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Hawaii - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Hawaii Department of Human Services (DHS) Med-QUEST Division (MQD) funds Respite Care Services through the 1115 QUEST Integration (QI) waiver and the 1915(c) Waiver for Individuals with Intellectual and Developmental Disabilities (I/DD). The service provides short-term relief to unpaid primary caregivers, ensuring the Medicaid participant receives continuous supervision and support in their home or a licensed community setting.

Approval requires securing a direct contract with a QUEST Integration Managed Care Organization (MCO) or obtaining a provider agreement from the Department of Health Developmental Disabilities Division (DOH-DDD) prior to submitting an application through the HOKU provider enrollment system. Standalone applications submitted to Med-QUEST without these prior network affiliations or waiver approvals are not processed.

1. Service Definition and Scope

In Hawaii, Respite Care is defined as a service provided to individuals unable to care for themselves, furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care. It is an essential Home and Community-Based Service (HCBS) designed to prevent institutionalization by supporting the primary unpaid caregiver.

The service can be delivered in the participant's home, a licensed Adult Foster Home, or an Adult Day Health Center. It is strictly for relief and cannot supplant the responsibilities of paid direct support workers or educational mandates.

2. Regulatory and Oversight Agencies

The Med-QUEST Division (MQD) under the Department of Human Services is the single state Medicaid agency responsible for overall program integrity and provider enrollment. However, day-to-day oversight is heavily delegated to Managed Care Organizations and the Department of Health.

The Department of Health's Developmental Disabilities Division (DDD) operates the 1915(c) waiver, while the Office of Health Care Assurance (OHCA) handles all facility-level licensure.

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii's Medicaid system relies almost entirely on managed care and delegated waiver operations. Consequently, a provider cannot simply enroll with Med-QUEST to offer respite services; they must first be accepted into a specific delivery network.

For the 1115 QI waiver, this means passing an MCO's credentialing and contracting process. For the 1915(c) waiver, it requires passing the DOH-DDD provider readiness review.

4. Licensure and Certification Requirements

Hawaii does not issue a distinct "Respite Agency" license. Instead, the licensure requirement depends entirely on where the service is delivered. In-home respite providers operate as non-medical agencies and are certified through waiver operators rather than licensed by OHCA.

If respite is provided outside the participant's home, the physical facility must hold the appropriate OHCA license for that setting type.

5. Medicaid Provider Enrollment

All Medicaid providers in Hawaii must enroll through the HOKU (Hawaii's Online Kahu Utility) system. Respite providers typically enroll as Atypical Agencies since they provide non-medical HCBS.

During enrollment, providers must upload their MCO contracts, DDD approvals, or OHCA licenses, and pay the required federal application fee.

6. Staffing, Training and Background Checks

Agencies must ensure that all direct support workers providing respite care meet strict state requirements before they have any contact with Medicaid participants. This includes comprehensive background screening and specific training.

Training must be tailored to the specific needs of the participant as outlined in their person-centered plan.

7. Documentation, Policies and Records

Respite providers must maintain detailed records to substantiate claims and demonstrate compliance with HCBS waiver requirements. Documentation must clearly show that the service provided relief to the primary caregiver.

State and federal auditors, as well as MCOs, frequently review these records during annual monitoring.

8. Billing, Rates and Claims

Because Hawaii operates under a managed care model for most Medicaid services, respite claims are typically submitted directly to the participant's contracted MCO rather than the state MMIS.

For 1915(c) waiver participants, billing procedures are dictated by DOH-DDD and the state's fiscal intermediary.

9. Approval Sequence and Timeline

Becoming a respite provider in Hawaii is a sequential process. A provider cannot simply apply to Med-QUEST first; they must build their business infrastructure and secure network approvals beforehand.

The entire process from business formation to active billing status can take 4 to 8 months, depending on MCO credentialing cycles.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied when providers misunderstand Hawaii's managed care structure and attempt to enroll in HOKU without prior MCO or DDD approval.

During ongoing operations, survey findings often center on inadequate documentation of caregiver relief or failure to maintain current background checks.

11. Key Contacts and Resources

Prospective providers should begin by contacting the specific waiver operating agency (DDD or the MCOs) before reaching out to Med-QUEST.

The HOKU portal provides user guides and training materials for the actual Medicaid enrollment step.

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