Hawaii Home Care Medicaid

Last updated: August 21, 2026 Jurisdiction: Hawaii

QUEST Integration includes community long-term care

Hawaii’s QUEST Integration program includes home- and community-based long-term services and supports as well as institutional LTSS. Med-QUEST says these benefits are available based on medical necessity and clinical criteria within the program’s capitated managed-care structure (Hawaii Med-QUEST, QUEST Integration).

Hawaii DHS states that a person seeking long-term-care services must meet financial and clinical requirements. The clinical standard is institutional level of care, communicated through DHS Form 1147; the same DHS notice says service settings can include the member’s own home and community settings as well as a facility (Hawaii DHS long-term-care notice).

In the provider manual, Med-QUEST describes HCBS as available in a client’s home or other private residence or in a certified residential setting, and says the services are delivered through QUEST Integration by a health plan. That is a different service-delivery structure from assuming every community service is a separate traditional 1915(c) elder waiver (Med-QUEST Long Term Care provider manual).

Assessment and care planning

DHS Form 1147 is titled the Level of Care and At Risk Evaluation in Med-QUEST materials. The form can be used for an initial request, annual review, reconsideration, or other review; its at-risk pathway addresses people who do not yet meet nursing-facility level of care but may deteriorate without LTSS (Med-QUEST DHS Form 1147 guidance).

The state says approved Form 1147s have an end date and can be approved for no more than 12 months. Families should therefore ask the health plan who will initiate the renewal and whether a change in function, setting, informal support, or provider requires a new assessment (Hawaii DHS long-term-care notice).

Waivers and waitlists

CMS separately lists Hawaii’s I/DD 1915(c) waiver as approved effective July 1, 2026. That waiver is specific to people with intellectual and developmental disabilities and should not be confused with QUEST Integration’s general community LTSS coverage (CMS Hawaii I/DD HCBS waiver record).

The Med-QUEST and DHS sources reviewed here do not publish a general QUEST Integration HCBS enrollment cap or waiting-list process. The provider manual contains unexplained “waitlisted” facility billing categories, but it does not establish a general home-care waitlist; confirm current plan capacity and authorization directly rather than inferring a statewide rule (Med-QUEST Long Term Care provider manual).

When requesting care, ask the health plan for the service plan, provider-network options, authorization status, reassessment date, and the written reason for any denial or reduction. These operational details are essential because the program ties LTSS to medical necessity, clinical criteria, and the member’s assessed level of care (Hawaii Med-QUEST, QUEST Integration).

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QUEST Integration includes community long-term care

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