Hawaii - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Hawaii, housing stabilization and tenancy support services are delivered under the Community Integration Services Plus (CIS+) program, a Medicaid benefit within the state’s QUEST Integration (QI) Section 1115 Demonstration Waiver. Expanded in 2026, CIS+ provides eligible members experiencing homelessness or housing instability with vital housing navigation (pre-tenancy) and tenancy-sustaining supports. These services are funded by Medicaid but administered entirely by Hawaii’s managed care organizations (MCOs) and the specialized Community Care Services (CCS) behavioral health plan.

The single biggest structural barrier to entry for prospective CIS+ providers in Hawaii is the strict Continuum of Care (CoC) gatekeeping requirement: before a provider can even submit a Medicaid enrollment application to Med-QUEST, they must obtain a formal confirmation letter from Partners in Care (for Oahu) or Bridging the Gap (for Neighbor Islands) verifying their active participation in the local homeless services network. Furthermore, because Hawaii operates its Medicaid program exclusively under managed care, providers are locked out of reimbursement unless they successfully secure contracts with the individual QI health plans.

1. Service Definition and Scope

The Community Integration Services Plus (CIS+) program provides specialized interventions to help Medicaid members attain and maintain safe, affordable housing. The program is divided into two main housing support categories: housing navigation (pre-tenancy) and tenancy sustaining services.

CIS+ is strictly a supportive service benefit; it does not pay for room and board, rent, or utility costs. The goal is to address the health-related social needs (HRSN) of vulnerable populations by providing case management and skills training directly linked to housing retention.

• Program Name: Community Integration Services Plus (CIS+)
• Housing Navigation (Pre-Tenancy): Includes identifying member needs, assisting with the housing search process, completing applications, and arranging move-in details.
• Tenancy Sustaining Services: Includes tenant/landlord education, lease compliance coaching, eviction prevention, and community inclusion assistance.
• Eligible Populations: QUEST Integration members aged 18 or older who are homeless, at risk of homelessness, or transitioning from an institution, and who meet specific health-needs criteria.
• Excluded Costs: CIS+ funds cannot be used to pay direct housing expenses such as rent, utility bills, or security deposits.

2. Regulatory and Oversight Agencies

Because Hawaii operates its entire Medicaid program under an 1115 Waiver managed care model, oversight is shared between state government divisions, local housing networks, and private health plans. The state sets the overarching rules, while the individual health plans handle daily authorization and quality oversight.

Providers must interface directly with both the regional homeless Continuums of Care (CoCs) for foundational standing, and the health plans for service delivery and payment.

• State Medicaid Agency: Department of Human Services (DHS), Med-QUEST Division (MQD).
• Behavioral Health Authority: Community Care Services (CCS), a specialized Medicaid plan for members with severe mental illness.
• Managed Care Organizations (MCOs): QUEST Integration (QI) health plans (e.g., HMSA, Kaiser Permanente, AlohaCare, ‘Ohana Health Plan, UnitedHealthcare Community Plan).
• Oahu Homeless Network: Partners in Care (PIC) – oversees the Coordinated Entry System and network participation for Oahu.
• Neighbor Islands Homeless Network: Bridging the Gap (BTG) – oversees network participation for Hawaii, Maui, and Kauai counties.

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii imposes strict structural preconditions that block an applicant before any Medicaid enrollment is accepted. The state does not permit standalone, independent businesses to bill for CIS+ simply because they have a business license; providers must be structurally integrated into the state's homeless response ecosystem and the MCO networks.

If a prospective provider cannot secure a letter of support from the local CoC or a contract with a QI health plan, they cannot operate or bill as a CIS+ provider in Hawaii.

• CoC Network Participation Letter: Providers must submit a formal confirmation letter from Partners in Care (Oahu) or Bridging the Gap (Neighbor Islands) indicating active participation in the local homeless services network.
• MCO Contracting Block: Providers must successfully contract with individual QUEST Integration health plans (or the CCS plan) to receive authorizations and payment; Medicaid enrollment alone yields no reimbursement.
• Settings Rule Prerequisites: New providers must complete Med-QUEST's mandatory HCBS Settings Rule online training and self-assessment surveys before enrollment validation.
• Electronic Enrollment Mandate: Applications are only accepted electronically via the Hawaii’s Online Kahu Utility (HOKU) portal.

