Self-Direction and FMS in Hawaii

All states: self-direction map

Hawaii self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Hawaii offer self-direction?

Hawaii offers self-direction in two Medicaid programs: QUEST Integration, the state's managed care program, and the Consumer-Directed (CD) Option in the Medicaid waiver for people with intellectual and developmental disabilities (I/DD). The two work differently. In QUEST Integration the member picks and directs the worker and the health plan pays that worker. In the I/DD waiver the participant is the employer, manages a budget and uses a state contractor for payroll.

• QUEST Integration Self-Direction (Self-Directed Personal Assistance Services): serves QUEST Integration members who are assessed as needing long-term services and supports at home, mainly older adults and people with disabilities. It is run by the Department of Human Services, Med-QUEST Division, through the QUEST Integration health plans (AlohaCare, HMSA, Kaiser Permanente, 'Ohana Health Plan and UnitedHealthcare Community Plan) under a Section 1115 demonstration. The member, or a surrogate acting for the member, selects and directs the worker, which is employer authority. We did not find a current statement on whether the member has budget authority.
• Consumer-Directed (CD) Option, Medicaid I/DD Waiver: serves children and adults with intellectual and developmental disabilities who are enrolled in the 1915(c) I/DD waiver. It is run by the Department of Health, Developmental Disabilities Division (DDD), with Med-QUEST as the state Medicaid agency. The participant, or a designated representative, has both employer authority and budget authority. Services that can be consumer-directed are Chore, Community Learning Services-Individual, Personal Assistance/Habilitation and Respite.

Employer authority means the person recruits, hires, schedules and supervises the workers. Budget authority means the person also manages a set amount of money for the services. In the CD Option the employer sets each worker's hourly wage within a pay range, can move dollars between most CD services, and can choose to buy workers' compensation coverage from the budget, according to the DDD CD Employer Handbook (June 2026). The handbook says the CD Option was added to the waiver in 2005 and budget authority in 2016.

In QUEST Integration, self-direction is offered for Personal Assistance Level I (chore services) and Level II (hands-on care). Members choose Agency, Self-Direction or both for each on the LTSS Choice Form, which health plans and community care management agencies have been required to use since April 1, 2025. We did not find confirmation that respite care can be self-directed in QUEST Integration today. Ask the member's health plan.

Who handles financial management services (FMS) in Hawaii?

It depends on the program. In the I/DD waiver CD Option, the state names Acumen Fiscal Agent as the Fiscal/Employer Agent (F/EA), and the participant or a designated representative is the legal employer. In QUEST Integration, each health plan pays its own members' self-directed providers. Participants do not choose among FMS vendors in either program, as far as the sources show.

A Fiscal/Employer Agent is an organization that handles the paperwork side of being an employer. It processes payroll, withholds and files taxes, and pays the workers on the employer's behalf, while the participant stays the employer.

• I/DD waiver CD Option: the participant, or a designated representative, is the common law employer and gets a federal employer identification number (EIN). Acumen Fiscal Agent processes payroll, withholds and files taxes, tracks the CD budgets and files the Medicaid claims. Acumen supplies the pay range, the employer sets each worker's hourly wage within it (at least minimum wage), and workers are paid twice a month.
• Designated representatives: a designated representative who acts as employer must be at least 18, must live on the same island as the participant and cannot be paid. A legal guardian is expected to serve as the designated representative.
• QUEST Integration Self-Direction: Med-QUEST's memo QI-2602 (February 6, 2026) confirms that the health plans pay self-directed providers. Since January 1, 2026, those providers are paid twice a month. The state's 2018 demonstration extension application describes the plans withholding taxes and setting the payment structure. We did not find a current document that repeats that description.
• Acumen and Kaiser Permanente: Acumen's Hawaii page lists a Kaiser Permanente program along with the DDD CD Option. We did not find a primary source that names the payroll vendor, if any, for the other four health plans.

Two points about QUEST Integration could not be confirmed. The sources we read do not use standard FMS terms for this program, and they do not say whether the member is formally the employer of record. They also do not say whether the member has any say over the worker's pay rate. For either question, ask the member's health plan or write to Med-QUEST at EVV-MQD@dhs.hawaii.gov, the mailbox given in memo QI-2602.

Who can be a paid caregiver under self-direction in Hawaii?

Family members can be paid in Hawaii, with limits that are spelled out for the I/DD waiver. In the CD Option a spouse cannot be a paid worker, and neither can a legal guardian or a designated representative. Parents, step-parents and legal guardians cannot be paid for services to a minor child. For QUEST Integration we did not find a current, readable statement of the family rules.

