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).
For more information, please go to the following link.
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:
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)
Adult (21 years of age or above)
*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 checkups include:
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.