CMS approves Hawaii’s 1115 waiver extension

Just days before Hawaii’s 1115 waiver demonstration was set to expire at the end of June, CMS sent a letter to Medicaid Director Judy Mohr Peterson granting a one-month temporary extension. The extension meant that CMS had until July 31 to approve the state’s application to extend the “QUEST Integration” demonstration.

In a letter marked July 31, CMS officially notified Mohr Peterson of their approval to extend Hawaii’s 1115 demonstration project through July 31, 2024.


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Hawaii’s QUEST Integration demonstration allows the state to use managed care as a delivery system. Through the demonstration, the state also provides additional Medicaid benefits such as home and community-based (HCBS) long-term services and supports.

“This extension authorizes Hawaii to continue providing benefits through its managed care delivery system, continue providing HCBS to certain populations, and expand access to and benefits of community integration services for beneficiaries who meet specified needs-based criteria,” reads the letter.

According to the letter, the expanded community integration services include the Community Transition Services pilot program. The program is designed to connect eligible beneficiaries – such as individuals who are homeless or at risk of homelessness — with housing services. These services are expected to improve health outcomes, increase care coordination effectiveness, and decrease costs by lowering emergency department usage.

“Community integration services will continue to be administered through managed care for beneficiaries who are homeless or at risk for homelessness and meet specific needs-based criteria, such as having a mental health need, substance use disorder, or a complex physical health need. Through this approval, one pilot program is being added to the CIS benefit. Under the Community Transition Services pilot program, the state will provide supportive services related to housing.”

CMS also states that as part of the approval of the extension, the state will be required to adhere to monitoring and evaluation requirements. This includes measuring progress and quality of care in areas identified as needing improvement during the previous demonstration period.

The state also applied to increase flexibility for a new Medical Respite Services pilot program. CMS states that the request is still under review, but that it is not approved at this time.