Hawaii - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Hawaii Department of Health (DOH) Developmental Disabilities Division (DDD) and the Department of Human Services (DHS) Med-QUEST Division fund one-time institutional discharge expenses under the 1915(c) I/DD Waiver and the QUEST Integration 1115 demonstration, referring to them as Community Transition Services.

Approval requires submitting a DOH Medicaid Waiver Services Program Proposal Application to the DDD Provider Network Branch before applying for Medicaid enrollment. Applicants must secure a recommendation from DOH-DDD to participate, which serves as the structural precondition before Med-QUEST will process a provider agreement through the HOKU enrollment portal.

1. Service Definition and Scope

Community Transition Services in Hawaii cover one-time, non-recurring set-up expenses for individuals transitioning from an institutional setting, such as an ICF/IID or nursing facility, to a private community-based residence where the person is directly responsible for their own living expenses.

The service coordinates and funds the logistical necessities of establishing a basic household. It does not cover ongoing living expenses, and all purchases must be strictly tied to the transition plan developed by the participant's case manager.

• Service Name: Community Transition Services
• Funding Authority: 1915(c) I/DD Waiver and QUEST Integration 1115 Waiver
• Covered Expenses: Security deposits, essential household furnishings, window coverings, and basic kitchen supplies
• Utility Costs: One-time set-up fees or deposits for utility or service access, including telephone, electricity, and heating
• Excluded Costs: Monthly rental or mortgage expenses, food, regular utility charges, and recreational items
• Service Cap: Capped at a specific lifetime or per-transition amount as defined in the approved waiver appendix

2. Regulatory and Oversight Agencies

The Department of Health (DOH) Developmental Disabilities Division (DDD) operates the 1915(c) waiver and conducts the initial provider approval and ongoing compliance monitoring.

The Department of Human Services (DHS) Med-QUEST Division is the single state Medicaid agency responsible for final provider enrollment, MMIS administration, and oversight of the QUEST Integration managed care plans.

• Medicaid Agency: Department of Human Services (DHS) Med-QUEST Division (https://medquest.hawaii.gov/)
• Waiver Operating Agency: Department of Health (DOH) Developmental Disabilities Division (https://health.hawaii.gov/ddd/)
• Provider Enrollment Portal: HOKU (Hawaii Online Kahu Utility) (https://medquest.hawaii.gov/en/plans-providers/provider-enrollment.html)
• Managed Care Plans: QUEST Integration MCOs such as HMSA (https://hmsa.com/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Hawaii does not require a Certificate of Need for Community Transition Services. However, a strict structural precondition exists: a provider cannot enroll directly with Med-QUEST for waiver services without first passing the DOH-DDD proposal process.

Additionally, because most Hawaii Medicaid beneficiaries receive services through managed care, providers must successfully contract with the QUEST Integration MCOs after state enrollment to receive authorizations and payment.

• Certificate of Need: None required for Community Transition Services in Hawaii
• Waiver Recommendation: DOH Medicaid Waiver Services Program Proposal Application approval required prior to Med-QUEST enrollment
• MCO Contracting: Required for QUEST Integration beneficiaries; providers must join the networks of the contracted MCOs
• Operating History: No specific minimum years of operation required by rule, but financial solvency documentation is required in the DOH proposal

4. Licensure and Certification Requirements

Hawaii does not issue a distinct facility or agency license for Community Transition Services. Instead, providers are certified through the DOH-DDD waiver approval process.

Agencies must demonstrate compliance with the DOH Medicaid Waiver Provider Standards Manual, which dictates administrative, fiscal, and operational requirements for all waiver providers.

• State License: No distinct state license exists for this specific administrative and transition service
• DOH Certification: Approved via the DOH-DDD Provider Standards Manual compliance review
• Business Registration: Must be registered and in good standing with the Hawaii Department of Commerce and Consumer Affairs (DCCA)
• Insurance: Commercial General Liability insurance required, naming the State of Hawaii as an additional insured

5. Medicaid Provider Enrollment

Once recommended by DOH-DDD, providers must complete their Medicaid enrollment through the HOKU (Hawaii Online Kahu Utility) system.

