Hawaii - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Hawaii, Adult Companion Services provide non-medical care, supervision, and socialization to help adults with functional impairments remain safely in their homes and communities. Hawaii does not issue a standalone "Adult Companion Agency" state license. Instead, these services are governed as Home and Community-Based Services (HCBS) under the state's 1115 QUEST Integration (QI) waiver or the 1915(c) waiver for Individuals with Intellectual and Developmental Disabilities (I/DD). Providers must meet the certification standards of the waiver program they intend to serve.

The single biggest structural barrier to entry for this service in Hawaii is the managed care contracting requirement. Enrolling as a Medicaid provider through the state's portal is only a preliminary step; to actually receive clients and bill for services, a provider must successfully secure a network contract with one or more of the QUEST Integration Health Plans (Managed Care Organizations) or obtain formal certification from the Department of Health's Developmental Disabilities Division (DOH-DDD). If the MCO networks in a specific county are closed due to adequate capacity, a new provider cannot operate.

1. Service Definition and Scope

Adult Companion Services in Hawaii consist of non-medical supervision, socialization, and assistance provided to a participant who requires support to avoid institutionalization. The service is designed to ensure the health and safety of the individual while promoting community integration.

This service is strictly non-medical. If a provider intends to offer hands-on personal care, nursing tasks, or medication administration, they cross the threshold into home health or personal care, which requires a formal Home Care Agency license from the state.

• Target Population: Medicaid-eligible adults enrolled in the QUEST Integration waiver or the I/DD waiver who require supervision.
• Covered Activities: Socialization, supervision, cueing, and light assistance with incidental activities of daily living (IADLs) like meal prep during the visit.
• Excluded Activities: Hands-on personal care, medication administration, wound care, and medical treatments.
• Setting: Delivered in the participant's private residence or integrated community settings.
• HCBS Final Rule: Services must comply with federal settings requirements, ensuring the participant has access to the broader community.

2. Regulatory and Oversight Agencies

Medicaid in Hawaii is administered by the Department of Human Services (DHS), specifically the Med-QUEST Division (MQD). MQD oversees the overarching 1115 QUEST Integration waiver and manages the centralized provider enrollment system.

Day-to-day oversight and authorization of services are delegated to the contracted Managed Care Organizations (MCOs) and the Department of Health. If a provider expands into personal care, the Department of Health's Office of Health Care Assurance (OHCA) becomes the licensing authority.

• DHS Med-QUEST Division (MQD): The state Medicaid agency responsible for overall waiver compliance and the HOKU provider enrollment system.
• QUEST Integration Health Plans: The MCOs (e.g., HMSA, AlohaCare, Kaiser Permanente) that credential providers, authorize care, and pay claims.
• DOH Developmental Disabilities Division (DDD): Operates the 1915(c) I/DD waiver and conducts readiness reviews for I/DD companion providers.
• DOH Office of Health Care Assurance (OHCA): The agency that licenses Home Care Agencies, required only if the provider adds hands-on personal care.
• Hawaii Department of Commerce and Consumer Affairs (DCCA): Regulates business registrations and corporate standing in the state.

3. Gatekeeping Prerequisites: Who Can Even Apply

Because Hawaii does not license this specific service category, the primary gatekeepers are the Medicaid enrollment system and the managed care networks. A provider cannot simply open an agency and bill the state.

Before an application for Medicaid enrollment is fully actionable, the provider must navigate network adequacy reviews by the MCOs or certification by the DDD. If an MCO determines it has enough companion providers in a specific zip code or island, it will deny the network contract, rendering the Medicaid enrollment functionally useless.

• MCO Network Contracting: Must secure a contract with a QUEST Integration Health Plan; subject to closed networks or moratoriums based on regional capacity.
• DOH-DDD Certification: Required prerequisite if intending to serve the I/DD waiver population; involves a rigorous pre-certification readiness review.
• HOKU Registration: Mandatory prerequisite; MCOs will not credential an agency that is not fully approved in the Med-QUEST HOKU system.
• Business Registration: Must hold an active, "Good Standing" business registration with the Hawaii DCCA.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) prior to initiating the HOKU application.

