Hawaii's CMS-Approved Community-Based Palliative Care Benefit: A Model for State Medicaid Innovation.

Abstract

Hawaii implemented a statewide Community Palliative Care benefit in 2025 under its Section 1115 Medicaid Demonstration waiver to expand access to interdisciplinary palliative care for Medicaid beneficiaries with serious illnesses. This policy analysis synthesizes federal and state policy documents, implementation guidance, and relevant literature to describe the development, operational design, and implementation strategy of the benefit. The benefit establishes standardized eligibility criteria, interdisciplinary staffing expectations, unified documentation standards, and a blended reimbursement model. Development incorporated extensive stakeholder engagement, including clinicians, managed care organizations, hospice programs, and community organizations. Hawaii's model provides a structured statewide framework for Medicaid-covered community-based palliative care and offers lessons for other states seeking to expand access to serious illness care.