Hawaii Gov. David Ige signed a bill into law Thursday that’s expected to help married couples, under certain circumstances, pay out of their own pocket to live together in long-term care facilities that were designed for residents on Medicaid.

The Legislature unanimously passed House Bill 1396 in May after killing a similar measure in 2015 despite a strong lobbying effort about the care home industry.

The Department of Health had opposed the 2015 bill over concerns that it would displace low-income elderly residents who depend on the Medicaid beds provided by community care foster family homes. Those are two- and three-bedroom facilities that provide a nursing-home level of care, but in a residential rather than institutional setting.

Jonathan Hanks, front right, sits next to left, Noboru Kawamoto, a private-pay resident at his community care family foster home in Kaneohe. 13 feb 2015. .photograph Cory Lum/Civil Beat
Caregiver Jonathan Hanks, front right, sits next to Noboru Kawamoto, a private-pay resident at his community care family foster home in Kaneohe, during a legislative hearing in 2015. Cory Lum/Civil Beat

CCFFHs, as they are called in the industry, previously allowed a private-pay client only if the facility already had two other clients on Medicaid.

The new law gives the Department of Health the discretion to allow two clients to pay out of their own pocket if they are married or in a civil union. There also must already be a client living in the home who is on Medicaid.

“The Department believes that unique and rare circumstances should allow for unique considerations,” state health officials said in their written testimony in support of the bill this year.

The Department of Human Services, which manages the Medicaid program, supported the measure too but expressed some skepticism.

“DHS notes that with this change, there remains some potential of reduced CCFFH beds for Medicaid recipients, which, in certain communities, could result in individuals having to remain for longer periods of time in an acute hospital bed until a community-based bed becomes available, or going into a more costly nursing facility,” state human services officials wrote in their testimony to lawmakers.

“Nonetheless, we believe the bill provides for sufficient protections in order to mitigate this risk.”

The measure faced little-to-no opposition as it worked its way through the Legislature.

Barbara Service, a member of AARP, Kokua Council and other groups for the elderly, was among the few to oppose it. She said the reason CCFFHs prefer to take private-pay patients is obviously because they pay more than Medicaid.

Vice Speaker John Mizuno legislature action
Rep. John Mizuno, the bill’s primary introducer, fought a similar battle in 2015. Cory Lum/Civil Beat

Rep. John Mizuno, who has for years championed legislation that benefits the adult care industry, was thrilled that Ige signed the bill into law.

He said it will help Elaine and Noboru Kawamoto, who have been married for 69 years, live together again. They became separated after Noboru, paying out of his own pocket, moved into a community care foster family home. The law prevented his wife from joining him because that type of facility previously barred two private-pay clients.

In 2015, Mizuno said reuniting the Kawamotos would have displaced a Medicaid client at the home.

The new law says there must be a vacancy for at least six months and bars the operator from transferring out a client in order to accept someone willing to pay out of their own pocket. It also says the department, at its discretion, must determine that no other care facility in the area has an available opening that could provide a similar level of care for a private-pay couple.

Generally, elderly residents who do not rely on Medicaid and want to live in a home setting opt for an adult residential care home, which can accept several clients who pay privately for a similar level of care.

“I am elated for the Kawamoto couple and their family,” Mizuno said in a statement. “I always felt that a state regulation should not deny a couple married for 69 years nor any married couple the right to live with each other.”

He noted that it’s not the first time the Legislature has passed such a bill. In 2009, a bill became law to allow a different married couple, the Kaides, to live together in a community care foster family home while paying privately. But that law had a sunset date that lapsed.

“The reason we worked so hard on this bill, providing a number of changes from the Kaide bill was to ensure that our State will be able to secure federal Medicaid funding, which in 2015 was $1.3 billion and represented 54 percent of the entire federal budget for Hawaii,” Mizuno said.

“Therefore, we needed to ensure any exception or waiver to allow married and civil union couples who are both private pay patients can reside in the same CCFFH without jeopardizing billions of dollars in federal funding,” he said.

Mizuno said the bill Ige signed “strikes an excellent balance and is legally sound.”

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