Hawaii

Hawai‘i was awarded RHTP funding to support the AHEAD model for rural healthcare transformation. The budget for 2026 is approximately $12 million, fully funded by CMS/HHS. The program focuses on enabling rural providers to succeed under value-based payment models with support for innovations such as quality reporting and practice transformation coaching.

Hawai‘i received $189 million per year over five years from CMS/HHS to support rural health transformation through multiple targeted initiatives. The state is in the pre-implementation and planning phase, coordinating closely with various partners to enable rural providers' success in value-based care models.

Hawai‘i's AHEAD initiative is a comprehensive state strategy to align payment reform for primary care across Medicare, Medicaid, and commercial payers, leveraging upfront investment and global budgets. The model includes enhanced payments for rural health providers, performance-based quality measures, and technical assistance for practices. Implementation is staged, with Medicaid primary care reform required by 2027 to avoid federal award termination.

This guidance document provides detailed financial and operational specifications for the AHEAD Model Hospital Global Budget. The AHEAD Model is a voluntary, state-based alternative payment model focusing on global hospital budgets, population health, and cost growth control. Rural hospitals, including CAHs and REHs, are key participants and receive payment methodology adjustments.

Hawaii received a $12M federal award to implement AHEAD program initiatives through 2029. State-level requirements include new Medicaid policies, expanded telehealth, and workforce reforms. Cooperative agreement performance milestones are defined for policy selection, enactment, and implementation.

The Steering Committee will guide planning and implementation of Hawaii's statewide AHEAD and hospital/primary care payment transformation, starting in 2025. Strategic priorities include developing health equity and quality targets, Medicaid/global hospital budgets, and advancing population health and cost management. Committee members represent a diverse cross-section of stakeholders and will meet monthly to plan and provide input.

This document outlines the design priorities and standards for the Hawai`i AHEAD Medicaid Advanced Primary Care Payment Model (APM) framework. It reviews requirements for medical home models, care coordination, health promotion, behavioral health integration, specialty care, and payment approaches for the Medicaid population. The framework emphasizes alignment with hospital global budgets, operational simplicity, and improving population health through primary care transformation. Event schedule: - Framework Discussion Meeting - 03/25/2026 - HT

This document summarizes changes from version 2.0 to 3.0 of the AHEAD Medicare Hospital Global Budget payment methodology for Hawaii. It discusses revisions to baseline calculations, hospital payments, social risk adjustment, and incentives. The summary primarily illustrates anticipated impacts for rural and critical access hospitals under the new 2025 CMS methodology.

This report provides an actuarial overview of Hawaii's proposed participation in the AHEAD Hospital Global Budget Model, summarizing trends in Medicare/Medicaid revenue, operational margins, and hospital quality measures. It analyzes required participation scenarios to meet AHEAD's benchmarks, including both CAH and non-CAH facilities. Hawaii’s hospitals show good quality and increasing Medicaid revenue, but CAHs and some systems demonstrate concerning margin trends.

This CMS summary reviews FY26 RHTP state applications, outlines state-level proposed funding and core initiatives. States prioritize digital health, rural workforce, chronic and maternal care transformation, and value-based care. Common strategies include telehealth, mobile clinics, regional hubs, and cross-sectoral partnerships to address access and outcomes.

This strategy document outlines a Medicaid Primary Care Advanced Payment Model (APM) intended to strengthen primary care, improve quality, and align payment with outcomes for rural and underserved populations in Hawaii. It includes analysis of current Medicaid utilization, payment attribution models, tiered participation requirements, and behavioral health integration. No explicit award or fiscal amounts are detailed.

The Hawai‘i AHEAD Primary Care Working Group is advancing stakeholder engagement and developing methodologies for improving primary care quality and cost management. The project has a strong timeline through 2027 with landmark submissions and contract executions to support implementation and recruitment.

Hawaii's Med-QUEST Division plans a transition to mandatory Medicaid Hospital Global Budgets, aligning incentives between hospitals and primary care through Pay-for-Performance and global budget payments. The total estimated statewide payments for 2025 are $1.1B, with $100M allocated for quality improvement P4P. Historical modeling shows most hospitals benefit from the new approach, especially during high trend years.

Hawai‘i AHEAD continues active engagement with stakeholders to develop the Hospital Global Budget and primary care methodologies. The program is supported by a $12 million CMS award and includes milestones through 2025 leading to a performance year starting in 2027. Collaborative efforts involve key partners such as Healthcare Association of Hawai‘i and the Hawai‘i Primary Care Association.

Kula Hospital is proposing an expansion to achieve CAH status by adding emergency services and reconfiguring beds. The project is locally debt-financed with no explicit federal subaward cited, but is designed to qualify for future cost-based Medicare (and potentially Medicaid) reimbursement. This will improve financial viability and enable better urgent care access for the rural Maui community.

The page currently has limited information on the RHTP program but provides contact details for the agency managing rural health efforts. No detailed program or strategy information is yet posted, with updates expected soon.

This document outlines Hawai‘i’s approach to Medicaid Hospital Global Budgets as part of AHEAD transformation planning. Key strategies include shifting funding from utilization-based to value-based payments, considering prospective, virtual, and hybrid global budget methodologies, and aligning Medicaid reforms with Medicare AHEAD policies and multi-payer quality measures. No specific awardees or executed contracts are announced; funding projections are presented at an aggregate/statewide level.

Agenda for the Hawai’i AHEAD Steering Committee meeting, including a presentation on the Rural Health Transformation Program and general updates. No specific funding or award details provided.

Hawai‘i has received a $12 million award from CMS to support the AHEAD model for rural health transformation, including hospital global budgets and advance primary care programs commencing in 2028-2029. The program focuses on improving rural health payment models and care delivery innovation.

The program addresses healthcare disparities for the 40.8% of Hawaiʻi’s population living in rural areas by investing in a statewide digital health network, telehealth, emergency services, workforce development, medical respite centers, and value-based care innovation. The award is notable for being among the highest per capita and per rural resident due to the program’s quality despite lower data-driven metrics.