• HOME RUN Investment Program Application

    HBMC Foundation AHEC
  • The HOME RUN Investment Program is supported through the Rural Health Transformation Program (RHTP), funded by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $188,892,439.75, with 100 percent funded by CMS/HHS. The contents of this program and related materials are those of the program administrators and do not necessarily represent the official views of, nor an endorsement by, CMS, HHS, or the U.S. Government.

  • General Information

  • The Hawaii Outreach for Medical Education in Rural Under-resourced Neighborhoods (HOME RUN) Investment Program is designed to strengthen Hawaii's rural healthcare workforce by supporting the recruitment, retention, and long-term sustainability of healthcare professionals serving rural and underserved communities throughout the state.
  • To qualify for a HOME RUN investment award, applicants must be healthcare professionals who are licensed, certified, or otherwise authorized to provide clinical care in Hawaii and who provide, or will provide, direct patient care services to individuals living in rural Hawaii. For purposes of this program, public insurance includes Medicare Fee-for-Service, Medicare Advantage, Medicaid Fee-for-Service, QUEST Integration (Med-QUEST), Veterans Administration, and TRICARE.
  • Applicants must be United States citizens, lawful permanent residents, or otherwise eligible individuals as permitted by applicable federal and state requirements. Applicants must not be excluded, debarred, suspended, or otherwise disqualified from participation in federal programs and must not have unresolved court-ordered child support obligations or judgments arising from federal debt.
  • Initial eligibility may include verification of professional licensure, certification, employment status, professional standing, and other information necessary to determine program eligibility.
  • Award recipients will be selected through a competitive review process conducted by the HOME RUN Investment Committee using approved eligibility criteria and scoring standards.
  • All applicants selected to participate in the HOME RUN Investment Program must commit to a minimum of five (5) years of full-time clinical service in a qualifying rural Hawaii practice setting. Participants are also encouraged to contribute to healthcare workforce development activities, including student mentoring, teaching, precepting, health career outreach, research, community education, and other workforce pipeline initiatives.
  • HOME RUN investment payments are awarded directly to the selected participant. Investment payments may be considered taxable income and may be reported to the Internal Revenue Service and applicable State of Hawaii tax authorities on required tax reporting forms, including IRS Form 1099, as required by law. Participants are responsible for consulting their tax advisor regarding any federal, state, or local tax obligations associated with receipt of an investment award.
  • HOME RUN Investment Representative Logos: JABSOM, HI/Pac. Basin AHEC, HBMC Foundation, Hawaii Island AHEC

  • Map of Hawaii Rural Districts

  • Map of Hawaii's Rural Districts

  • Instructions for Applying

  • Contracts will be awarded on a competitive basis. Priority consideration may be given to primary care providers and behavioral health providers working throughout the state, specialists in rural Hawaii, and individuals in residency programs as defined by Hawaii Revised Statutes 1B-1. Priority will also be given to other healthcare providers working in professions and areas for which there is a documented shortage.
  • Priority consideration may be given based upon:
    • Workforce investment category
    • Rural workforce shortages
    • Healthcare profession or specialty
    • Geographic need
    • Recruitment or retention impact
    • Workforce development contributions
    • Availability of program funding
  • The following documents MUST BE submitted for an application package to be considered complete:
    1. Completed Application, including all parts.
    2. Copy of current Hawaii professional license or certificate (i.e., for certain technologists).
    3. Copy of a valid government-issued identification (such as passport or driver's license)
  • *An employment start date is required.
  • Please read the application instructions very carefully. If you have questions regarding the application, application process, or your eligibility for the HOME RUN program, please email us at hbmcfoundation@hhsc.org or call 808-932-3636

  • Program Awareness

  • Where did you hear about Hawaii's HOME RUN program?
  • Where did you hear about Hawaii's HOME RUN program?

  • HOME RUN

  • HOME RUN Workforce Investment Categories

  • The HOME RUN Investment Program is designed to strengthen Hawaii's rural healthcare workforce by supporting provider recruitment, provider retention, workforce advancement, and practice sustainability. The following categories are intended to guide program priorities and funding discussions.

    Allied Health Professions and/or Upskilling – Up to $50,000 per Individual
    Purpose: Support allied health professionals who play a critical role in rural healthcare delivery and assist healthcare workers/providers pursuing additional education, certification, licensure, or expanded scope of practice to address workforce shortages and improve access to care in rural communities.

