For many residents of Moloka‘i and Lāna‘i, air travel is a routine part of accessing medical care. But reduced airline service has made reaching doctors more difficult, resulting in missed appointments and delayed treatment for some patients. A new state-funded initiative aims to address that challenge through a medical transport program that launched last week.
The $2 million Essential Rural Medical Air Transport (ERMAT) pilot program provides charter flights for residents of the two islands who have off-island medical appointments. The initiative will also support travel for doctors from Honolulu to reach patients on the islands.
To be eligible, patients must be referred by a primary care provider. Charter flight costs are fully covered for those meeting the criteria.
“This is a game changer,” said Lani Ozaki, executive director of Pulama Ka Heke, a Moloka‘i health nonprofit operating the program along with Lāna‘i Kinaole, a home health care agency. She said some older residents have recently avoided specialists due to travel disruptions.
The first nine-seat charter flight, operated by Pacific Air Charters, is expected to depart from Moloka‘i’s Ho‘olehua Airport to Honolulu later this month. Flights from Lāna‘i are scheduled to begin in February.
The program plans to serve about 1,500 Moloka‘i residents with 12 monthly charter flights and about 1,000 Lāna‘i residents with weekly service by 2026. In some cases, the program will also cover commercial travel costs via Mokulele Airlines, Lana‘i Air, or Expeditions ferry service.
Funded by the state legislature in 2024, the program is part of broader efforts to improve rural health care access across Hawai‘i. However, limitations remain. Flights do not accommodate wheelchairs, and the program does not cover ground transportation costs. Funding only extends through 2024, and additional legislative support will be needed to continue the program in 2027.
Ozaki estimated a charter flight seat costs roughly twice as much as a roundtrip ticket on Mokulele Airlines. “It might seem like $2 million is a lot,” she said, “but charters are expensive.”
State Sen. Joy San Buenaventura, chair of the Senate Health and Human Services Committee, said she would advocate for future funding based on the program’s results and the availability of alternative transit options.
Residents of both islands must fly to O‘ahu or Maui for various medical services, including specialist care, surgeries, and diagnostic tests. Delays due to flight unavailability have disrupted urgent medical needs, including for a Moloka‘i resident awaiting a kidney transplant. When no commercial seats were available, ERMAT arranged a private charter in time for surgery.
Another patient with broken ankles waited three weeks due to booked flights before a seat opened on a Mokulele Airlines plane, coordinated through the program.
Morning flights to Honolulu are in high demand for both health and work needs. Fully booked flights can limit access to timely care, especially when a case is not classified as an emergency by insurers.
A 2025 report tracking physician shortages in Hawai‘i found that the state needs 23% more doctors overall, with Moloka‘i requiring an 83% increase to meet demand. The island, home to about 7,400 people, has the lowest household incomes and highest unemployment in Hawai‘i, and its population is primarily Native Hawaiian, a demographic experiencing higher rates of food insecurity and chronic disease.
Approximately two-thirds of Moloka‘i residents rely on public insurance, such as Medicaid and Medicare. Reimbursement rates for providers are among the nation’s lowest, making it difficult to recruit and retain physicians in rural areas.
Some doctors who used to fly to Moloka‘i and Lāna‘i have stopped due to unreliable transportation. ERMAT aims to address that issue by offering charter flights to providers at a discounted roundtrip rate of $200.
“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 is evaluating whether its staff can use the new charter service for patient care visits on Moloka‘i.
The project is one component of a larger federal initiative to improve rural health infrastructure. Hawai‘i is receiving nearly $189 million in federal funding under a national plan to strengthen medical access in remote areas. The investment supports a five-year strategy to expand rural clinics, stabilize hospitals, train providers, and improve mobile and virtual care.
Gov. Josh Green said the federal funds would help bridge the geographic divide between Honolulu-based care and outlying communities. About 14% of Hawai‘i residents live in rural areas.
The ERMAT pilot, while limited in scope, reflects a growing effort to overcome geographic and logistical challenges in delivering health care to remote parts of the state.