A new charter-flight pilot starts for Molokai and Lana‘i patients
Hawaii has launched a pilot program intended to help some Molokai and Lana‘i residents reach off-island medical appointments by chartering flights to Honolulu, while also offering travel support for Honolulu-area doctors to visit the neighbor islands. The initiative, known as Essential Rural Medical Air Transport, or ERMAT, is described as a $2 million project that began launching last week.
To get a seat on an expenses-paid ERMAT charter flight, a patient needs a referral from a primary care physician, according to the report. The charter flights are set up for visits to medical appointments in Honolulu or Maui, and in some cases the program will also cover travel costs for patients using other transport options.
Molokai route begins first; Lana‘i flights planned for February
The first ERMAT charter flight—operated by Pacific Air Charters with nine seats—is expected to depart later this month from Ho‘olehua Airport in Molokai to Honolulu, the report said. Flights serving Lana‘i are expected to begin in February.
The program is designed to serve large numbers of neighbor-island residents during 2026, with targets that include helping 1,500 Molokai residents via a dozen monthly charter flights and 1,000 Lana‘i residents via weekly charter flights, the report said. In some cases, ERMAT will cover costs for patients to travel on Mokulele Airlines, Larry Ellison’s charter service Lana‘i Air, or the Maui-Lana‘i passenger ferry Expeditions.
“Game changer” for patients facing flight disruptions
Lani Ozaki, executive director of Pulama Ka Heke, said ERMAT is “a game changer.” She said the project is intended to reach “kupuna” who, she said, have given up on participating in specialist appointments that require air travel, and that the program could make them reconsider.
The report also described what makes the need acute on Molokai and Lana‘i: boarding a plane is often required for residents to see specialists, and flight availability can affect whether appointments happen on time. It said Morning flights to Honolulu’s Daniel K. Inouye International Airport are in high demand, with seats sometimes selling out days or weeks in advance.
Limits remain, including wheelchair access and ground travel
The report emphasized the pilot is not a comprehensive fix for all travel barriers. ERMAT does not cover costs associated with ground transportation to appointments, and Pacific Air Charters flights cannot accommodate wheelchair-bound passengers, the report said.
The project is funded through the end of the year, but would need additional revenue to continue in 2027, the report said. Ozaki said charters are expensive and that additional legislative support will be needed to keep the program going. The report also said a seat on a charter flight costs roughly double the typical price of a roundtrip flight on Mokulele Airlines.
State lawmakers seek funding if early tests show results
State Sen. Joy San Buenaventura, who chairs the Health and Human Services Committee, said she plans to advocate during the next legislative session—beginning Wednesday—for more funding to keep the project alive into 2027. The report said she described the advocacy as depending on whether the charter flights prove successful in transporting more rural patients to off-island medical appointments and whether new transit options do not emerge.
Early examples point to faster access for time-sensitive care
The report described early tests intended to show whether charter flights can help when commercial travel is fully booked. Ozaki recounted a case involving a Molokai resident on a waitlist for a kidney transplant who received a late-year call that a kidney was available, but faced fully booked commercial flights from Molokai to Honolulu for days. She said kidneys typically survive outside a donor’s body for no more 36 hours, and said ERMAT coordinators arranged a charter flight so the patient could arrive in time for the transplant.
A separate example described by the report involved ERMAT working with Mokulele Airlines to create an open seat for a Molokai patient with broken ankles and heels. It said the patient had waited three weeks to see an orthopedic surgeon in Honolulu after running into shortages of open seats on the airline.
Doctor shortages and reimbursement gaps add pressure in rural areas
Beyond travel disruptions, the report tied the pilot to broader challenges in rural health care. It said Hawaii needs to grow its supply of doctors by about 23% to meet patient demand, citing a 2025 annual report. On Molokai specifically, the report said the physician workforce needs to grow by 83%, as stated by Dr. Kelley Withy, a physician at the University of Hawai‘i’s John A. Burns School of Medicine who oversees the study.
The report also said that roughly two-thirds of Molokai residents rely on government health insurance, and that doctors serving Medicaid and Medicare patients receive some of the nation’s lowest reimbursement rates, sometimes lower than the cost of providing care. It said the mismatch makes it difficult to recruit and retain medical staff in rural parts of the state, and that flight disruptions have contributed to some doctors stopping travel to see neighbor-island patients.
Ozaki said coordinating ERMAT’s Molokai flights is intended to support a more reliable flight schedule that could encourage more health care workers to fly to Molokai and Lana‘i. The report said the program will charge physicians a discounted rate of $200 roundtrip to use the service.
Queen’s Health Systems Chief Operating Officer Darlena Chadwick said the hospital network is exploring how its medical staff can use the new charter flights to reach patients on Molokai.
Federal grant backs longer-term rural health system upgrades
The report also described additional federal funding aimed at improving rural health care beyond transportation. It said Hawaii will receive nearly $189 million of a $50 billion national grant to strengthen health care in isolated areas across the country where access is limited by geography, workforce shortages, and infrastructure gaps.
Hawaii’s award for fiscal year 2026, which ends Sept. 30, is described as one of the largest investments measured per capita, and said to cover the first year of a five-year strategic plan to modernize the state’s rural health care system. The report said Gov. Josh Green stated the money will help close the distance between the Honolulu medical hub and rural residents, who represent roughly 14% of Hawaii’s population, and that the funding would support expanded clinics, hospital stabilization, workforce training and recruitment, and broader virtual and mobile care options across neighbor islands and rural parts of O‘ahu.