Additional Covered Benefits

Learn about additional covered benefits below.

The Community Care Services (CCS) program provides intensive behavioral health services, in addition to basic behavioral health services covered by Medicaid health plans, to adults diagnosed with a qualifying serious mental illness (SMI) and/or a serious and persistent mental illness (SPMI).  These adults must be enrolled in a Medicaid health plan and meet CCS eligibility criteria as determined by Med-QUEST Division (MQD).

  • 24/7 Hotline
  • Accessible transportation services
  • Adverse events policy/reporting
  • Ambulatory behavioral health services and crisis management
    • Mobile crisis response
    • Crisis stabilization
    • Crisis hotline
    • Crisis residential services
  • Appointment follow-up
    • Face-to-face case manager visit within two (2) days of discharge from an inpatient psychiatric hospitalization
    • Case manager to ensure a visit with the member’s behavioral health provider within seven (7) days following discharge
  • Behavioral health outpatient services
    • Screening, registration, and referral
    • Treatment/service planning
    • Individual/group therapy and counseling
    • Family/collateral therapeutic support and education
    • Continuous treatment teams
    • Other medically necessary therapeutic services
  • Cultural/interpretation services
  • Diagnostic services and treatment to include psychiatric or psychological evaluation and treatment
    • Psychological testing
    • Psychiatric or psychological evaluation and treatment (including neuropsychological evaluation)
    • Psychosocial history
    • Screening for and monitoring treatment of substance abuse and mental illness
    • Other medically necessary behavioral health diagnostic services to include labs
  • Emergency and post stabilization services
  • Inpatient behavioral health hospital services
    • Room and board
    • Nursing care
    • Medical supplies, equipment and drugs
    • Diagnostic services
    • Psychiatric services
    • Other practitioner services as needed
    • Physical, occupational, speech and language therapy
    • Post-stabilization services
    • Other medically necessary services
  • Intensive case management
    • Case assessment
    • Case planning (service planning, care planning)
    • Outreach
    • Ongoing monitoring and service coordination
    • Coordination with member’s health plan and PCP
  • Medically necessary alcohol and chemical dependency services
  • Medications and medication management
    • Medication evaluation
    • Medication counseling and education
    • Psychotropic medications
  • Member education
  • Methadone management services which includes outpatient counseling services
  • Other services
    • Other medically necessary practitioner services provided by licensed and/or certified healthcare providers
    • Other medically necessary therapeutic services including services which would prevent institutionalization
    • Maintenance of member’s medical assistance eligibility
  • Outreach to ensure the provision of services to members
  • Partial hospitalization or intensive outpatient hospitalization
    • Medication management
    • Prescribed drugs
    • Medical supplies
    • Diagnostic tests
    • Therapeutic services including individual, family, and group therapy and aftercare
    • Other medically necessary services
  • Peer specialist
  • Psychosocial rehabilitation/Clubhouse
    • Work assessment service
    • Intensive day treatment
    • Day treatment
    • Residential treatment services
    • Social/recreational therapy services
  • Representative payee
  • Supported employment
    • Work assessment service
    • Pre-employment service
  • Supportive housing
  • Therapeutic living supports which includes specialized residential treatment 

For more information, please go to the following link. 

https://www.wellcare.com/Hawaii/Members/Medicaid-Plans/Community-Care-Services

Dental services for Hawaii’s Medicaid beneficiaries are covered through the fee-for-service program administered by Hawaii Dental Service (HDS) and coordinated by Community Case Management Corporation (CCMC).  The available dental benefits may vary depending on the beneficiary’s age.

Dental services includes (with limitations) diagnostic, preventive, restorative, endodontic, periodontal, prosthetic, orthodontic and select oral surgery services.  Under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, Medicaid beneficiaries under the age of 21 are eligible for all required preventative and medically necessary dental services.

Dental services for Medicaid beneficiaries 21 years and older are limited to emergency treatments to relieve dental pain, eliminate infections and treatment of acute injuries to the teeth or supporting structures of the oro-facial complex.

