Health officials urge caution, funding and technical fixes for sweeping home- and community-based services bill

The Committee on Health and Veterans Affairs received technical and stakeholder testimony June 15 on Bill 329-38, a comprehensive measure introduced by Chair Senator Sabrina Solless Matsinani to establish licensing standards, resident protections and a tiered structure for home- and community-based services (HCBS) on Guam.

Lede: Chair Sabrina Solless Matsinani said Bill 329 is intended to create a modern, person-centered framework that covers assisted living, adult family care, supported living, adult day services and other community-based options to help seniors and people with disabilities remain in the least restrictive setting appropriate to their needs.

Nut graf: While stakeholders broadly supported the bill’s goals, the Department of Public Health and Social Services (DPHSS) and other witnesses urged careful sequencing, removal of technical inconsistencies, and dedicated funding and staffing for implementation. The primary concerns were: alignment with the near-term plan to implement a 1915(c) Medicaid waiver, the unsuitability of relying on Guam’s local medically indigent program (MIP) as a stopgap funding source, and the need for rulemaking resources and inspection capacity.

Acting DPHSS Director Peter John Kamacho provided detailed edits and policy cautions. DPHSS commended the bill’s person-centered focus but recommended removing prescriptive lists of services and housing references that could confuse Medicaid financing rules; instead, the department suggested using terms like "residential supports" and keeping Medicaid authority definitions general. DPHSS warned that, "MIP is funded entirely through local appropriations and is subject to annual budgetary constraints," and that using MIP as a bridge to Medicaid-funded HCBS would create coverage gaps because MIP and Medicaid populations and eligibility rules differ.

DPHSS also flagged administrative burdens in the bill: the department asked for more time and resources for rulemaking (the draft sets a 180-day timeline), recommended phased complaint and intake mechanisms rather than duplicative hotlines and portals, and urged a tiered penalty structure instead of a flat maximum fine that could be disproportionate to minor violations. The Division of Environmental Health told the committee it lacks statutory clarity and staffing to take on the bill’s proposed inspection and enforcement responsibilities and requested an initial appropriation to hire at least two environmental public health officers dedicated to HCBS oversight.

University of Guam Centers for Disabilities representative June DeLeon welcomed inclusion in rulemaking and emphasized that meaningful stakeholder engagement and program design will take time and resources. A sector advocate also praised the bill’s structure but cautioned that Guam’s capped Medicaid financing means that federal matching dollars will be limited and urged clarity on who will be eligible for services and how person-centered plans will be created and resourced.

Committee members said they plan to use the testimony to revise the bill’s language. Sponsors and DPHSS both indicated they prefer phased, data-informed implementation tied to the island’s 1915(c) waiver timeline rather than rapid, broad rule changes that could outpace staffing and budget capacity.

What’s next: The committee expects to hold markups and additional stakeholder meetings to resolve the technical Medicaid, funding and regulatory issues before moving the bill to the floor. DPHSS and legislative staff will continue to coordinate language on definitions, fee and penalty structures, and the timeline for rulemaking.

Sources: public hearing testimony, Committee on Health and Veterans Affairs (June 15, 2026), including DPHSS acting director Peter John Kamacho, June DeLeon (University of Guam) and sector advocates.