Hawaii Medicaid waiver guide
Learn how Hawaii Medicaid waiver services work, which state agency to start with, how the application process usually begins, and where to search for home and community-based services.
Last reviewed July 2026. See something out of date? Use the “Suggest an edit” button to let us know.
Hawaii runs a single Medicaid home and community-based waiver for people with intellectual and developmental disabilities — the Medicaid I/DD Waiver — operated by the Developmental Disabilities Division (DDD) of the Department of Health. Two agencies are involved and it helps to know which does what: DDD decides whether you have a developmental or intellectual disability under Hawaii Revised Statutes chapter 333F and assigns you a case manager, while the Department of Human Services Med-QUEST Division (MQD) decides Medicaid, Long-Term Care, and level-of-care eligibility. You cannot apply for the waiver directly — you become DDD-eligible first, get a case manager, and then apply for the waiver together with them.
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People with intellectual and developmental disabilities who need an ICF-IID level of care
Hawaii's definition of developmental disability comes from HRS § 333F-1: an impairment, or combination of mental and physical impairments, manifested before age 22, that results in substantial functional limitations in three or more major life activities — self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic sufficiency. To then receive waiver services you must also be assessed as needing an ICF-IID level of care, qualify for Medicaid through MQD, and qualify for the Long-Term Care benefit.
The impairment — mental, physical, or a combination — must have manifested before the person turned 22, per HRS § 333F-1.
You must have substantial functional limitations in three or more of: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic sufficiency. This three-area threshold is the core of the determination.
For the waiver, you must be assessed as needing services at the Intermediate Care Facility for Individuals with Intellectual Disabilities level of care. The Medical Director of Med-QUEST approves this.
You must qualify for Medicaid coverage and for the Long-Term Care benefit, both determined by the Department of Human Services Med-QUEST Division — not by DDD.
Hawaii does not publish a standing waiting list for the Medicaid I/DD Waiver the way many states do. The gating factors are the eligibility steps themselves: DDD eligibility, the ICF-IID level of care assessment, and Medicaid plus Long-Term Care determination through Med-QUEST. Once those clear, services are expected to start on a defined timeline rather than after a queue.
Community Services for the Developmentally Disabled determines eligibility under HRS chapter 333F. You cannot apply for the waiver until this is done. DDD publishes an Intake Booklet that walks through what is needed.
Open linkOnce DDD-eligible, you are assigned a case manager through your island's District Health Office. They are your partner for everything that follows — the waiver application is something you do with them, not on your own.
Tell your case manager you want the waiver. They help you complete the “Request to Participate in Home and Community-Based Services for People with Intellectual and Developmental Disabilities” form.
Open linkYour case manager gathers the required documents and submits them for approval by the Medical Director of Med-QUEST Division.
With your case manager's help, apply for Medicaid coverage and the Long-Term Care benefit. MQD issues the determination — if it is a denial, you have 90 days from the date of the MQD notice to appeal.
Once Long-Term Care eligibility is determined, your case manager works with you to get services started within 90 days.
Exact covered services depend on the waiver, assessed need, Medicaid rules, funding, and state program requirements. Confirm services, availability, and payment acceptance with the state, support coordinator, and provider.
Hawaii's I/DD Waiver includes self-direction options that let participants and families hire and manage their own support workers rather than relying only on agency providers. Ask your case manager which services can be self-directed and what the fiscal arrangements look like.
Approved waiver services are paid through Hawaii Medicaid once you qualify for the Long-Term Care benefit. There is generally little or no direct cost for covered services.
Med-QUEST decides both Medicaid coverage and Long-Term Care eligibility. Being approved for one does not mean the other is settled — ask your case manager to confirm both.
In residential settings the waiver pays for services, not room and board, which is typically covered by the person's own income such as SSI.
Hawaii's Early Intervention Section serves infants and toddlers with delays, separately from DDD waiver services.
The Hawaii Department of Education provides special education under an IEP. Waiver services are separate from and additional to what school provides — keep the evaluations, since they document functional limitations.
The impairment must be documented as manifesting before age 22. Hawaii's window is wider than the age-18 rule many states use, so a young adult who was never formally assessed may still qualify.
Adult supports run through the I/DD Waiver, with employment services built around discovery and career planning. Med-QUEST generally assesses financial eligibility on the person's own income once they are an adult.
If Med-QUEST denies Medicaid, Long-Term Care, or level of care, you can appeal within 90 days of the dated MQD notice — and you can also reapply later if your circumstances change. Read the notice carefully, since the clock runs from its date. Hawaii Disability Rights Center is the state's protection and advocacy organization and provides free help.
Protection & Advocacy organization for Hawaii
1-800-882-1057Visit siteState DD agency — 1250 Punchbowl Street, Room 463, Honolulu
808-586-4400Visit siteYour case manager, assigned by island — Oahu, Maui, Hawaii, and Kauai offices
Visit siteMedicaid, Long-Term Care, and level of care determinations
Visit siteFree disability rights and appeals help
1-800-882-1057Visit siteLocal help & referrals — dial 211
Visit siteNo. In Hawaii you must first be found eligible for DDD services under HRS chapter 333F and be assigned a case manager. The waiver application is then something you complete together with that case manager.
Hawaii requires substantial functional limitations in at least three of seven areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic sufficiency. Documentation across three of those areas is the core of the eligibility case.
Hawaii does not publish a standing waiting list for the I/DD Waiver. The time is spent clearing three eligibility steps — DDD eligibility, the ICF-IID level of care assessment, and Medicaid plus Long-Term Care through Med-QUEST. Once Long-Term Care eligibility is determined, services are to start within 90 days.
DDD decides whether you have a qualifying developmental or intellectual disability and assigns your case manager. Med-QUEST decides level of care, Medicaid coverage, and Long-Term Care eligibility. If something is stalled, knowing which agency owns that step saves a lot of time.
You can appeal within 90 days of the dated Med-QUEST notice. You can also reapply later if your circumstances change. Hawaii Disability Rights Center can help you with either route at no cost.
Hawaii's definition of developmental disability comes from HRS § 333F-1: an impairment, or combination of mental and physical impairments, manifested before age 22, that results in substantial functional limitations in three or more major life activities — self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic sufficiency. To then receive waiver services you must also be assessed as needing an ICF-IID level of care, qualify for Medicaid through MQD, and qualify for the Long-Term Care benefit.
apply for ddd eligibility first, get assigned a case manager, request to participate in the waiver, complete the icf-iid level of care assessment, then enroll and choose providers. Start with Hawaii Department of Health Developmental Disabilities Division.
Covered services vary by waiver and assessed need, and commonly include in-home supports, respite, supported employment, day services, behavior support, residential supports. Confirm specifics with the state and provider.
Approved waiver services are generally covered by Medicaid at little or no direct cost once enrolled, though some enrollees may owe a monthly patient responsibility based on income.
The four-step waiver application process, from request form to service start.
HawaiiDDD's main page, including the Intake Booklet for prospective participants.
HawaiiThe statutory definition of developmental disability Hawaii applies.
HawaiiFree protection and advocacy services, including help with appeals.
HawaiiFind waiver providers and services in Hawaii on Waiverly.
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