SB2285

SECTION 1. The legislature finds that complex patients – those with co-occurring substance use disorders, mental health disorders, and chronic physical conditions – represent a high-need, high-cost population that requires a modern, integrated care strategy. Yet these individuals frequently face adverse social determinants of health, including housing instability, food insecurity, early trauma, limited transportation, poverty, chronic stress, and limited social support. Systemic barriers, such as historical underinvestment, fragmented services, stigma, and limited provider incentives, further restrict access to high-quality integrated care, resulting in only a small percentage of complex patients receiving appropriate treatment.

Complex patients often cycle through fragmented, siloed health care systems that fail to produce meaningful outcomes while generating significant costs. This leads to frequent emergency room visits, repeated hospitalizations, justice system involvement, homelessness, and poor health outcomes, placing an outsized burden on social services, including medicaid and medicare. In many cases, jails and prisons become default providers of behavioral health services, and the lack of treatment contributes to higher rates of recidivism.

The legislature further finds that in Hawaii, approximately seventy-five thousand adults have co-occurring mental health and substance use disorders, with over fifty-four thousand experiencing chronic conditions. About twenty-one thousand adults in this population are diagnosed with severe mental illness, which is treated by the adult mental health division of the department of health. Many individuals remain untreated until their conditions become severe, which often results in chronic physical illnesses and triple diagnosis cases. Approximately 161,000 adults in the State have untreated substance use disorders, with roughly thirty-six per cent classified as complex patients.

In Hawaii, high health care costs are driven primarily by cardiovascular disease, diabetes, cancer, and asthma, with cardiovascular disease accounting for over eighteen thousand hospitalizations annually. The State also has above-average rates of methamphetamine and alcohol use, frequent polysubstance use, prescription drug misuse, and emerging fentanyl-laced methamphetamine risks, which highlights the urgent need for coordinated prevention and treatment efforts.

The legislature additionally finds that patients with overlapping behavioral and physical health conditions achieve better outcomes when treated simultaneously in integrated care models. Effective treatment combines medical, behavioral, and social supports in coordinated care plans delivered by multidisciplinary teams, including psychiatrists, physicians, nurses, counselors, case managers, and peer recovery staff. Residential and intensive outpatient programs that integrate substance use, mental health, and chronic disease care improve engagement, reduce fragmentation, lower relapse and hospitalization rates, and support long-term recovery and well-being.

The legislature believes that developing a statewide, evidence-based complex patient model is needed to close gaps in care, improve outcomes, reduce emergency and inpatient utilization, position Hawaii to compete for federal grants, and align medicaid and medicare funding to support integrated services.

The purpose of this Act is to establish a statewide integrated care initiative for adults with co-occurring substance use disorders, mental health disorders, and chronic physical health conditions by appropriating funds for the alcohol and drug abuse division of the department of health to contract with community-based organizations for a behavioral health complex patient model.

SECTION 2. (a) The alcohol and drug abuse division of the department of health may contract with community-based organizations for a behavioral health complex patient model.

(b) The department of health shall submit a report to the legislature no later than twenty days prior to the convening of the regular session of 2027. The report shall include but not be limited to:

(1) The manner in which funds appropriated pursuant to this Act have been expended;

(2) The service providers that have received funding pursuant to this Act;

(3) The number of persons served and a description of the services provided;

(4) Any measurable outcomes; and

(5) Any proposed legislation.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $3,000,000 or so much thereof as may be necessary for fiscal year 2026-2027 for the alcohol and drug abuse division of the department of health to contract with community-based organizations for a behavioral health complex patient model.

The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2026.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2285
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII