individual's
likelihood of needing long‑term care services and limit the scope of
services needed; and

(C)  The benefits of implementing home- and
community‑based reform measures for health care and other supportive
services to provide care to eligible persons in their home or other community
settings, rather than in institutional settings; and

(2)  Recommendations for the most economically
viable option for establishing a long-term care financing program, including a
proposed plan, timeline, and any subsequent steps necessary to implement the
program.

(c)  No later than twenty days prior to the
convening of the regular session of 2027, the executive office on aging shall
submit a report to the legislature that includes:

(1)  The framework and scope of work developed
pursuant to subsections (a) and (b);

(2)  The estimated cost to procure the proposed
study;

(3)  Recommendations for any subsequent actions
necessary to conduct the proposed study and to select and implement a long-term
care services financing program;

(4)  Proposed legislation, including necessary
funding, to procure the proposed study; and

(5)  Any other findings and recommendations,
including any other proposed legislation.

SECTION
3.  The executive office on aging may contract
with the university of Hawaii to perform the activities required by section 2
of this Act.  Any services contracted
under this section shall be exempt from chapter 103D, Hawaii Revised Statutes.

SECTION
4.  There is appropriated out of the
general revenues of the State of Hawaii the sum of $100,000 or so much thereof
as may be necessary for fiscal year 2026-2027 for the executive office on aging
to carry out the purposes of this Act, including contracting with the
university of Hawaii.

The sum
appropriated shall be expended by the executive office on aging for the purpose
of this Act.

SECTION 5.  This Act shall take effect on July 1, 2026.