Hawai'i Medicaid State Plan and Demonstration


The State of Hawai‘i, Department of Human Services has received a five-year extension of the QUEST Integration Section 1115 demonstration from CMS. The extension will run from August 1, 2019 through July 31, 2024.

For over two decades, the demonstration has efficiently and effectively delivered comprehensive benefits to a large number of beneficiaries through a competitive managed care delivery system. Under the extension, “QUEST Integration” (QI) will continue to build on this success by delivering services through managed care, while integrating the demonstration’s programs and benefits to ensure more patient-centered care delivery. All eligible beneficiaries will continue to be enrolled under QUEST Integration, and access to services will be determined by clinical criteria and medical necessity.

The Med-QUEST Division is committed to laying the foundation for innovative programs that support and create healthy families and healthy communities through the QUEST program. To accomplish this goal, MQD is building the Hawai‘i ‘Ohana Nui Project Expansion (HOPE) program, a five-year initiative to develop and implement a roadmap to achieve this vision of healthy families and healthy communities. The QUEST Integration waiver will be the vehicle for the HOPE program to be put into practice.

Hawaii QUEST Integration "Demonstration" (Project No. 11-W-00001/9) Approved 07/31/2019 Effective 08/01/2019

Attachment E- Behavioral Health Services Protocol Approved 09/01/2020

Section 1115 Waiver Demonstration Approved Evaluation Design - 10/15/2020

Approved Hawaii COVID-19 Public Health Emergency Demonstration

Approved Hawaii COVID-19 Section 1115 Demonstration Final Evaluation Design

CMS Reports

The Hawaiʻi Medicaid State Plan is an agreement between Hawaii and the Federal government describing how that Hawaiʻi administers its Medicaid programs.  Department of Human Services is the single State agency designated to administer the Medicaid program under Title XIX of the Social Security Act.

Hawaiʻi Medicaid State Plan

Approved State Plan Amendments

State Plan Amendment 20-0003 "Update to Rate Changes to Non-Institutional Items and Services: Dental, Early Periodic Screening, Diagnostic and Treatment, Home Pharmacy, Home Health Agency and Medical Supplies" - Posted 11/30/20

20-0003 Public Notice Addendum - Posted 02/10/21

State Plan Amendment 21-0004 "New Eligibility Group under Ticket to Work Incentives Improvement Act" - Posted 12/30/20

21-0004 Public Notice Addendum -  Effective Date updated to 01/01/21 - Posted 02/10/21

State Plan Amendment 21-0006 "Nursing Facilities and Pass-through Payment" Public Notice - Posted 01/12/21

State Plan Amendment 21-0003 "Smoking Cessation Services-Alternative Benefit Plan" Public Notice - Posted 01/14/21

State Plan Amendment 21-0011 "All Patient Refined Diagnosis Related Group (APR DRG)" Public Notice - Posted 05/28/21

21-0011 Public Notice Addendum - Effective Date updated to 07/01/22 - Posted 09/10/21

State Plan Amendment 21-0014 "Disproportionate Share Hospital(s) (DSH)" Public Notice - Posted 09/01/21

State Plan Amendment 21-0012 "Pharmacy Services" Public Notice - Posted 09/10/21

State Plan Amendment 21-0015 "Hospice Services" Public Notice - Posted 09/10/21

Non-Emergency Medical Transportation (NEMT)-State Plan Amendment 21-0016 attachments - Posted 11/15/21

State Plan Amendment 21-0013 “Pharmacy and Podiatry Services-Alternative Benefit Plan” Public Notice - Posted 12/10/21

State Plan Amendment 21-0017 “Third-Party Liability” Public Notice - Posted 12/10/21

21-0017 Public Notice Addendum - Attachment content updated - Posted 12/22/21

State Plan Amendment 21-0019 “Critical Access Hospital Limit Removal” Public Notice - Posted 12/10/21

21-0013 Public Notice Addendum-related to §440.345 compliance - Posted 02/07/22

State Plan Amendment 22-0005 “Consolidated Appropriations Act (CAA)-Alternative Benefit Plan” Public Notice – Posted 03/09/22

Yearly Optional State Supplementary Payment-State Plan Amendment 22-0001 attachments - Posted 04/08/22