    Provider Retention – Up to $75,000 per Individual
    Purpose: Retain experienced healthcare professionals currently serving rural communities and reduce workforce turnover that disrupts patient access and continuity of care.

    Provider Recruitment – Up to $100,000 per Individual
    Purpose: Recruit healthcare professionals to rural Hawaii and attract new talent to communities experiencing workforce shortages.

    Rural Practice Leadership – Up to $200,000 per Individual
    Purpose: Support healthcare professionals whose leadership helps sustain access to care, workforce development, and healthcare infrastructure in rural communities.

     

  • For applicants selecting Upskilling, complete the additional section highlighted in the application in lieu of questions that do not apply to your current role.
  • Please select the workforce investment category that best aligns with the primary purpose of your application. This selection is intended to assist the HOME RUN Investment Committee during the review process. The Committee reserves the right to determine the final workforce investment category for review, scoring, and funding consideration based on the information provided in the application.*
  • HOME RUN investments are intended to support workforce outcomes rather than organizational size. Funding decisions will prioritize the workforce needs of rural communities, the anticipated impact on healthcare access, and the long-term sustainability of Hawaii's healthcare workforce.

  • For more detailed information on each HOME RUN Workforce investment category please visit: hbmcfoundation.org/homerun

  • Part A: Personal Information

  • Date of Birth*
     / /
  • Gender*
  • Format: (000) 000-0000.
  • Phone 1 Type*
  • Format: (000) 000-0000.
  • Phone 2 Type*
  • Email Type*
  • Are you a veteran of the U.S. Armed Forces?*
  • Race/Ethnicity:
    The race/ethnicity information requested is optional and will not be used for the purposes of evaluating your application. It will be used to satisfy federal and/or State of Hawaii reporting requirements and may be used for other purposes allowed by law.
  • Please select all that apply.*

  • Professional School where graduated

  • Board Eligible*
  • Board Certified*
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  • HOME RUN Investment Representative Logos: JABSOM, HI/Pac. Basin AHEC, HBMC Foundation, Hawaii Island AHEC

  • Part B: Qualifications and Eligibility

  • I understand that participating practice sites must currently accept public insurance (Medicare, Medicaid, QUEST Integration, TRICARE, and/or Veterans Administration) for at least 30% of annual patient billing claims, or, for new practices, agree to meet this requirement during the participant's five-year service commitment.*
  • Are you a United States citizen or lawful permanent resident?*
  • Do you have a current unrestricted Hawaii license or state/national certification to practice your profession in Hawaii?*
  • Are you free of judgements arising from Federal debt?*
  • Are you delinquent with any court-ordered child support?*
  • Are you currently participating in or have you applied for other workforce incentive, scholarship, or loan repayment programs?*
  • Do you still have a service commitment for the program(s)?
  • Have you ever received a provider subsidy from another organization in Hawaii?*
  • Do you still have a service commitment on the subsidy?
  • Have you received loan repayment funding from the state of Hawaii?*
  • If yes, did you fulfill your service term agreement?
    • Upskilling (Complete only if applicable) 
    • Expected completion date:
       / /
    • Will you remain employed while completing your education?
    • Completion of this program will: (Choose all that apply)
    • Estimated date you will begin practicing in your new role:
       / /

  • Part C: Employment Information

  • Are you employed at a healthcare site?
  • Do you own a solo or small practice?*
  • Do you pay for your own malpractice?
  • Do you pay rent for your office space?
  • Do you need to update or purchase equipment?
  • Are you planning to open a new healthcare practice?
  • Rows
  • Do you participate in clinical teaching, precepting or workforce pipeline programs?*
  • If yes, check all activities you are actively participating in.
  • Rows
  • If no, would you be willing to teach students pursuing a career in healthcare?
  • Which workforce or community activities do you currently participate in? (Check all that apply)*
  • Do you provide interisland specialty coverage?*
  • Do you have educational debt?*
  • Are you in a residency program?*
  • What is your expected graduation date?
     / /
  • Are you in a fellowship program?*
  • What is your expected completion date?
     / /
  • Do you work full-time (36 hours per week, 45 weeks per year)?*
  • Are you planning to pursue additional training/certifications in the next 12 to 24 months?*
  • Are you currently experiencing recruitment or staffing shortages that limit patient access or service capacity?*
  • Are you accepting new patients?*
  • Are you planning to expand services, patient capacity or clinical offerings within the next 1-3 years?*
  • Do you currently serve or plan to serve culturally or linguistically underserved populations?*
  • Do you currently receive or qualify for other workforce support programs (loan repayment, tax credits, etc.)?*
  • Are there provider wellness or burnout concerns that may impact retention?*

  • Part D: Baseline Workforce & Access Measures

  • The following questions are intended to establish baseline information about your primary practice site and the rural community it serves. This information will help the HOME RUN Investment Committee evaluate workforce needs and measure program outcomes over time. Unless otherwise indicated, please answer these questions based on your primary practice site or organization. Solo practitioners should respond based on their individual practice.

