Hawai'i Medicaid State Plan and Demonstration

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


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.


Section 1115 Waiver Demonstration Approved Evaluation Design - October 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


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

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


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