Hawai'i Medicaid State Plan and Demonstration

APPROVED 1115 DEMONSTRATION (11-w-00001/9)


The State of Hawai‘i, Department of Human Services is seeking a five-year extension of the QUEST Integration Section 1115 demonstration from CMS.

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 1115 Cover Letter

QUEST Integration:  §1115 Waiver Extension Application

Attachment A:  EQRO and Quality Summaries

Attachment B:  Interim Evaluation

Attachment C:  Quality Strategy

Attachment D:  Special Terms and Conditions

Attachment E:  Summary of 2017 Post Award Forum

Attachment F:  Evaluation and Analysis of the Uncompensated Care Pool

Attachment G:  BN 1115 Renewal

Attachment H:  Email Notice

Attachment I:  Abbreviated Public Notice

Attachment J:  2nd Public Notice (Full Version)

Attachment K:  1115 Tribal Consultation Letter

Attachment L:  Hawaii Medicaid Ohana Nui Project Expansion

Attachment M:  Potential Initiatives Under HOPE


CMS’s demonstration website can be found here: https://www.medicaid.gov/medicaid/section-1115-demo/index.html

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