4. Licensure and Certification Requirements

Hawaii does not have a statutory license named "Adult Companion Agency." Providers offering strictly non-medical companion services operate without a facility or agency license from OHCA, relying instead on their Medicaid enrollment and MCO/DDD credentialing to operate legally.

However, if the business model includes any hands-on personal care (bathing, dressing, feeding), the provider must apply for a Home Care Agency license from OHCA under Hawaii Administrative Rules Title 11, Chapter 97, before they can be credentialed for those specific codes.

• Statutory License: None exists for strictly non-medical companion services in Hawaii.
• Home Care Agency License: Required via OHCA only if services cross into hands-on personal care or nursing.
• DDD Provider Certification: Required for I/DD waiver providers; involves policy review, staff credential verification, and site inspection by DOH-DDD.
• HCBS Final Rule Compliance: Providers must pass a state assessment demonstrating they integrate participants into the community and do not isolate them.
• Liability Insurance: MCOs and DDD require proof of commercial general liability and professional liability insurance prior to certification.

5. Medicaid Provider Enrollment

All Medicaid providers in Hawaii must enroll through the Med-QUEST Division's Hawaii Online Kahu Utility (HOKU) system. This system centralizes the screening and validation of providers before they can interact with the MCOs.

Under the Affordable Care Act, HCBS providers are subject to enhanced screening. This includes a mandatory application fee and potential on-site visits by MQD to verify operational readiness and compliance with enrollment standards.

• Enrollment Portal: HOKU (Hawaii Online Kahu Utility) Provider Enrollment System.
• Application Form: DHS 1139 (Medicaid Provider Application), submitted electronically via HOKU.
• Application Fee: $500 fee required for institutional and HCBS providers upon initial enrollment and revalidation.
• Risk Categorization: HCBS providers are typically designated as moderate or high risk, triggering mandatory site visits by MQD.
• Revalidation: Providers must revalidate their enrollment in HOKU every five (5) years.
• Ownership Disclosure: Must disclose all individuals or entities with 5% or more direct or indirect ownership.

6. Staffing, Training and Background Checks

Direct care staff providing companion services must meet strict background and training requirements to ensure participant safety. Because these services are delivered in vulnerable individuals' homes, the state mandates comprehensive registry and criminal history checks.

High-risk providers and their owners are subject to fingerprint-based background checks. All staff must complete basic safety training and waiver-specific education before providing billable services.

• Criminal Background Check: Fingerprint-based state and federal background checks required for owners (5%+) and direct care staff.
• Registry Screenings: Mandatory clearance through Adult Protective Services (APS) and the Child Abuse and Neglect (CAN) registry.
• Basic Certifications: All direct care staff must hold current CPR and Basic First Aid certifications.
• Mandatory Reporting Training: Staff must be trained on Hawaii state law requirements for reporting abuse, neglect, and exploitation.
• Age Requirement: Direct care companions must be at least 18 years of age.
• Universal Precautions: Documented training on infection control and universal precautions is required.

7. Documentation, Policies and Records

Providers must maintain detailed administrative and client records that are subject to audit by MQD, DOH-DDD, and the QUEST Integration MCOs. Failure to maintain these records can result in immediate recoupment of funds.

Hawaii mandates the use of Electronic Visit Verification (EVV) for in-home services. Providers must have the technological infrastructure to capture the exact time and location of service delivery.

• EVV System: Must utilize an operational Electronic Visit Verification system to electronically log check-in and check-out times for every shift.
• Person-Centered Care Plan: Services must strictly align with the authorized care plan developed by the MCO or DDD service coordinator.
• Personnel Files: Must contain background check clearances, I-9s, training certificates, and performance evaluations.
• Incident Reporting Policy: Must have written procedures for reporting adverse events to the authorizing MCO or DDD within 24 hours.
• Record Retention: Medicaid records, including EVV data and care notes, must be retained for a minimum of ten (10) years in Hawaii.
• Daily Progress Notes: Staff must document the specific socialization and supervision activities provided during each shift.