4. Licensure and Certification Requirements

The Hawaii Department of Health (DOH) does not issue a specific facility or business license for "Housing Stabilization" or "Community Integration Services." Because these are community-based supportive services rather than clinical or residential facility services, approval is based on Medicaid credentialing rather than state licensure.

Instead of a DOH license, providers achieve certification by meeting Med-QUEST’s provider-type criteria in HOKU and successfully passing the credentialing standards of the QI health plans they contract with.

• State Licensure: No distinct DOH facility license exists or is required for CIS+ tenancy support.
• Med-QUEST Provider Type: Applicants must apply in HOKU specifically under Provider Type A3 or Provider Type 77.
• MCO Credentialing: Health plans (e.g., HMSA via the HHIN+ portal) require submission of Facility or Long-Term Services & Support Applications to verify organizational capacity.
• Federal Compliance Validation: MQD conducts validation checks on the provider’s completed HCBS settings self-assessment to ensure the agency does not isolate participants or operate in an institutional framework.

5. Medicaid Provider Enrollment

All CIS+ providers must enroll with the Med-QUEST Division through the state’s MMIS provider portal, HOKU (Hawaii’s Online Kahu Utility). HOKU acts as the central clearinghouse for provider data, background checks, and federal exclusions screening.

During the HOKU enrollment process, the required CoC gatekeeping documents must be uploaded directly. Without these documents, the application will be rejected by Med-QUEST before it ever reaches a health plan.

• Enrollment System: Hawaii’s Online Kahu Utility (HOKU).
• Required Upload: The PIC or BTG network participation confirmation letter must be attached to the HOKU application.
• Application Fee: Subject to the standard ACA institutional provider application fee (unless waived by prior Medicare/Medicaid enrollment).
• Revalidation Cycle: Enrolled providers must revalidate their information in HOKU every five years.
• Status Activation: Once HOKU issues the 6-digit Med-QUEST Provider ID, the provider can finalize MCO network contracts.

6. Staffing, Training and Background Checks

Staff delivering CIS+ services are typically case managers, community health workers, or housing navigators. While Med-QUEST does not mandate specific clinical degrees for tenancy support staff, agencies must adhere to stringent background check and training requirements.

Health plans and CoCs may impose additional training requirements on provider staff, particularly regarding data entry into the homeless management information system (HMIS).

• Background Checks: Mandatory state checks via the Hawaii Criminal Justice Data Center (eCrim).
• Federal Exclusions: Monthly screening against the OIG List of Excluded Individuals/Entities (LEIE) is required for all member-facing staff.
• Mandatory State Training: All staff must complete Med-QUEST’s online HCBS Settings Rule training.
• Network Training: Staff must participate in Coordinated Entry System (CES) and HMIS training as dictated by Partners in Care or Bridging the Gap.
• Supervision: Non-clinical staff must operate under the administrative supervision of the enrolled CIS+ organizational provider.

7. Documentation, Policies and Records

Med-QUEST tightly controls the documentation standards for CIS+ to ensure statewide uniformity across all health plans. Providers must use a specific suite of state-mandated forms to initiate, track, and sustain care.

A unique feature of the Hawaii CIS+ program is the use of specialized "H-Codes" (Member Status Codes) to track a member's progress through the housing continuum.

• Standardized Initiation Forms: Providers must use the official MQD CIS+ Referral form and CIS+ Consent form.
• Care Planning Forms: Services must be guided by the standardized CIS Assessment and CIS Action Plan, updated regularly.
• Status Code HC: Members are not officially enrolled in CIS+ until they sign the consent form, transitioning their status code to HC (CIS–Eligible Consented).
• Status Code H5: Denotes a member actively receiving Housing Pre-Tenancy services.
• Status Code H6: Denotes a member successfully housed and receiving Housing Tenancy sustaining services.
• Discharge Policy: If a provider discharges a member, they must continue delivering authorized services until another provider accepts the member or the authorization expires.

