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

Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusions:

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.