I/DD Waivers in Hawaii

All states: Medicaid disability services map

Hawaii I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Hawaii?

Two state departments share the work. The Department of Human Services, Med-QUEST Division (DHS/MQD) is Hawaii's Medicaid agency. The Department of Health, Developmental Disabilities Division (DOH/DDD) runs the state's one I/DD waiver for Med-QUEST under a memorandum of agreement, and DDD's own state case managers plan and authorize every waiver service.

• Med-QUEST Division (DHS/MQD): the state Medicaid agency. It decides who can enter the waiver (Medicaid eligibility and level of care), enrolls providers and pays claims through its fiscal agent.
• Developmental Disabilities Division (DDD): operates the waiver day to day. DDD decides who is eligible for DDD services, reviews providers before they enroll, sets the fee schedule with Med-QUEST's approval and monitors EVV.
• Front door: the DDD intake office on the person's island. The Oahu office is (808) 733-1689 (TTY 711), doh.dddintake@doh.hawaii.gov. Maui and Lanai, Molokai, Kauai, Kona, Hilo and Waimea have their own intake offices.
• Case management: DOH/DDD state case managers build each person's Individualized Service Plan and prior authorize all waiver services.

What Medicaid waivers and programs serve people with I/DD in Hawaii?

Hawaii has one I/DD waiver: the HCB Services for People with Intellectual and Developmental Disabilities waiver, usually called the Medicaid I/DD Waiver. It is a 1915(c) waiver, a federal Medicaid option that lets a state pay for home and community services instead of institutional care. It serves children and adults of all ages, and CMS approved its five-year renewal (control number HI.0013.R09.00) on June 24, 2026, effective July 1, 2026.

• Who it serves: people with intellectual or developmental disabilities who are eligible for DDD, eligible for Medicaid with the long-term care benefit, and meet the level of care for an intermediate care facility for individuals with intellectual disabilities (ICF/IID). Med-QUEST sets the first level of care decision and DDD does the reevaluations.
• Size: the renewal approves 2,998 participants in year 1, rising to 3,237 in year 5. DDD served 3,567 people in fiscal year 2025, 3,034 of them on the waiver.
• Residential services: Residential Habilitation, Residential Care Supports (new July 1, 2026) and Additional Residential Supports.
• Day and employment services: Adult Day Health, Community Learning Services (individual and group), Discovery and Career Planning, and Individual Employment Supports.
• In-home and family supports: Personal Assistance/Habilitation, Personal Care Assistance (new July 1, 2026), Respite, Chore and Private Duty Nursing.
• Other services: Community Navigator, Non-Medical Transportation, Training and Consultation, Waiver Emergency Services, Assistive Technology, Environmental Accessibility Adaptations, Personal Emergency Response Systems (PERS), Specialized Medical Equipment and Supplies, and Vehicle Modifications.

ICF/IID care is the institutional option that the waiver is an alternative to. DDD also runs two state-funded programs, LASR and FSSP, for people who are eligible for DDD but not on the waiver; these are not Medicaid programs. Hawaii's QUEST Integration health plans cover waiver members' regular medical care, but not waiver services.

Does Hawaii pay for I/DD services through managed care?

No. Hawaii pays I/DD waiver services fee-for-service, not through health plans. DDD case managers authorize the services, the Med-QUEST fiscal agent loads those authorizations into the state's Medicaid claims system (HPMMIS), and providers bill the fiscal agent electronically or on a CMS 1500 claim form.

• Health plans: waiver members are also in QUEST Integration, Hawaii's Medicaid managed care program under an 1115 demonstration. Those health plans cover state plan medical services such as doctor visits, not waiver services.
• Who coordinates services: DDD state case managers, not health plan care coordinators.

Is there a waiting list for I/DD services in Hawaii?

No. State law (HRS 333F-6) requires DDD to keep and report waiting lists, and the Department of Health's December 2025 report to the Legislature says no one was waitlisted for DDD services in fiscal year 2025 and there was no I/DD Waiver waiting list as of June 30, 2025.

• How entry works: the 2026 waiver application says people are admitted as soon as they are approved, and crisis applications are expedited.
• Slots: the state does not cap enrollment at any point in time and does not reserve slots for particular groups.
• Next report: the fiscal year 2026 report is due in December 2026. Until it is out, the no waiting list finding rests on the fiscal year 2025 report.

