PATCH Act Guarantees Higher Medicare Pay for Hawaii Doctors Starting 2026

The Protecting Access To Care in Hawaii Act, or the PATCH Act, is a targeted piece of legislation focused squarely on how Medicare pays doctors in Hawaii. Starting January 1, 2026, the bill mandates a minimum payment floor for physicians providing services to Medicare patients in the state.

The Guaranteed Pay Floor

This bill zeroes in on the “work geographic index.” This index is part of the complex formula Medicare uses to adjust physician payments based on where they practice—the idea being that costs of running a practice vary by location. Under the PATCH Act, if the standard calculation for this index in Hawaii falls below 1.5, the Secretary must automatically bump it up to 1.5 for payment purposes (Sec. 2). Think of it like this: if the existing formula says Hawaii doctors should get a 1.2 payment multiplier based on local practice costs, the bill forces that multiplier up to a guaranteed 1.5.

What This Means in the Real World

For doctors in Hawaii, this translates directly into higher reimbursement rates for every Medicare service they provide. The bill explicitly states that this increase is not subject to “budget neutrality” rules. Usually, when Medicare increases payments in one area, they have to find cuts elsewhere to keep the overall budget balanced. Not here. This is a straight-up, non-offset increase in federal spending for physician services in Hawaii.

For regular people, especially Medicare recipients in Hawaii, this is a big deal because it addresses a persistent problem: keeping doctors practicing in high-cost, geographically isolated areas. If the pay is too low, doctors leave, and access to care shrinks. By ensuring a higher, guaranteed minimum payment, the PATCH Act aims to stabilize the financial viability of medical practices, which should, in theory, help retain and recruit the physicians needed to serve the state’s population.

Who Pays for the Bump?

While this is clearly beneficial for Hawaii’s healthcare providers and potentially its Medicare patients, it’s important to note the financial mechanism. Since this payment increase is explicitly not budget neutral, the increased costs are borne by the Medicare program itself. Essentially, this is a mandated increase in federal Medicare expenditures, meaning the cost is ultimately covered by the Medicare trust fund and, by extension, taxpayers. It’s a targeted subsidy designed to address a specific regional access issue, but it comes with a clear price tag attached to the federal budget.