Game Changer? Free Medical Flights Start For Some Neighbor Island Residents
(ASSOCIATED PRESS) – Sources from Associated Press say boarding an airplane to see a doctor is a widely accepted way of life in rural Hawai‘i.
But a drop in the number of airlines that service Moloka‘i and Lana‘i residents has left patients with fewer travel options and, many people say, more frequent flight disruptions that can lead to missed appointments. As a result, some residents say they now skip a visit to the doctor when it requires air travel.
A $2 million pilot project that launched last week aims to provide a new link to the state’s Honolulu medical hub by chartering flights for Moloka‘i and Lana‘i patients with off-island medical appointments, as well as offering flights to Honolulu doctors willing to travel to Moloka‘i or Lana‘i to provide care.
A patient needs a referral from a primary care physician to secure a seat on an expenses-paid charter flight to reach a medical appointment in Honolulu or Maui through the Essential Rural Medical Air Transport pilot program, or ERMAT.
“It’s a game changer,” said Lani Ozaki, executive director of Pulama Ka Heke, a Molokaʻi health care nonprofit hui that’s running the project with Lānaʻi Kinaole, a home health care agency. “We have kupuna who have just given up and decided not to participate in specialist appointments. We hope this makes them reconsider.”
The first nine-seat charter flight operated by Pacific Air Charters to Honolulu from Moloka‘i’s Ho‘olehua Airport is expected to take off later this month. Lānaʻi flights are expected to begin in February.
The ERMAT program aims to serve 1,500 Moloka‘i residents on a dozen monthly charter flights and 1,000 Lana‘i residents on a weekly charter flight in 2026. In some cases, the program will cover costs for patients to travel on Mokulele Airlines, the only public airline servicing Moloka‘i and Lana‘i, billionaire Larry Ellison’s charter service Lana‘i Air, or the Maui-Lana‘i passenger ferry Expeditions.
The flights, funded by state lawmakers in 2024, are part of a modest but growing effort to bring more comprehensive and timely medical care to isolated parts of the state.
It is not a panacea.
The program does not cover costs associated with ground transportation to medical appointments. Pacific Air Charters flights cannot accommodate wheelchair-bound passengers.
The program is funded through the end of the year but will need additional revenue to continue in 2027.
“It might seem like $2 million is a lot,” Ozaki said, “but charters are expensive and to keep this program going we’re going to need more legislative support.”
A seat on a charter flight costs roughly double the typical price of a roundtrip flight on Mokulele Airlines.
State Sen. Joy San Buenaventura, who chairs the Health and Human Services Committee, said she plans to advocate during the next legislative session, which begins Wednesday, for more funding to keep the project alive into 2027 if the charter flights prove successful in transporting more rural patients to off-island medical appointments and if no new transit options materialize.
Early Tests Show Potential
Boarding a plane is essential for Moloka‘i and Lana‘i residents to see a dermatologist or cardiologist. Lana‘i residents must also fly for colonoscopies, mammograms, any kind of surgery — even an ankle fracture.
Ozaki tells the story of a Moloka‘i resident on a waitlist for a kidney transplant who finally got the call he was hoping for late last year.
A kidney was available. But there was a problem. Commercial flights from Moloka‘i, where the patient resides, to Honolulu, where the organ donor died, were booked out for days. Kidneys typically survive outside a donor’s body for no more 36 hours.
ERMAT project coordinators put the patient on a charter flight — an early test of the program. The patient landed in Honolulu in time to receive the life-saving transplant, Ozaki said.
The program also recently worked with Mokulele Airlines to create an open seat on a fully booked commercial flight for a Moloka‘i patient with broken ankles and heels who had waited three weeks to see an orthopedic surgeon in Honolulu due to shortage of open seats on the airline.
Morning flights to Honolulu’s Daniel K. Inouye International Airport are in high demand among Moloka‘i residents who must travel by airplane to earn an income or see a doctor. It’s not uncommon for seats on early flights to sell out days or weeks in advance.
This can curtail the ability of residents to count on quick transport to a faraway medical center when a sudden health problem fails to meet an insurer’s definition of emergency.
In the case of the Moloka‘i resident who spent weeks trying to reach a Honolulu surgeon to repair his broken feet and ankle bones, Ozaki said the patient’s health insurance policy had declined air ambulance coverage.
Doctor Shortage Worse In Rural Outposts
Hawai‘i needs to grow its supply of doctors by about 23% to meet patient demand, according to a 2025 annual report that tracks the state’s medical professional needs. On Moloka‘i, the physician workforce needs to grow by 83%, said Dr. Kelley Withy, a physician at the University of Hawaiʻi’s John A. Burns School of Medicine who oversees the study and is its primary researcher.
The island of 7,400 people may be small but it has diverse medical needs. It has the state’s lowest household incomes and highest unemployment. And its population is predominantly of Native Hawaiian ancestry, a group with significant socioeconomic disparities. Native Hawaiians face high rates of food insecurity and chronic disease, studies show.
The economics of providing health care on the island are also grim.
Roughly two-thirds of Moloka‘i residents rely on government health insurance. In Hawai‘i, doctors who serve Medicaid and Medicare patients receive some of the nation’s lowest reimbursement rates, sometimes lower than the cost of providing care. The discrepancy makes it difficult to recruit and retain medical staff in the state’s rural areas.
A small number of medical professionals opt to travel to Moloka‘i and Lana‘i to provide residents with routine care, But the same flight disruptions that vex patients have led some time-pressed doctors to stop flying to see neighbor island patients.
Ozaki, who is coordinating the ERMAT program’s Moloka‘i flights, said she hopes the ERMAT program’s charter flights can keep to a more reliable flight schedule, which might entice more health care workers to fly to Moloka‘i and Lana‘i to see patients.
The program will charge physicians who use the service a discounted rate of $200 roundtrip to stay competitive with commercial airline ticket rates.
“A lot of providers want to provide care here,” Ozaki said, “but they don’t because they can’t risk the unreliable transportation factor.”
The Queen’s Health Systems Chief Operating Officer Darlena Chadwick said the hospital network is exploring how its medical staff can take advantage of the new charter flights to reach patients on Moloka‘i.
Hawai‘i Wins Transformational Rural Health Grant
Charter flights offer a fix to one piece of an intricate health care delivery problem. Funding to address other issues is on the way.
In a significant show of federal investment toward solving rural health care issues, Hawai‘i will receive nearly $189 million of a $50 billion national grant to strengthen health care in isolated areas of all 50 states where access to care is limited by geography, workforce shortages and infrastructure gaps.
Hawai‘i’s award for fiscal year 2026, which ends Sept. 30, is one of the largest investments when measured per capita. The funds cover the first of a five-year strategic plan to modernize the state’s rural health care system, with additional annual grant opportunities expected through 2030.
Gov. Josh Green said in a statement that the money will help close the distance between the state’s Honolulu medical hub and rural residents, who represent roughly 14% of Hawai‘i’s population.
Targeting efforts that reduce the need for rural residents to fly to O‘ahu just to see a doctor, the funds will support initiatives to expand medical clinics, stabilize hospitals, train and recruit health care providers to work in rural areas and broaden virtual and mobile care options on neighbor islands and in rural parts of O‘ahu.