How do people apply for I/DD services in Hawaii, and how are budgets set?

A person or family calls or emails the DDD intake office on their island, sends the requested documents and has an intake interview. DDD decides eligibility within 30 working days of a complete application. Joining the waiver is a second, separate application that Med-QUEST decides, and the DDD case manager helps with it. Adults are then assessed with the Supports Intensity Scale-Adult Version (SIS-A), which sets their budget range.

• DDD eligibility: U.S. citizenship or qualifying status (including people from the Compact of Free Association nations), Hawaii residency, and an intellectual or developmental disability as defined in HRS 333F-1 and HAR 11-88.1. Children from birth to age 9 may qualify based on a developmental delay and must be reassessed by age 9.
• Timeline: the applicant has 90 working days to complete the file. All applications go to the Oahu Intake Section for a decision, as described in the DDD Intake Booklet.
• Waiver eligibility: ICF/IID level of care and Medicaid eligibility with the long-term care benefit, decided by Med-QUEST.
• Assessment: adults 18 and older are assessed with the SIS-A by an assessor recognized by the American Association on Intellectual and Developmental Disabilities (AAIDD), at least every three years. The July 2026 renewal moved to the SIS-A 2nd Edition.
• Budgets: SIS-A results place each adult in one of 7 levels. The level sets the person's Individual Supports Budget range, which also varies by living setting and by Oahu or neighbor island, and the rate tier for shared services.
• Self-direction: the Consumer-Directed option lets participants hire and manage their own workers, with employer and budget authority, for Chore, Community Learning Services-Individual, Personal Assistance/Habilitation and Respite.

What day and residential services can I/DD providers offer in Hawaii?

Waiver agencies can offer Adult Day Health, Community Learning Services and two employment services during the day, and three residential services in homes that the Department of Health licenses or DDD certifies. Hawaii does not use group homes by that name. Residential services happen in DD Domiciliary Homes, Adult Residential Care Homes and certified Adult Foster Homes. Standards are in DDD's Waiver Provider Standards Manual, revised effective July 1, 2026.

Day and employment services

• Adult Day Health (ADH): center-based activities that build daily living, communication, social and choice-making skills, with personal care and nurse delegation as needed and transport from home included in the rate. It is meant to be paired with group Community Learning Services in the community. Billed in 15-minute units. The provider must be an enrolled waiver agency meeting the waiver standards and the federal home and community settings rule, with a yearly fire inspection; we did not find a separate DDD license. Recommended staffing is 1:6 for tier 1 (SIS levels 1 to 2), 1:4 for tier 2 (levels 3 to 4) and 1:3 for tier 3 (levels 5 to 7), and never more than one staff to six participants. Short-term 1:1 staffing needs an exceptions review.
• Community Learning Services (CLS): activities in community places alongside people without disabilities, to build independence, communication and friendships. CLS-Group staffing is recommended at 1:3 (tier 1), 1:2 (tier 2) and 2:3 (tier 3), and never more than 1:3. The individual version can also be consumer directed. We did not confirm the billing unit from a current rate sheet.
• Discovery and Career Planning and Individual Employment Supports: services aimed at a competitive job in the community. The 2026 renewal aligned both with federal customized employment and competitive integrated employment definitions. The research did not find a published ratio or confirm the billing unit.

Residential services

• Residential Habilitation (ResHab): skill building, help with daily living, community inclusion and transportation for people living in a licensed or certified home. Authorized per day and billed up to 344 days per plan year; room and board are not included. Agencies must visit each home monthly. Homes are DD Domiciliary Homes (HRS 333F, HAR 11-89) or Adult Residential Care Homes and Expanded ARCHs (HAR 11-100.1), licensed by DOH's Office of Health Care Assurance (OHCA), or Adult Foster Homes (HAR 11-148) certified by DDD.
• Residential Care Supports (RCS): new July 1, 2026. Personal care and support from a live-in primary caregiver in a certified Adult Foster Home or other licensed or certified home, without skill-building training. Authorized per day, up to 344 days per plan year, paid at ResHab rates, and not billable on the same day as ResHab.
• Additional Residential Supports (ARS): short-term 1:1 staff added in a certified Adult Foster Home, DD Domiciliary Home or other licensed setting named in the waiver. The renewal extended the short-term limit from 60 to 90 days.

How are I/DD provider rates set and how do agencies enroll in Hawaii?