Med-QUEST performs comprehensive screening and credentialing for all Hawaii Medicaid providers, assigning a provider ID that is required before MCO contracting can begin.

• System: HOKU (Hawaii Online Kahu Utility)
• Application Fee: Subject to the ACA institutional provider application fee unless waived or previously paid to Medicare
• Form: DHS 1139 (Provider Application) data is now processed digitally via the HOKU portal
• Revalidation: Required every 5 years per federal Medicaid rules

6. Staffing, Training and Background Checks

Staff coordinating transitions must meet DOH-DDD standards for direct service workers, even if their primary role is administrative coordination and purchasing.

Agencies must maintain strict personnel files demonstrating that all background checks and health clearances were completed prior to the staff member's first day of service delivery.

• Background Checks: State and federal criminal history record checks via Hawaii Criminal Justice Data Center (eCrim) and Fieldprint
• Clearances: Child Abuse and Neglect (CAN) registry and Adult Protective Services (APS) registry checks required
• Health Clearance: TB clearance required for staff with direct participant contact
• Training: DOH-DDD mandated waiver provider training, including incident reporting and person-centered planning

7. Documentation, Policies and Records

Providers must maintain records in accordance with the DOH-DDD Medicaid Waiver Provider Standards Manual, ensuring all transition expenses are fully documented.

Because this service involves purchasing goods and paying deposits on behalf of the participant, financial record-keeping and receipt retention are heavily scrutinized during audits.

• Record Retention: Minimum of 6 years from the date of service
• Participant Files: Must include the Individualized Service Plan (ISP) and the approved transition budget
• Receipts: Original receipts for all purchased goods, deposits, and moving expenses must be retained for auditing
• Policy Requirement: Written policies on participant rights, grievance procedures, and incident reporting

8. Billing, Rates and Claims

Community Transition Services are billed as a one-time or milestone-based service, reimbursing the provider for the actual costs incurred up to the authorized limit.

Providers must secure prior authorization from the DOH-DDD case manager or the MCO service coordinator before making any purchases or signing any agreements on behalf of the participant.

• Procedure Code: T2038 (Community Transition, waiver; per service)
• Reimbursement Methodology: Cost reimbursement based on actual receipted expenses up to the waiver cap
• Claim System: Billed to the respective QUEST Integration MCO or via the state MMIS for fee-for-service participants
• Prior Authorization: Required before any purchases are made or services are rendered

9. Approval Sequence and Timeline

The approval process is strictly sequential. A provider cannot access the HOKU enrollment portal for waiver services without the DOH-DDD recommendation.

Prospective providers should plan for a multi-month process, as DOH-DDD proposal reviews, Med-QUEST enrollment, and MCO credentialing each take several weeks to complete.

• Step 1: Register business with Hawaii DCCA (1-2 weeks)
• Step 2: Submit DOH Medicaid Waiver Services Program Proposal (3-6 months for review and recommendation)
• Step 3: Enroll in Med-QUEST via HOKU (30-60 days)
• Step 4: Credential and contract with QUEST Integration MCOs (90-120 days)

10. Common Denials and Survey Findings

Denials during the application phase often stem from incomplete DOH-DDD proposals or failure to provide adequate financial solvency documentation.

During post-payment reviews, the most common findings relate to unallowable costs or missing documentation for purchased items.

• Unallowable Costs: Billing for monthly rent, food, or recreational items, which are strictly prohibited
• Missing Receipts: Failure to maintain original receipts for transition purchases
• Lapsed Clearances: Staff background checks or TB clearances expiring without timely renewal
• Policy Deficiencies: Inadequate written policies for incident management or participant rights

11. Key Contacts and Resources

Prospective providers should begin by reviewing the DOH-DDD Provider Standards Manual and contacting the DDD Provider Network Branch.

For questions regarding the HOKU portal or MMIS billing, providers should contact the Med-QUEST Health Care Services Branch.

• DOH Developmental Disabilities Division: https://health.hawaii.gov/ddd/
• Med-QUEST Provider Enrollment: https://medquest.hawaii.gov/en/plans-providers/provider-enrollment.html
• Hawaii DCCA Business Registration: https://cca.hawaii.gov/breg/
• HOKU Provider Portal: https://hokuinfo.med-quest.hawaii.gov/

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