State payments totaling about $90 million a month to five insurance plans providing health coverage for low-income residents will be delayed in May and June, and possibly April, says state Human Services Director Lillian Koller.

The delays come on top of deferrals in December and January payments because the federal share of funds could not be accessed.

Delayed payments over several months could force suspension of services or even closure of some health centers, which serve a disproportionate share of Medicaid beneficiaries, said Beth Giesting, executive director of the Hawaii Primary Care Association, which represents community health centers.

The proposed payment delays result from “;just not having enough money appropriated to us to make full payment, primarily because of increased enrollment (in the plans),”; Koller said last week.

Dr. Kenneth Fink, Med-QUEST administrator, said enrollment in the health plans has been increasing about 13 percent per year. About 240,000 islanders are covered by Hawaii Medical Service Association, Kaiser Permanente and AlohaCare with Quest plans and Ohana Health Plan and EverCare for QUEST Expanded Access for the aged, blind and disabled.

A Senate Health Committee hearing is scheduled for 2:45 p.m. tomorrow in Room 016 at the Capitol.

The same thing occurred last year with May and June payments to insurers deferred until July when the new fiscal year began, Koller said. The Budget Department then advanced money from the annual appropriation to cover the payments.

She said December and January payments were deferred because the QUEST contract was being renegotiated with federal officials, and until it was approved the state could not access the federal money.

Fink said Human Services paid the health plans entirely with state money in December but did not have enough to do it again in January.

However, he said the contract has been approved, and the department will soon draw on federal funds retroactive to Dec. 1 and catch up with payments.

Insurers and community health leaders were alarmed when Koller reported the department was running out of money to cover health payments April through June.

HMSA, which receives $23 million a month in QUEST payments, already has borrowed on its credit lines and liquidated portions of its investment portfolio to continue payments to health care providers serving members, said Steve Van Lier Ribbink, HMSA executive vice president, chief financial officer and treasurer.

In a letter to Koller Feb. 2 and in a Star-Bulletin edi- torial board meeting, Van Ribbink said HMSA understands the state's problems, but “;we don't want them to misunderstand the underpinnings of the health system.

“;We're happy to run the program as close to a breaking point as we can, but we don't want one population to subsidize another,”; Van Ribbink said.

Delayed payments merely “;kick the can down the road,”; affecting what insurers can pay doctors, hospitals and nursing homes, he said.

“;HMSA's balance sheet is simply not as liquid as supposed,”; Van Ribbink said. “;If we don't get paid until September, we can't afford that and would need to delay payments to providers.”;