Gov. Josh Green is seeking $50 million for the expansion of Hilo Medical Center’s Intensive Care Unit and Medical Surgical Unit.
Green, a physician, unveiled the proposal Monday in a press conference to announce the submission of his executive budget for the fiscal biennium to the Legislature. The proposed general funds budget is $19.4 billion — $9.8 billion for fiscal year 2024 and $9.6 billion for fiscal year 2025.
Total requests for capital improvement projects amount to $2.1 billion in fiscal year 2024 and $1.4 billion in fiscal year 2025. That includes $620 million in general funds and $820.8 million in general obligation bond funds.
“We need to take a multipronged and holistic approach to address our health care worker shortage and access to high-quality care,” said Green, who noted a shortage of about 600 doctors and 700 nurses statewide. “Therefore, in this budget, I included expanding Hilo Medical Center, improving health care access to low-income families by increasing the Medicaid reimbursement rate, and providing educational programs to expand our ability to train and retain high quality medical professionals in our state.”
The number of admitted patients at HMC runs routinely at 30% over capacity. Plans for the hospital’s ICU expansion to 18 beds are complete, but funding fell through during the last legislative session.
“Gov. Green’s leadership in identifying our ICU and hospital bed expansion project among his priorities in his budget is key in helping us establish the importance of our project for the health care of our neighbor island communities,” said Dan Brinkman, HMC’s CEO. “Emergency Department holds are unfortunately routine as patients wait for beds to open up in the hospital. These waits … are in spite of the addition of temporary emergency beds located within our long-term care facility, where patients are four to a room.”
According to Green, the disappearance of an air ambulance en route to the Big Island from Maui over the weekend highlights the need for the expansion of Hilo’s 166-bed hospital.
“There’s a lot of elderly individuals who live in Hilo. The largest part of the (Big Island’s) population lives there,” he said. “… If we do a good job with Hilo’s hospital and improve it — and, of course, in time, Maui Memorial and so on — we won’t need to transfer 12 to 15 people a day (via air ambulances). Hopefully, only one or two will need to be transferred.”
Green said each air ambulance patient transfer to Oahu costs $25,000 to $35,000.
“So, solve the problem (and) you won’t have to pay for it again on the back end,” he said.
Green also included a few high-priority requests related to health care and homelessness. They include $15 million in each fiscal year for the ‘Ohana Zones Pilot Program — which served over 5,510 previously homeless individuals and has placed 1,368 people into permanent housing — and $10.8 million in each fiscal year for homeless services and outreach programs including the Rapid Re-Housing and Housing First programs.
“This is a newfound commitment to seriously addressing the homeless crisis,” Green said. “The good news is that the federal government’s finally catching on. People laughed years ago when I said ‘housing is health care.’ Now, they’re paying for services directly out of the Medicaid budget for these kinds of things
“People who are without a roof over their head, they die three decades sooner. … They go into the hospital constantly. They cost hundreds of millions of dollars to our health care system.”
High-priority items related to health care and homelessness in this budget include:
• $10 million in FY24 and $20 million in FY25 for the Hawaii State Loan Repayment Program. This program pays off educational loans for primary care and behavioral health providers who care for patients in designated shortage areas in the state.
• Over 60 positions and $4.4 million for nursing and medical-related programs across University of Hawaii campuses and community colleges.
• $5 million in FY24 and $10 million in FY25 for Medicaid provider payments to encourage expanded access to high-quality health care and improve health outcomes for low-income families and individuals.
In addition, Green announced the release of almost $50 million in grants to nonprofit organizations. The grants were previously delayed, and Green worked with the attorney general’s office and the Department of Budget and Finance to prioritize their release.
“We know that these nonprofits are relying on these funds to serve our most vulnerable in the community,” Green said. “What better time than the holiday season to give relief and much-needed support to these community partners?”
Green also included $500 million in this budget for the Rainy Day Fund.
“It’s critical that we do this so we don’t have to cut services if or when times get tough in the coming years,” he said. “That’ll take us to $1.5 billion total, in case we have significant concerns in the coming months or years.”
Green said his administration continues to review departmental budget requests that haven’t yet been vetted for inclusion in the budget and intends to send additional budget requests to the Legislature during the 2023 session, which begins next month.
“This is only the beginning,” he said. “… We know there is a lot of need in the state, and we are going to address it.”
Email John Burnett at jburnett@hawaiitribune-herald.com.
