Hawaii launched a $2 million charter-flight pilot program for Moloka’i and Lana’i patients who face barriers reaching off-island medical specialists amid commercial airline disruptions. The program will provide free chartered flights for patients with physician referrals, with service beginning this month.
The Essential Rural Medical Air Transport program, or ERMAT, aims to serve 1,500 Moloka’i residents through 12 monthly flights and 1,000 Lana’i residents through weekly flights in 2026, but will require additional legislative support to continue beyond this year.
Program Structure and Mechanics
Pulama Ka Heke, a Moloka’i health care nonprofit, and Lānaʻi Kinaole, a home health care agency, are running the program with funding approved by state lawmakers in 2024. The first nine-seat charter flight operated by Pacific Air Charters is expected to depart Moloka’i’s Ho’olehua Airport for Honolulu later this month, with Lana’i flights beginning in February.
Patients need physician referrals to secure free seats on chartered flights. The program also covers certain alternative travel options, including service on Mokulele Airlines, billionaire Larry Ellison’s charter service Lana’i Air, and the Maui-Lana’i passenger ferry Expeditions.
The Access Crisis
For decades, Moloka’i and Lana’i residents have relied on commercial flights to reach specialists for dermatology, cardiology, and surgery. The decline in airlines serving the islands has left residents with fewer reliable options. Morning flights to Honolulu’s Daniel K. Inouye International Airport are in high demand, with seats frequently selling out days or weeks in advance—forcing many to forgo specialist care entirely.
“It’s a game changer,” said Lani Ozaki, executive director of Pulama Ka Heke. “We have kupuna who have just given up and decided not to participate in specialist appointments. We hope this makes them reconsider.”
A kidney transplant case in late 2025 illustrated the program’s potential. A Moloka’i resident on the transplant waitlist received word that an organ had become available. The window for transplant is narrow—kidneys survive outside a donor’s body for no more than 36 hours—but commercial flights from Moloka’i to Honolulu were fully booked for days. ERMAT project coordinators arranged a charter flight, and the patient landed in Honolulu in time to receive the transplant, according to Ozaki.
The program recently assisted another patient: a Moloka’i resident with broken ankles who had waited three weeks to see an orthopedic surgeon was placed on a fully booked Mokulele Airlines flight through the program’s coordination.
Limitations and Funding Outlook
The program has real constraints. It does not cover ground transportation to medical appointments, and charter flights cannot accommodate wheelchair-bound passengers. A seat on a charter flight costs roughly double the typical roundtrip on Mokulele Airlines.
The program is funded through the end of 2026 but will need additional revenue to continue into 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.”
State Sen. Joy San Buenaventura, who chairs the Health and Human Services Committee, said she plans to advocate during the next legislative session for more funding if charter flights prove successful in transporting rural patients and no new transit options emerge.
The Broader Context: Physician Shortage and Federal Investment
The charter flights address one piece of a larger healthcare access crisis. Moloka’i, with 7,400 residents, faces acute physician shortages. According to a 2025 annual report tracking the state’s medical professional needs, Hawaii needs to grow its doctor supply by about 23% to meet patient demand—but Moloka’i needs to grow its physician workforce by 83%, said Dr. Kelley Withy, a physician at the University of Hawaiʻi’s John A. Burns School of Medicine who oversees the study.
Rural healthcare in Hawaii faces economic headwinds. Roughly two-thirds of Moloka’i residents rely on government health insurance. In Hawaii, doctors who serve Medicaid and Medicare patients receive some of the nation’s lowest reimbursement rates—sometimes lower than the cost of providing care. This discrepancy makes it difficult to recruit and retain medical staff in rural areas.
Moloka’i’s population is predominantly Native Hawaiian, a group facing significant socioeconomic disparities. The island has the state’s lowest household incomes and highest unemployment. Native Hawaiians face high rates of food insecurity and chronic disease, studies show.
Ozaki said she hopes ERMAT’s reliable flight schedule will entice more healthcare workers to visit the islands. The program will charge physicians a discounted $200 roundtrip to stay competitive with commercial rates. “A lot of providers want to provide care here,” she said, “but they don’t because they can’t risk the unreliable transportation factor.”
The Queen’s Health Systems is exploring how its medical staff can take advantage of the charter flights to reach patients on Moloka’i.
Federal support is expanding rural health capacity. Hawaii will receive nearly $189 million of a $50 billion national grant to strengthen healthcare in isolated areas where access is limited by geography, workforce shortages, and infrastructure gaps. The award is one of the largest per capita in the nation.
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 Hawaii’s population.
The funds cover the first year of a five-year strategic plan to modernize the state’s rural health care system, with additional annual grant opportunities expected through 2030. The investment will support expansions to medical clinics, stabilization of rural hospitals, recruitment and training of healthcare providers, and expansion of virtual and mobile care options on neighbor islands and in rural parts of O’ahu.