Hawaii Medicaid pays for in-home personal care and related services through 3 programs, including the QUEST Integration HCBS (institutional level of care) and the QUEST Integration HCBS ("At Risk" population). Hawaii delivers long-term services and supports for aged and disabled members through the QUEST Integration Section 1115 demonstration (approved January 8, 2025 through December 31, 2029), with services set in each member's Care Coordination Plan; the DOH Developmental Disabilities Division operates the separate 1915(c) waiver for intellectual and developmental disabilities. Confirm EVV requirements with Med-QUEST.
Which Hawaii waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
QUEST Integration HCBS (institutional level of care)
Population
QUEST Integration members who meet institutional level of care ("1147 certified") and choose to receive care at home or in the community.
Services covered
personal assistance
respite care
adult day care
adult day health
home delivered meals
home maintenance
personal emergency response system
community care foster family homes
specialized case management
Billing format
Delivered through QUEST Integration managed care health plans; rates paid by each health plan may differ from Med-QUEST's fee-for-service HCBS rates.
Members who do not meet institutional level of care but are assessed to be at risk of deteriorating to it (formerly the "Personal Care-Level I/Chore" population).
Services covered
personal assistance
adult day care
adult day health
home delivered meals
personal emergency response system
assisted living facility
Billing format
Delivered through QUEST Integration managed care health plans.
People with intellectual and/or developmental disabilities who meet DDD eligibility.
Services covered
personal assistance/habilitation
chore
respite (family home only)
adult day health
community learning services
non-medical transportation
residential habilitation
personal emergency response system
Billing format
Providers sign a Medicaid Provider Agreement with the DHS Med-QUEST Division and deliver services authorized in the Individualized Service Plan; several services can also be consumer-directed.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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