DDD sets one statewide fee schedule, approved by Med-QUEST, so every agency is paid the same rate for the same service. The rates come from rate models in a full rate study done at least every five years, most recently in 2024 by the Burns and Associates division of Health Management Associates. Rates rose for 13 services on January 1, 2026. Agencies enroll by applying to DDD first and then to Med-QUEST.

• Rate structure: Residential Habilitation, Adult Day Health and CLS-Group are tiered by SIS level (7 levels grouped into 3 rate tiers), and rates are higher off Oahu. Equipment, adaptations and vehicle modifications are priced case by case, and Waiver Emergency Services are cost settled.
• Latest rate change: CMS approved amendment HI.0013.R08.12 on November 14, 2025, raising rates effective January 1, 2026 for services including Personal Assistance/Habilitation, Residential Habilitation, Adult Day Health, Community Learning Services, employment services, Respite, Chore and Private Duty Nursing. The increase was based on the 2024 rate study and Hawaii's higher minimum wage.
• New supplemental payments (from July 1, 2026): $1,250 per quarter for each direct support professional (DSP) the agency employs who holds National Alliance for Direct Support Professionals (NADSP) level 1 certification; $5,000 when a member keeps a new competitive job for 90 days; and $5,000 (plus $2,500 for a second placement) for a stable placement in a newly certified neighbor island Adult Foster Home.
• Rate sheet: DDD's provider page lists a rate sheet effective July 1, 2026 as coming soon. The newest posted rate sheet is effective July 1, 2025 and mainly updated service codes and modifiers.
• Enrollment: agencies apply to DDD's Community Resources Branch ((808) 733-2135), which reviews program and fiscal requirements within 90 days and may visit the site. If DDD recommends the agency, it enrolls with Med-QUEST using form DHS 1139 and a $500 fee. No one may be served until the agency has a signed Medicaid provider agreement, a Med-QUEST approval letter and DDD's employee validation approval letter. Details are on DDD's prospective provider page.
• EVV: electronic visit verification is required for Chore, Personal Assistance/Habilitation, Personal Care Assistance, Respite and Private Duty Nursing, for agencies and for the Consumer-Directed option. Hawaii uses Sandata as its state EVV system and aggregator. Agencies may use a Sandata-certified alternate system, but consumer-directed workers must use Sandata. DDD reviews manual visit edits each month against a 15 percent benchmark.

What is changing next for I/DD services in Hawaii?

As of October 23, 2026, we did not find a confirmed change with a set date ahead for Hawaii's I/DD services. The largest recent change, the waiver renewal, took effect on July 1, 2026. Med-QUEST has announced that it will re-procure its statewide EVV vendor contract, but no date has been published.

• EVV vendor re-procurement (announced, not final): Med-QUEST memo QI-2520 (October 2025) says the EVV vendor contract, held today by Sandata, will be re-procured through a request for proposals. We did not find a release, award or transition date. Agencies can ask Med-QUEST at EVV-MQD@dhs.hawaii.gov.
• July 1, 2026 renewal (in place): the approved renewal added Personal Care Assistance (with EVV) and Residential Care Supports, extended Additional Residential Supports to 90 days, raised Private Duty Nursing limits, moved to the SIS-A 2nd Edition and added the three supplemental payments described above.
• 2026 rate sheet: DDD has not yet posted the rate sheet effective July 1, 2026. Ask the Community Resources Branch whether rates changed on that date or only service codes.

Hawaii I/DD sources

• Hawaii DOH Developmental Disabilities Division
• CMS approval letter: Hawaii I/DD Waiver renewal effective July 1, 2026
• Hawaii 1915(c) HCBS Medicaid Waiver application (approved, July 2026)
• CMS approval letter: amendment HI.0013.R08.12 (rates effective January 1, 2026)
• Hawaii DOH: DDD annual report to the 2026 Legislature (waiting list)
• DDD Intake Booklet
• DDD: Supports Intensity Scale
• DDD Waiver Provider Standards Manual (effective July 1, 2026)
• DDD: Prospective Medicaid I/DD Waiver provider
• Med-QUEST memo QI-2520: EVV vendor issued smartphone device

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• What is Active Support in Disability Services?
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Hawaii EVV requirements

Other states that report no I/DD waiting list

California, Minnesota, Nebraska, Wisconsin. See every state on the I/DD services map.

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.