  • If you provide care at multiple locations, please answer the following questions based on the primary practice site where you intend to fulfill your HOME RUN service commitment.

  • What rural service coverage do you participate in? Check all that apply:*
  • Rows
  • Approximately how far do your patients typically travel to receive care?*
  • Check all that apply:*
  • Rows
  • Rows
  • Rows
  • If this investment is awarded, which of the following outcomes do you anticipate? (Check all that apply)*
  • If you were no longer practicing in this community, what would most likely happen to your patients? (Check all that apply)*

  • Part E: Ties to Hawaii

  • Please check all that apply:*
  • Perform outreach activities in Hawaii?*

  • Part F: Applicant Certification

  • I certify that I am the person herein named subscribing to this application; that I have read the complete application, know the full content thereof, and declare under penalty of perjury, that all the information contained herein, and evidence or other credentials submitted herewith are true and correct and that I  am willing to sign, or have signed a HOME RUN participation agreement with a practice setting committing to an expected period of time in rural Hawaii of five years of direct patient service on a full-time (36 hours per week, minimum of 45 weeks per year) basis.

    I authorize representatives of the University of Hawaii, including but not limited to representatives from the John A. Burns School of Medicine, Hawaii Pacific Basin Area Health Education Center (UH JABSOM Hawaii Island AHEC and Hilo Benioff Medical Center Foundation), to contact educational institutions I attended, institutions holding any of the listed educational loans, and employers to verify the accuracy of the information contained in this application. I understand that the University of Hawaii/Hilo Benioff Medical Center Foundation will utilize an outside firm(s) to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will occur, and my application for the HOME RUN Investment Program will not be processed further.

    The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications and delinquent conduct committed as a juvenile. I understand that if I remain a participant, the criminal history records check, and credit check may be repeated at any time.

    I hereby affirm that my answers to the foregoing questions are true and correct and that I have not knowingly withheld any fact of circumstances that would, if disclosed, affect my application unfavorably. I understand that false information submitted in this application may result in my discharge and/or termination from the HOME RUN program.

    I understand that if I fail to satisfy the required service commitment, I may be subject to repayment obligations as outlined in the HOME RUN Participation Agreement.

    I understand that participants are expected to provide healthcare services consistent with applicable professional standards, evidence-informed practice, and all federal, state, and professional licensing requirements.

    I, the undersigned, do, for myself, my heirs, executors, and administrators, hereby waive, release, and discharge any and all claims, demands, actions, rights, and causes of action for any and all illness, personal or bodily injury, death, economic and property damage, severe emotional loss, and any other loss, damage, or injury (collectively the "Injuries/Damages"), that I may sustain or suffer from the investigation of my background in connection with my application to become a participant of the HOME RUN Investment Program (collectively the "Released Claims").

    I agree to indemnify, defend, and hold harmless the Hilo Benioff Medical Center Foundation and University of Hawaii, and its past, present and future Board of Regent members and University of Hawaii and Hilo Benioff Medical Center Foundation officers, employees, agents, and assigns from any and all Released Claims and any and all demands, actions, judgments, injunctions, orders, directives, penalties, assessments, liens, liabilities, losses, damages, costs, and expenses (including attorneys' fees), arising or resulting from or caused by the investigation of my background in connection with my application to become a participant of the HOME RUN Investment Program.

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  • Part G: Certification of Participating Site

    Please report the following information regarding your current workplace:

  • Participating Site Information
    (The next section is to be completed and signed by your main practice site)

    The remaining portion of Part G must be filled out by the participating site's certifier. Examples of certifiers include the site owner, lead finance officer, or an authorized official of the employer. 

    In the field below include ther certifier's email for them to complete the remaining portion of Part G. Once completed, Part G will automatically be submitted with Applicant's name. All parties will be notified that Part G has been submitted.

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