Report urges lawmakers: Let Hawaii patients see mainland doctors online

The practice worked well and safely during the COVID-19 crisis and could do so again, the Grassroot Institute of Hawaii says

News Release from Grassroot Institute

HONOLULU, June 17, 2025 >> The Grassroot Institute of Hawaii released a white paper today that examines how state lawmakers could improve healthcare access and outcomes in the islands by allowing local patients to receive medical care via telehealth from providers licensed and located in other U.S. states, districts or territories.

Titled “Why Hawaii lawmakers should adopt interstate telehealth,” the document notes that local telehealth access “might improve slightly with Hawaii now being a member of the Interstate Medical Licensure Compact. … However, Hawaii’s in-state licensure requirement for telehealth will continue to limit the use and scope of telehealth.”

Grassroot Policy Director Malia Hill, author of the white paper, says temporary measures that allowed cross-border care during the COVID-19 crisis “demonstrated that states can safely and effectively improve healthcare access by expanding telehealth beyond geographic licensing restrictions.”

But as lockdown-era telehealth waivers expired, local healthcare experts “expressed concern about how the end of cross-border telehealth would affect patient health,” and “as expected, the end of interstate telehealth marked a return to the access-to-care issues that existed before the waivers were enacted.”

Hill recommended three broad policy options for Hawaii lawmakers to consider that would once again enable local patients to access out-of-state medical providers and see improvements in their healthcare access and outcomes. They are:

>> Establish a registration program through which out-of-state providers who meet specified qualifications could register with the state medical board, agree to the terms of the registry and pay any required fees. Once accepted into the program, the providers would be able to offer telehealth services to Hawaii residents without the burden of obtaining a full Hawaii medical license.

>> Offer temporary or special licenses that allow out-of-state providers to deliver telehealth services to patients in Hawaii under specific circumstances.

>> Enter into reciprocity agreements with one or more states that negate Hawaii’s restriction on cross-border telehealth between participating states.

The Grassroot white paper also discusses how lawmakers could instead simply “carve out a few minor exceptions to the requirement that Hawaii patients receive telehealth services from only healthcare providers licensed in Hawaii,” noting that “27 states currently have some kind of exception or alternative to full licensure for out-of-state telehealth providers.”

Another alternative, Hill writes, would be for lawmakers to “take steps to lift Hawaii’s in-state telehealth licensing requirement for certain specialties, such as mental health providers, whether on a permanent or temporary basis.”

The white paper concludes that reforming Hawaii’s telehealth law to afford local patients access to qualified physicians located out of state “would be a cost-effective avenue to expand the pool of healthcare providers available to Hawaii patients, and one of the most promising ways to improve patient care statewide.”

Grassroot President and CEO Keli‘i Akina underscored the significance of the report, saying it makes a convincing case for the expansion of telehealth in Hawaii.

“Hawaii faces unique healthcare challenges, such as its geographic location and profound physician shortage that disproportionately affects rural residents,” he said. "And this well-researched report shows that telehealth expansion deserves serious consideration as a safe way to improve patient access and outcomes throughout our islands.”

PDF: DOWNLOAD THE REPORT