I/DD 1915c Home and Community-Based Services (HCBS) Medicaid Waiver program

This HCBS program provides services for people with Intellectual and Developmental Disabilities ( I/DD) who live with their family, in their own home, or in a residence with no more than four people who also receive services.  Medicaid I/DD participants are institutional level of care. Services meet the person’s needs so the person can maintain himself or herself in the community and have opportunities to participate as a citizen to the maximum extent possible.  

The I/DD HCBS listed below are available to persons enrolled in the I/DD 1915c Medicaid Waiver Program:

  • adult day health
  • discovery & career planning
  • individual employment services
  • personal assistance/habilitation
  • respite
  • nursing
  • additional residential supports
  • assistive technology,
  • chore
  • community learning services
  • environmental accessibility adaptation
  • non-medical transportation
  • personal emergency response system
  • specialized medical equipment & supplies
  • training and consultation
  • vehicular modifications
  • waiver emergency services

I/DD Case management services are provided by the Department of Health (DOH) /Developmental Disabilities Division (DDD).   

Additional information about the I/DD Medicaid Waiver HCBS Program can be found at:  Link: http://health.hawaii.gov/ddd/ddd_home/about/

This program allows termination of pregnancy, requires prior authorization.

The State of Hawai‘i Organ and Tissue Transplant (SHOTT) Program is for eligible QUEST Integration and Medicaid Fee-for-Service beneficiaries.  Medicaid covers medically necessary transplantation services and the related immunosuppressant drugs and services. The program covers non-experimental and non-investigational transplants for beneficiaries who meet specific medical conditions.

Medicaid beneficiaries are referred to the SHOTT Program by their physician with assistance from the Medicaid member’s health plan. Please contact health plan for more information.

The transplants listed below are provided by the Medicaid Program through the SHOTT Program.

Children (Under Age 21)

  • Heart
  • Liver
  • Lung
  • Heart and Lung
  • Stem Cell Transplant/Bone Marrow Transplant
  • Small Bowel with and without Liver
  • Kidney*
  • Pancreas
  • Pancreas/Kidney

Adult (21 years of age or above)

  • Heart
  • Liver
  • Lung
  • Heart and Lung
  • Stem Cell Transplant/Bone Marrow Transplant
  • Kidney*
  • Pancreas
  • Pancreas/Kidney

*Kidney transplant is a covered benefit for all Medicaid beneficiaries. Adults who require kidney transplant and have another health plan (Medicare or commercial) as their primary health insurance coverage shall remain with their current Medicaid health plan. Kidney transplant will be covered by the health plan and does not need to be referred to the SHOTT program.

If you have any questions, please call Koan at: 808-469-4500, toll free 1-844-235-5472, TTY/TDD 711.

Early Periodic Screening, Diagnostic, & Treatment (EPSDT) for Medicaid-Enrolled Individuals Under 21 Years of Age

Revised: October 2016

Medicaid-enrolled children under 21 years of age are eligible for EPSDT services. These medically necessary services, including behavior therapy for children, are provided at no cost to patient or family. The behavior therapies include intensive behavioral therapy for children with autism spectrum disorder (ASD) that include applied behavioral analysis (ABA) for the treatment of children with an autism spectrum disorder (ASD) diagnosis. For more information on EPSDT services and how you can get these benefits, please talk with your provider or the health plan you are enrolled in for help.

EPSDT provides:

  • Preventative care for members from newborn through age 20
  • Complete medical, mental and behavioral health, and dental care
  • Services and medicines
  • Treatment for problems that are identified
  • Intensive Behavioral Therapies (e.g. Applied Behavioral Analysis (ABA) services for members with an Autism Spectrum Disorder (ASD) diagnosis.

EPSDT checkups include:

  • Complete physical exam
  • Lab tests (as needed)
  • Immunizations
  • Vision/Hearing screening
  • Developmental/Behavioral and Mental health screening (as needed)
  • Referrals to specialists (as needed)
  • Oral (mouth) check
  • Prescription medications (as needed)


EPSDT is provided at no cost to you

Dental care is also covered for children under age 21

For help finding a dentist, call Community Case Management Corporation toll free at 1-888-792-1070.