Consolidated Appropriations Act in connection with qualifying clinical trials-State Plan Amendment 22-0004 attachments - Posted 04/08/22

State Plan Amendment 22-0003 "Child and Adolescent Mental Health Division" Public Notice and attachments - Posted 04/12/22

Pregnant Women-1 year Post Partum Period-State Plan Amendment 22-0008 attachment - Posted 06/03/22

Recovery Audit Contractor (RAC) 2022 Renewal-State Plan Amendment 22-0011 attachment - Posted 06/03/22

State Plan Amendment 22-0007 “American Rescue Plan Act (ARPA) COVID-19 Templates" Public Notice - Posted 09/12/22

American Rescue Plan Act (ARPA) COVID-19 Templates-State Plan Amendment 22-0007 attachments - Posted 06/07/22

State Plan Amendment 22-0009 “ Pregnant Woman Proxy Payment Methodology” Public Notice and attachments - Posted 06/17/22

Restoration of Basic Dental Benefit for Adults State Plan Amendment 22-0012 attachments - Posted 09/16/22

State Plan Amendment 22-0013 “Palliative Care” Public Notice - Posted 10/14/22

State Plan Amendment 22-0014 “Monkey Pox” Public Notice - Posted 10/14/22

Pregnant Woman Reviewable Unit (RU)-unborn State Plan Amendment 22-0016 attachment - Posted 12/09/22

2023 Standards for Optional State Supplementary Payments-State Plan Amendment 23-0001 attachment - Posted 02/10/23

Coverage of Over the Counter (OTC) Naloxone and Birth Control Coverage-State Plan Amendment 23-0005 attachment - Posted 02/10/23

Medicaid Coverage of Youth Formerly in Foster Care Changes under Section 1002(a) of the SUPPORT Act-State Plan Amendment 23-0004 attachment - Posted 02/10/23

Medicaid Coverage of Youth Formerly in Foster Care Changes under Section 1002(a) of the SUPPORT Act-State Plan Amendment 23-0004 attachment - Posted 02/14/23

Waive of Provider Application Fee-State Plan Amendment 23-0009 attachments - Posted 04/14/23

Hawaii Medicaid Application (DHS 1100 “Application For Health Coverage & Help Paying Costs”) SPA 23-0007 attachments -Posted 06/09/23

Extended Services (post partum care coverage 60 day period to 12 months-already implemented) SPA 23-0006 attachments -Posted 06/09/23

One Year Continuous Eligibility for Children Under Medicaid and CHIP SPA 23-0010 attachments - Posted 08/11/23

Nursing Facility Payment Methodology Change-State Plan Amendment 23-0014 attachments - Posted 09/18/23


This page includes protections to ensure that the content of the issued notice is not modified after the initial publication and is maintained on the Web site for no less than a 3-year period.


SPA Memo 20-01 - Updates the standards for optional state supplementary payments.

SPA Memo 20-02 - Implements an additional clarification to bed hold day payment policy under the Hawaii Medicaid State plan.  This is a temporary policy that is effective only during the period of the Presidential and Secretarial emergency declarations related to the COVID-19 outbreak.

SPA Memo 20-03 - Updates Attachment 4.19-B page 2.1 to include updated fee schedule dates, methodology and weblinks for dental, EPSDT, home pharmacy, home health agency services and medical supplies.

SPA Memo 21-01 - Updates the standards for optional state supplementary payments.

SPA Memo 21-02 - Removes the limits on smoking cessation counseling and pharmacotherapy services on Supplement to Attachment 3.1-A and 3.1-B pg. 2.1 and identifies smoking cessation services available under Preventative Services Supplement to Attachment 3.1-A and 3.1-B (13c.) pg. 4 in the State Plan.

SPA Memo 21-03 - Removes the limits on smoking cessation counseling and pharmacotherapy services in alignment with SPA 21-0002, Smoking Cessation, for the Medicaid Alternative Benefit section of the State Plan.

SPA Memo 21-04 - Creates a new eligibility group “Working Individuals with Disabilities” to keep Medicaid coverage by allowing a more liberal income and resource methodology and clarifies that working disabled adults will not have any premiums or other cost sharing charges.

SPA Memo 21-06 - Increases the component prices for private nursing facility rates by 12 percent, effective January 13, 2021.

