Hawaii’s Title V program and staff utilize a collaborative approach to leverage federal and state resources to assure healthcare services delivery capacity in the state. Hawaii partners with many public and private entities to promote optimal health and contributes to the building of the healthcare system. FHSD works at all levels of service (direct, enabling, and infrastructure building) to assure healthcare service delivery statewide.

FHSD assures a statewide system of care through provision of safety-net and gap-filling community-based services through purchase of serve contracts or subsidies.

Perinatal Support Services Program (PSS) provides support services and resources for high-risk pregnant women. The goal for the Perinatal Support Services Program is to promote health education, best practices, and increase the likelihood of positive birth outcomes. The objectives of the program include increasing early prenatal care; decreasing incidence of preterm, low, and very low birth infants; and improving the health of the participants. This program provides services for pregnant women before, during, and after pregnancy (up to six months after birth). These contracts will end July 1, 2021 and will be replaced with new RFP for State Reproductive Health Care and Support Services that combines state matching funds for Hawaii’s former Title X family Planning program and PPS funding.

Hospital Subsidies are supported by state general funds and administered by FHSD to the following entities.

• Hana Urgent Care - In partnership with American Medical Response and Maui Memorial Medical Center, Hāna Health provides urgent medical care around the clock. As the only medical provider in the district, Hāna Health physicians are on-call 24 hours a day, 7 days a week, 365 days a year.
• Waianae Coast Emergency Services - the Health Center's Emergency Department has operated at its main site in Waianae since 1975 and has provided 24-hour emergency services since 1986. Recognized as a Trauma Support Facility by the state of Hawaii, it serves as a critical safety net for the residents of the Leeward coast. For the period July 1, 2016 – June 30, 2017, the ED registered 24,687 patients of which 89% were residents of the Waianae Coast.
• Wahiawa General Hospital is a community-owned, nonprofit hospital serving Wahiawa and the communities of Central Oahu and the North Shore. It is the community’s most comprehensive healthcare facility.
• Molokai General Hospital, a member of The Queen’s Health Systems family of companies, is the only hospital on the island of Molokai, providing 24/7 care for the island’s 7,500 residents and visitors. Services include a blood banking laboratory, digital CT, digital x-ray, digital mammography, outpatient chemotherapy, acute care, skilled nursing physical therapy, and a full-service midwifery program.

Community Health Centers - Funded by the Community Health Center Special Fund for contractual services to improve access to healthcare for medically underserved populations through Federally Qualified Health Centers (FQHC). The array of services includes primary care, mental health care, dental health care, and pharmacy. The core mission of FQHCs is to provide access to primary care services for the most vulnerable populations, regardless of the ability to pay. These services are sometimes known as safety net services and are provided to uninsured and underinsured individuals at or below 250% of the federal poverty level. Access to primary health services reduces morbidity and mortality by providing timely, appropriate, and less expensive care, and thereby preventing the development and exacerbation of serious health conditions.

FHSD’s Office of Primary Care and Rural Health assure a statewide system of care and supporting workforce needs.

• State Primary Care Office (PCO): Funded by the federal Bureau of Health Workforce to designate statewide health professional shortage areas that increase eligibility of skilled healthcare professionals for federal and state scholarships and loan repayments in exchange for a commitment to work in needy communities. This makes it possible for healthcare providers to recruit and retain health professionals, thereby improving the health of underserved and vulnerable populations.
• State Office of Rural Health (SORH): Funded by the federal Office of Rural Health Policy to create a focal point for rural health issues within each state, linking communities with state, federal, and nonprofit resources and helping to find long-term solutions. Program goals include educating providers about new healthcare initiatives, collecting and disseminating data and resources, and supporting workforce recruitment and retention.
• Medicare Rural Hospital Flexibility Program (FLEX): Funded by the federal Office of Rural Health Policy for strategic planning activities with an emphasis on quality and financial and operational improvements for Hawaii’s Critical Access Hospitals (CAH). This assists small rural hospitals to improve access to health services in rural communities via data tracking, analysis, and benchmarking toward quality improvement. Contracts for rural hospitals provide essential access to inpatient, outpatient, and emergency medical services in rural communities.

In a 2021 survey of Title V program managers, a majority of direct service managers reported modifying service contracts during pandemic primarily to allow for greater flexibility in spending for personal protection equipment (PPE), workplace safety and personnel costs and allowing for billing of telehealth/remote services.

Developing critical statewide partnerships and system-building efforts. At the leadership level and serving on commissions and boards, Title V staff participate in efforts to meet the needs of women and children.

• The Early Learning Board (ELB) is tasked with formulating statewide policy relating to early learning and is responsible for directing the Executive Office on Early Learning (EOEL) on how to best meet the developmental and educational needs of children from prenatal care to entry into kindergarten. Title V Project Director, Matthew Shim, serves on the as an ex officio member
• Hawaii Early Intervention Coordinating Council advises the Early Intervention Section and is established as required by state law and Part C of the Individuals with Disabilities Education Act. This council is responsible for helping to develop the programs and services and system for children with special needs in partnership with families.
• The Hawaii Maternal Infant Health Collaborative is a public-private partnership committed to improving birth outcomes and reducing infant mortality. Hawaii’s Maternal and Child Health Branch staff sit on the Steering Committee and chair workgroups.

Improving quality to assure services are family-centered, culturally relevant, and community-based (contract monitoring, program evaluation).

• Hawaii’s Home Visiting Program promotes the use of evidence-based home visiting programs through the Maternal Infant Early Childhood Home Visiting (MIECHV) model, manages contracts, and ensures programs maintain fidelity to their model and meet benchmarks set by MIECHV. Currently, there are six contractors who provide services statewide.
• Early Intervention Section provides services required by Individuals with Disabilities Education Act Part C through a mix of EIS programs and contracted providers and ensures their services are family-centered and community-based, which are tenets of IDEA. Currently, there are four state-run programs and 15 contracted agencies. As part of federal reporting, contractors can see all the data across programs and indicators.

Assuring development/dissemination of public health messaging.

• The Hawaii Childhood Lead Poisoning Prevention Program developed a variety of materials for parents, providers, and community members. Many of these materials are in 12 different languages.
• Hawaii’s Adolescent Wellness Program staff networks with public and private groups, community organizations, and youth to provide training and technical assistance relating to adolescent health and wellness, recently supporting TeenLink Hawaii to develop a website resource for teens with social media and videos to support teens, parents, and providers.