1.1 – WAIVER OVERVIEW
A. Medicaid I/DD Waiver Purpose and Objectives
Medicaid 1915(c) Home and Community-Based Services (HCBS) waivers, authorized under
§1915(c) of the Social Security Act, provide services in homes and communities where people
live rather than in institutional settings. The federal law permits a state to develop an array of
home and community-based services that help Medicaid beneficiaries live in the community and
avoid institutionalization. States have broad discretion to design their waiver programs to
address the needs of the waiver’s target population.
All HCBS waiver programs must:
• Demonstrate that providing waiver services won’t cost more than providing these
services in an institution
• Ensure the protection of people’s health and welfare
• Provide adequate and reasonable provider standards to meet the needs of the target
population
• Ensure that services follow an individualized and person-centered plan of care
Waiver services complement and supplement services available to participants through the
Medicaid State Plan and other federal, state, and local public programs, as well as the supports
that families and communities provide.
Hawai‘i’s Medicaid I/DD Waiver enables individuals with intellectual and developmental
disabilities (I/DD) who meet an institutional level of care the choice to live in their homes and
communities with appropriate quality supports designed to promote their health, community
integration, safety and independence.
The overarching goals of the Medicaid I/DD Waiver are to:
1. Provide necessary supports to participants in the waiver to have full lives in their
communities and to maximize independence, autonomy and self-advocacy; and
2. Evaluate and continuously improve the quality of services to participants, including
measuring the satisfaction of the benefits and services the participants receive, to improve
them.
As mentioned above, the Medicaid I/DD Waiver uses federal Medicaid funds and State matching
funds for HCBS as an alternative to institutional services, provided that the overall cost of
supporting individuals in their homes and communities is no more than the institutional cost for
supporting that same group of individuals. This is called “cost neutrality.”
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The Medicaid I/DD Waiver also requires that the State meet assurances required in the law.
Hawai‘i must report to CMS annually its performance measures to demonstrate compliance with
the federally-mandated assurances.
B. Eligibility for Waiver Services
Individuals interested in applying for Hawai‘i’s Medicaid I/DD Waiver must first be determined
eligible for DOH-DDD services (STEP 1). After the determination of eligibility is made, the
individual may apply for admission to the Medicaid I/DD waiver by completing STEP 2 and
STEP 3.
STEP 1:
Meets DOH-DDD eligibility requirements. Once eligible, the individual can
receive DDD services based on their support needs.
STEP 2:
Meets DHS-MQD Level of Care eligibility criteria; and
STEP 3:
Meets DHS-MQD Medicaid and Long-Term Care (LTC) eligibility criteria. If
determined to meet STEP 2 and STEP 3, the individual may choose to be
admitted to the waiver.
The application process is described in Section 1.3: Application for Waiver Services.
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C. Definition of Developmental Disability and Intellectual Disability
Hawai‘i has defined Developmental Disability and Intellectual Disability in Chapter 333F,
Hawai‘i Revised Statutes (HRS).
1. “Developmental Disabilities" means a severe, chronic disability of a person which:
a. Is attributable to a mental or physical impairment or combination of mental and physical
impairments;
b. Is manifested before the person attains age twenty-two;
c. Is likely to continue indefinitely;
d. Results in substantial functional limitations in three or more of the following areas of
major life activity; self-care, receptive and expressive language, learning, mobility, selfdirection, capacity for independent living, and economic sufficiency; and
e. Reflects the person's need for a combination and sequence of special, interdisciplinary, or
generic care, treatment, or other services which are of lifelong or extended duration and
are individually planned and coordinated.
An individual from birth to age nine who has a substantial developmental delay or specific
congenital or acquired condition may be considered to have a developmental disability
without meeting three or more of the criteria described above, if the individual, without
services and supports, has a high probability of meeting those criteria later in life.
2. "Intellectual Disability" means significantly sub average general intellectual functioning
resulting in or associated with concurrent moderate, severe, or profound impairments in
adaptive behavior and manifested during the developmental period.
D. Coordination with Medicaid State Plan Services through QUEST Integration
DDD will coordinate services with QUEST Integration health plans for participants in need of
State Plan Services and any needed transition supports.
E. Access and Availability
Waiver participants must have access to all Medicaid I/DD Waiver services, regardless of where
the participant lives. Providers must ensure the following:
1. The Providers must have capacity to serve the geographic area for every service proposed in
its Waiver Provider application;
2. If the Provider no longer has the capacity to serve an area and/or island or provide a
particular waiver service, even though it may still be providing services elsewhere, the
Provider must notify DOH-DDD in writing at least 30 calendar days in advance of the
requested change. The written notification must include the reason for the request and
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information detailing coordination efforts with the DOH-DDD Case Manager (CM) to
transition participants who are currently receiving services to a new Provider.
•
DOH-DDD may request additional time beyond the 30 calendar days to allow for smooth
transition for participants to locate other Providers.
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