8. Billing, Rates and Claims

CIS+ tenancy and pre-tenancy services are structured around a managed care payment model rather than fee-for-service. Providers submit claims directly to the authorizing QI or CCS health plan, not to the state.

Unlike outpatient billing that relies on 15-minute increments, CIS+ housing supports utilize a bundled per-member-per-month (PMPM) framework, significantly reducing the administrative burden of tracking micro-units of time.

• Payment Methodology: Reimbursed as a flat per-member-per-month (PMPM) bundled payment.
• Proration: PMPM payments reflect the full monthly amount and are not prorated, regardless of the days served in that month.
• Claim Limits: Providers are limited to billing one monthly bundled payment per member for either the outreach category or the supports (pre-tenancy/tenancy) category.
• Billing Identifiers: Claims must be submitted to the MCO using the provider’s 6-digit Med-QUEST Provider ID and appropriate HCPCS codes (e.g., H0044).
• Prior Authorization Mandate: Claims submitted without a prior health plan authorization are automatically held or denied; retroactive authorizations (up to one month prior) are possible once eligibility is established.

9. Approval Sequence and Timeline

Becoming a fully operational CIS+ provider in Hawaii takes several months due to the sequential nature of local network integration, state enrollment, and MCO credentialing. Providers cannot skip steps or run them concurrently.

• Step 1: Network Integration (1-3 months): Engage with Partners in Care (Oahu) or Bridging the Gap (Neighbor Islands) to obtain the required network participation letter.
• Step 2: State Training (1-2 weeks): Complete the Med-QUEST HCBS Settings Rule training and self-assessment surveys.
• Step 3: HOKU Enrollment (30-60 days): Submit the application under Provider Type A3 or 77 and wait for MQD validation and issuance of a Provider ID.
• Step 4: MCO Credentialing (90-120 days): Apply for network inclusion with QI health plans (e.g., via HMSA’s HHIN+ portal) and negotiate contracts.
• Step 5: Member Authorization (Ongoing): Submit CIS+ Referral and Consent forms to the MCO to receive the necessary prior authorization to begin billing.

10. Common Denials and Survey Findings

State and MCO audits frequently identify non-compliance regarding specific documentation and authorization sequencing. Providers most often fail due to administrative oversight rather than poor service delivery.

• Gatekeeping Denial: HOKU applications rejected outright for failing to upload the PIC or BTG CoC participation letter.
• Unauthorized Billing: Claims denied by the health plan because the provider billed before securing a formal authorization or a retroactive T1023/H0044 approval.
• Code Mismatch Errors: Audit findings for billing tenancy sustaining services while the member is still officially logged under an H5 (Pre-Tenancy) status code instead of H6 (Tenancy).
• Form Non-Compliance: Using legacy CIS forms instead of the updated 2026 CIS+ Assessment and Action Plan templates mandated by MQD.
• Discharge Abandonment: Audit findings issued when a provider ceases services upon discharge without supporting the transition of care until a new provider accepts the member.

11. Key Contacts and Resources

Accurate navigation of the Hawaii CIS+ landscape requires utilizing the distinct portals and help desks assigned to state enrollment, homeless coordination, and health plan billing.

• Hawaii Med-QUEST Division (MQD): Operates the HOKU system and issues overarching CIS+ policy memos.
• HOKU Provider Help Desk: The primary contact for technical issues related to Medicaid enrollment and validation checks.
• Partners in Care (PIC): The Oahu Continuum of Care responsible for issuing network participation letters for providers on Oahu.
• Bridging the Gap (BTG): The Continuum of Care responsible for network participation letters for providers on Hawaii Island, Maui, and Kauai.
• HMSA Provider Portal (HHIN+): The designated system for submitting Facility/LTSS applications and managing authorizations for HMSA QI members.
• Community Care Services (CCS): The specialized behavioral health MCO (often managed by ‘Ohana Health Plan) that must authorize all CIS+ services for its enrolled members.

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