Hawaii Medicaid Resources

• State Medicaid Website: Hawaii
• Hawaii State Council on Developmental Disabilities Website
• The Arc of Hawaii

Hawaii Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 25,100 people with disabilities covered by Medicaid in Hawaii. Hawaii spent $14,472 on each Medicaid recipient with a disability in 2007.

12% of all people covered by Medicaid in Hawaii have a disability, while the national percentage is 15%.

Hawaii spends 34% of all money spent on Medicaid on services for people with disabilities, while the national percentage is 42%.

Hawaii QUEST Expanded (QEx)

The Hawaii Quest Expanded program was one of five state programs identified in 2009 by the federal government as a pioneer in delivering care to adults with disabilities. This program provides access for children and adults with disabilities to a wide range of services not usually included under Medicaid programs as well as standard basic services. Most dual-eligible Medicare patients are eligible for this plan.

• Community: transportation
• Health: cornea transplants, kidney transplants, bone grafts, dental care, dietary services, durable medical equipment, early and periodic screening, diagnosis and treatment, hearing, maternity care, occupational therapy, optometry, midwife services, nurse practitioner and physician’s assistant, pharmacy, physical therapy, physician services, preventive treatments, skilled nursing facilities, speech therapy, sterilization and hysterectomies, sub-acute care, hospice, hospital, mental health, substance abuse disorders, intermediate care facilities, x-ray, laboratory
• Home: home health care
• Social Services: language and interpreter services

Program of All-Inclusive Care for the Elderly (PACE)

PACE programs are designed for people 55 and older who might otherwise need nursing home placement. This includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary. Services are provided through PACE centers, so people must live close enough to an approved center to be eligible.

Ages: 55 and older

Restrictions: You must have access to a PACE care center

• Community: health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs, day health care
• Home: home health care, home and environmental modifications
• Social Services: social services

Hawaii Developmental Disabilities waiver (MR/DD)

This waiver provides home and community-based services to people with developmental disabilities.

Level of Care: Intermediate

• Community: adult day care, transportation
• Health: habilitation, specialized medical equipment and supplies
• Home: personal assistance, respite care

Aged and Disabled waiver (Residential Alternatives)

Like other Aged and Disabled waivers, Hawaii’s waiver provides a nursing home level of care to older people and people with physical disabilities that require this care. This program enables them to stay out of nursing homes by providing a place in an adult foster home, residential care facility, or assisted living facility.

Ages: 65 and older for adult with or without disabilities, and adults with physical disabilities

Level of Care: nursing

• Community: transportation
• Home: personal care, homemaking services
• Social Services: case management

Nursing Home without Walls waiver

This waiver is intended to cover people with physical disabilities who need a nursing home level of care. Services can be provided to these people in the community or in their homes, instead of in an institution.

Level of Care: nursing

• Community: adult day care
• Health: private-duty nursing
• Home:  personal assistance, home delivered meals, respite
• Social Services: case management

Medically Fragile Children’s waiver

This waiver applies to children who need the level of care provided by a nursing home or hospital. Services can be provided to these children and their families in the family home instead of at one of those facilities.

Ages: 21 and younger

Level of Care: nursing

Restrictions: the child must have at least two caregivers who are trained to provide care in an appropriately equipped home.

• Health: medical equipment and supplies
• Home: attendant care, respite care
• Social Services: case management