8. Billing, Rates and Claims

In Hawaii's managed care environment, providers do not typically bill the state Med-QUEST Division directly for companion services. Instead, claims are submitted to the specific QUEST Integration Health Plan that covers the participant.

Rates are either negotiated directly with the MCOs or established by the DOH-DDD fee schedule for the I/DD waiver. All claims must be supported by matching EVV data to be approved for payment.

• Billing Destination: Claims are submitted to the participant's specific MCO (e.g., HMSA, Ohana) or the DDD fiscal intermediary.
• Prior Authorization: 100% of companion services require prior authorization from the MCO or DDD before services begin.
• Coding: Billed using standard HCPCS codes (e.g., S5135 for companion care) as dictated by the MCO contract.
• EVV Linkage: Claims will be denied if they do not perfectly match the electronic check-in/out data captured by the EVV system.
• Rate Structure: Reimbursed in 15-minute increments or hourly units, depending on the specific waiver and MCO contract.
• Timely Filing: Claims must typically be submitted within 120 to 365 days of the date of service, depending on the specific MCO's timely filing limits.

9. Approval Sequence and Timeline

Becoming a fully operational provider is a multi-step process that can take 6 to 12 months. Providers must sequence their applications correctly, as MCOs will not review a contract request without an approved HOKU profile.

The timeline is heavily dependent on the provider's responsiveness to document requests and the scheduling of the MQD or DDD site visits.

• Step 1: Register the business with Hawaii DCCA and obtain a Type 2 NPI (1-2 weeks).
• Step 2: Submit the DHS 1139 application and $500 fee via the HOKU portal (30-90 days for MQD review).
• Step 3: Complete fingerprinting, APS/CAN checks, and pass the MQD on-site visit (concurrent with HOKU review).
• Step 4: Apply for DOH-DDD certification or submit network participation requests to QUEST Integration MCOs (90-180 days).
• Step 5: Execute MCO contracts, complete EVV system training, and begin receiving client authorizations.

10. Common Denials and Survey Findings

Applications are frequently delayed at the HOKU stage due to incomplete ownership disclosures or failure to complete the required APS/CAN background checks. At the contracting stage, MCOs often deny providers simply because their network is full.

During post-enrollment audits, the most common citations involve EVV discrepancies and providing services outside the scope of the authorized care plan.

• Network Adequacy Denials: MCOs rejecting credentialing applications because they already have sufficient companion providers in the region.
• HOKU Application Errors: Failure to list all individuals with 5% or more ownership or missing the $500 application fee.
• Background Check Failures: Direct care staff beginning work before the APS, CAN, and fingerprint checks are fully cleared.
• EVV Non-Compliance: Billing for hours that lack corresponding electronic check-in/out data, leading to immediate recoupment.
• Care Plan Deviations: Billing for companion services when the staff actually performed unauthorized hands-on personal care.
• HCBS Final Rule Violations: Failing to demonstrate that the service promotes community integration, resulting in DDD certification denial.

11. Key Contacts and Resources

Prospective providers must interact with multiple state portals and divisions. The HOKU system is the starting point for all Medicaid enrollment activities.

For waiver-specific requirements, providers should consult the Med-QUEST Division for QUEST Integration or the Department of Health for the I/DD waiver.

• Med-QUEST Division (MQD): hcsbinquiries@dhs.hawaii.gov or 808-692-8099 for general HCBS and HOKU inquiries.
• HOKU Portal: The official Hawaii Medicaid provider enrollment website for submitting the DHS 1139.
• DOH Developmental Disabilities Division (DDD): Contact for 1915(c) waiver provider certification and readiness reviews.
• DOH Office of Health Care Assurance (OHCA): Contact for Home Care Agency licensing if expanding into personal care.
• Hawaii DCCA: Business Registration Division for establishing corporate entities in the state.
• QUEST Integration MCOs: Provider relations departments at HMSA, AlohaCare, Kaiser Permanente, Ohana Health Plan, and UnitedHealthcare.

See all Hawaii services · Hawaii Medicaid consulting · book a consultation.