HI HB2133

Requires the Hawaii state auditor to conduct biennial audits of all Medicaid managed care contractors, their subcontractors, and provider networks, examining claims data, provider enrollment, network adequacy, and program integrity safeguards starting January 1, 2027.

Mandates a separate biennial audit of the Department of Human Services and its Med-QUEST division, reviewing data governance, federal reporting accuracy, secret shopper surveys, advisory council functioning, and overpayment detection processes.

Addresses documented Medicaid program weaknesses including overpayments from provider ineligibility, inconsistent encounter data reconciliation, suspended verification activities, and a 2023 federal program integrity review that identified operational deficiencies.

Grants the auditor broad access to contractor claims systems, department enrollment files, reporting templates, and external quality review work products, with requirements for data use agreements to protect confidential information.

Appropriates unspecified general funds for fiscal year 2026-2027 to implement the multi-year audit schedule, procure consulting expertise, and acquire data analytic tools, with the Act taking effect July 1, 2026.