Hawaii Launches Bold Plan to Fix Its $3.2B Long-Term Care Crisis

Hawaii is taking steps to tackle the rising cost of long-term care, which now exceeds $3.2 billion annually. A new advisory commission will explore ways to fund and reform home and community-based services, aiming to ease the financial burden on families. The move follows years of stalled efforts to address unaffordable care expenses across the state.

Legislators have introduced House Bill 1804 and Senate Bill 2554 to create an independent Long-Term Care Financing Advisory Commission. This group will review financial assessments, policy reforms, and public engagement strategies for long-term support services (LTSS). Their goal is to propose fair, progressive financing methods to replace the current system, which often relies on regressive payments.

The need for action is urgent. Over half of working families in Hawaii earning between £25,000 and £125,000 a year cannot afford LTSS costs or car insurance. A year in a skilled nursing home now tops £230,000, while comparable at-home care can be even more expensive. Currently, 75% of the state's £3.2 billion annual LTSS bill is covered by unpaid family caregivers.

Hawaii hopes to follow states like Washington, which has implemented a payroll-funded social insurance model for long-term care. Other states, including Massachusetts, Minnesota, and New York, rely on a mix of marketplace, private insurance incentives, and state-specific programs. The commission will study these models and submit legislative proposals within three years.

The new commission marks a shift after decades of inaction on long-term care funding. If successful, Hawaii could become one of the few states with a dedicated public insurance program for LTSS. The outcome will determine how families access and afford care in the years ahead.