HI HB1546

Establishes a three-year Health Coverage Continuity Pilot Program administered by the Department of Human Services to assist Hawaii residents who lose Medicaid coverage due to federal eligibility changes, including an estimated 35,000 undocumented immigrants losing coverage on October 1, 2026, and 30,000 enrollees subject to new 80-hour monthly work/community engagement requirements.

Provides two coverage options: enrollment in federally facilitated marketplace silver level plans with state subsidies covering the difference between plan costs and what individuals can afford for those qualifying for federal advanced premium tax credits, or a $1,000 annual preventive care subsidy for those with high-deductible plans who don't qualify for federal credits.

Targets specific populations including seasonal/agricultural workers, independent contractors, freelancers, underemployed adults, and college students without other health insurance coverage.

Authorizes the Department to contract with nonprofit health insurers or community-based organizations to operate the program, issue portable premium subsidies or vouchers, and apply for federal waivers under Section 1332 of the Affordable Care Act and Section 1115 of the Social Security Act.

Requires annual reports to the legislature on enrollment data, health outcomes, fiscal impact, and program sustainability, with the pilot program set to expire on June 30, 2029.