• I/DD waiver CD Option, who cannot be paid: spouses of participants, legal guardians, designated representatives, and parents, step-parents or legal guardians of a minor child.
• I/DD waiver CD Option, co-guardians: when an adult participant has co-guardians, one co-guardian may be the employer and the other may be the paid employee.
• I/DD waiver CD Option, hours and overtime: employees are entitled to time and a half for hours over 40 in a Sunday to Saturday workweek. Overtime is charged to the participant's service budget. Live-in employees may be exempt from overtime, and the FMS contractor makes that decision.
• QUEST Integration Self-Direction: not confirmed, as noted above. We did not find a published weekly hour cap for self-directed workers in this program either.

These limits come from the DDD CD Employer Handbook dated June 1, 2026. Questions about a specific family situation in the CD Option go to the participant's DDD case manager or to Acumen.

Does EVV apply to self-directed workers in Hawaii?

Yes. Electronic visit verification (EVV) applies to self-directed workers in both programs. Med-QUEST says self-direct members and providers must use the state Sandata EVV system, and that self-direct and consumer-directed services must be captured in EVV to receive payment. The alternate EVV option, which lets a provider use a different system, is offered only to provider agencies.

• QUEST Integration Self-Direction: members and their workers use the state Sandata system, according to Med-QUEST's EVV FAQs.
• I/DD waiver CD Option: EVV is required for consumer-directed Chore, Personal Assistance/Habilitation and Respite. It is not required for Community Learning Services-Individual. The FMS contractor administers EVV time entry, and the employer arranges the EVV method with it. An employer whose workers do not use a required EVV method can be terminated from the CD Option.
• Manual edits: Med-QUEST monitors each account by the member's Medicaid ID against a limit of 15 percent of visits that are manually edited or entered. The health plan or DDD may move a member who does not comply to a provider agency, under memo QI-2305C (August 15, 2024).

Two points could not be confirmed. We did not find a published EVV exemption for live-in self-directed caregivers. The DDD handbook mentions live-in status only for overtime. We also did not find which tool I/DD waiver workers clock into day to day, because the handbook does not name the EVV system. Ask Acumen (HI-CDO@acumen2.net) for the CD Option, or the member's health plan for QUEST Integration.

What is changing next for self-direction in Hawaii?

The next dated item is about pay timing in QUEST Integration. A state labor department exception lets health plans pay self-directed workers up to 15 days after a pay period ends, and it expires July 20, 2027 unless it is renewed. This is a pay timing rule, not a change to who can self-direct or which services are covered.

The exception is to Hawaii Revised Statutes Chapter 388, the state wage payment law, and is described in Med-QUEST memo QI-2602. Under it, a self-directed provider whose work is terminated must be paid by the next working day. An earlier exception allowed health plans to pay once a month, and that ended when twice-monthly pay began on January 1, 2026. We did not find a statement on whether the state plans to renew the current exception.

Three other items have been announced without dates, so treat them as things to watch:

• EVV vendor contract: Med-QUEST said in an October 2025 memo that it will seek new bids for the state EVV vendor contract. This matters to self-direction because self-directed workers must use the state system. No request for proposals date or transition date has been published.
• Payment withhold for manual edits: Med-QUEST has described a payment withhold for self-direct and consumer-directed accounts with too many manual edits as to be determined at a future date. That has been the wording since 2024, and no date is set.
• Non-Medical Transportation: DDD's Consumer-Directed Option page lists Non-Medical Transportation as a consumer-directed service that is coming soon, with no date.

Hawaii self-direction sources

• Hawaii DOH Developmental Disabilities Division: Consumer-Directed (CD) Option
• Hawaii DOH Developmental Disabilities Division: CD Employer Handbook (June 2026)
• Med-QUEST memo QI-2602: Exception to HRS Chapter 388, Self Direct Provider (February 6, 2026)
• Med-QUEST memo QI-2502: LTSS Choice Form
• Med-QUEST: QUEST Integration 1115 Waiver Extension Application (2018)
• Med-QUEST: Electronic Visit Verification FAQs
• Med-QUEST memo QI-2305C: EVV Manual Editing and Entry of Visits (August 15, 2024)
• Med-QUEST memo QI-2520: EVV Vendor Issued Smartphone Device Memo (October 2025)
• Acumen Fiscal Agent: Hawaii programs

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Hawaii EVV requirements

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.