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Hawaii - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Hawaii Department of Health, Developmental Disabilities Division (DOH/DDD) directly employs the case managers who conduct assessment, person-centered service planning, and monitoring for the 1915(c) I/DD Waiver. Private agencies cannot enroll as independent fee-for-service HCBS case management providers under this waiver, as the state retains this function internally to comply with federal conflict-free case management requirements.

For the 1115 QUEST Integration demonstration, care coordination is managed directly by the contracted Managed Care Organizations (MCOs). Entities wishing to provide care coordination services must either operate as a designated MCO or secure a delegated subcontract directly with an active QUEST Integration health plan rather than applying through the Med-QUEST Division (MQD) HOKU portal as a standalone case management agency.

1. Service Definition and Scope

In Hawaii, HCBS case management encompasses the development of the Individualized Service Plan (ISP), continuous monitoring of service delivery, and coordination across multiple systems. Under the I/DD waiver, DOH/DDD case managers facilitate the person-centered planning process and authorize waiver services.

For individuals enrolled in managed care, MCO service coordinators perform similar functions, ensuring members receive necessary medical, behavioral, and long-term services and supports.

2. Regulatory and Oversight Agencies

The Department of Human Services (DHS) Med-QUEST Division (MQD) serves as the single state Medicaid agency overseeing all waivers. The Department of Health, Developmental Disabilities Division (DOH/DDD) operates the 1915(c) waiver and directly employs the case managers.

MQD's Health Care Services Branch monitors the performance of the QUEST Integration MCOs, including their care coordination activities.

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii operates a closed system for HCBS case management. There is no open enrollment for private agencies to become standalone fee-for-service case management providers under the I/DD waiver.

Entities seeking to perform care coordination under the 1115 waiver must be procured as an MCO or secure a subcontract with an existing MCO.

4. Licensure and Certification Requirements

Because private agencies do not provide this service independently, there is no specific state facility license for an HCBS case management agency. Individual case managers employed by the state or MCOs must meet specific educational and professional qualifications.

Professionals performing specialized medical or behavioral case management must hold the appropriate Hawaii state licenses for their discipline.

5. Medicaid Provider Enrollment

Private entities cannot enroll as case management providers through the HOKU system. Agencies enrolling to provide other HCBS services use Form DHS 1139, but case management is not an available standalone enrollment type for private agencies.

MCOs and direct service providers use the HOKU portal to manage their Medicaid enrollment and revalidation.

6. Staffing, Training and Background Checks

State-employed case managers and MCO service coordinators must complete mandatory training on the HCBS Final Rule and person-centered planning. Background checks are required for all personnel interacting with vulnerable populations.

DOH/DDD provides ongoing training and quality guides for its internal case management staff.

7. Documentation, Policies and Records

Case managers must maintain comprehensive records of the person-centered planning process. The Individualized Service Plan (ISP) must document the participant's goals, preferences, and authorized services.

Hawaii utilizes electronic portals where case managers and providers can access person-centered service plans.

8. Billing, Rates and Claims

Case management under the I/DD waiver is funded as an administrative activity or through state appropriations, not billed as a fee-for-service claim by private providers. Under QUEST Integration, care coordination costs are included in the capitated rates paid to MCOs.

There is no fee schedule or procedure code for private agencies to bill Medicaid directly for HCBS case management.

9. Approval Sequence and Timeline

Since private agencies cannot apply, there is no approval sequence for independent case management enrollment. Individuals seeking to become case managers must apply for employment with DOH/DDD or an MCO.

For providers enrolling in other HCBS services, the standard Medicaid enrollment process applies.

10. Common Denials and Survey Findings

Oversight focuses on the performance of state case managers and MCOs rather than private agency surveys. CMS and state quality reviews frequently examine the adequacy of person-centered planning and conflict-free compliance.

Deficiencies typically involve documentation gaps or failure to update plans in a timely manner.

11. Key Contacts and Resources

Primary contacts for HCBS programs in Hawaii include the Med-QUEST Division and the Developmental Disabilities Division. MCOs handle inquiries related to QUEST Integration care coordination.

Prospective providers of other HCBS services should utilize the HOKU portal for enrollment information.

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