SPA Memo 21-08 - Implements temporary policies only effective during the period of the Presidential and Secretarial emergency declarations related to the COVID-19 outbreak.

SPA Memo 21-10 - Provides expanded benefits to Hawaii Medicaid State Plan. Under the provisions of Section 2105(a)(1)(D)(ii) of the Social Security Act, Hawaii will use administrative funds under a Health Service Initiative (HSI) to create a new vision service in the CHIP State Plan Section 2.2 for children under age 19 who are eligible for Medicaid and CHIP.

SPA Memo 21-11 - Changes the current payment methodology for inpatient acute services for the Hawaii Medicaid program.

SPA Memo 21-12 - Changes in laws at the federal and state level allow pharmacists to administer and bill for certain services.

SPA Memo 21-13 - Clarifies Pharmacy Services under “Services of Other Licensed Providers” and removes the $100 limit under Podiatry Services.

SPA Memo 21-14 - Changes the payment methodology for distribution Medicaid Disproportionate Share Hospital (DSH) funds to reflect a more equitable distribution by adding new verbiage to describe each hospital's uncompensated cost adjustment methodology effective 10/01/2021.

SPA Memo 21-15 - Amends Attachment 4.19-B pg. 8.3 and creates a new page (Attachment 4.19-B pg. 8.4) of the Hospice payment section in the state plan to clarify the payment methodology and to minimize administrative burden.

SPA Memo 21-16 - Regulatory requirements for states to assure necessary transportation for beneficiaries to and from covered services are longstanding.

SPA Memo 21-17 - Allows for third-party liability payment up to 100 days instead of 90 days for claims related to medical support enforcement.

SPA Memo 21-19 - Effective January 1, 2022, removes the application of the routine cost limit and customary charge limit for cost reimbursement of distinct part nursing facilities of critical access hospitals.

SPA Memo 22-01 - Effective January 1, 2022, Supplemental Security Income beneficiaries received a 5.9% Cost of Living Adjustment increase from the Social Security Administration.

SPA Memo 22-03 - Adds a new Child and Adolescent Mental Health Division (CAMHD) Fee Schedule to include code descriptions, updated rates and description of modifiers.  Also adds additional description and CMS recommendations to the Peer Support Services section in the Hawaii Medicaid State Plan.

SPA Memo 22-04 - On December 7, 2021, the Centers for Medicare and Medicaid Services (CMS) outlined new Medicaid State Plan requirements for assuring coverage of routine patient costs associated with participation in qualifying clinical trials.

SPA Memo 22-05 - Updates the Alternative Benefit Plan pages to align with the approval of SPA 22-0004 “Routine Costs for Clinical Trials” in the Medicaid State Plan.

SPA Memo 22-07 - This amendment attests to the state’s coverage of COVID-19 vaccines and vaccine administration, COVID-19 testing, and COVID-19 treatment, as required by sections 1905(a)(4)(E) and 1905(a)(4)(F) of the Social Security Act.

SPA Memo 22-08 - Extends postpartum medical coverage from a period of 60 days to 12 months effective April 1, 2022.

SPA Memo 22-12 - Amends Supplement to Attachment 3.1-A and 3.1-B pg. 3-3a and Supplement to Attachment 3.1-A and 3.1-B pg. 3.5 to restore and expand the basic dental benefit for adults receiving Medicaid benefits.

SPA Memo 23-01 - This amendment is required to increase the monthly income standards for Domiciliary Care Type I from $1,492.90 to $1,565.90 and for Domiciliary Care Type II from $1,600.90 to $1,673.90 for 2023.

SPA Memo 23-02 - Waives counseling signature requirements under §456.705-Prospective drug review (c) and 1927 (g)(2)(A)(ii) during the Public Health Emergency (PHE) period.

SPA Memo 23-05 - Hawaii has amended Attachment 3.1-A and 3.1-B pg. 3.2.b related to non-legend drugs. Coverage is listed on the Hawaii Medicaid website.

SPA Memo 23-06 - Hawaii received approval to waive collecting enrollment application and revalidation fees for institutional providers statewide.

SPA Memo 23-09 - Submitted to CMS for housekeeping purposes to align the extended services section in the Hawaii state plan with the expansion of postpartum care “60 days to 12 months” which has already been implemented.