Hawaii Developmental Disabilities Division outlines five goals of $30 million HCBS spending plan

The Developmental Disabilities Division (DDD) of the Hawaii Department of Health confirmed Friday that it submitted a joint spending plan with Med-QUEST, the state’s Medicaid agency, to the Centers for Medicare & Medicaid Services (CMS) regarding increased Federal Medical Assistance Percentages (FMAP) for home and community-based services (HCBS). This plan would bring additional funding for programs such as the 1915(c) waiver for individuals with intellectual and developmental disabilities (I/DD), which works to create alternative models of care and prevent long-term institutionalization. 


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The increased FMAP comes from President Biden’s American Rescue Plan Act (ARPA), and will boost percentages by 10%. These funds must be spent on services between April 1, 2021 and March 31, 2022. Based on Hawaii’s FMAP, the I/DD waiver will have a total of $30 million to spend, including state funds that are replaced with federal funds and can be spent through March 31, 2024. The I/DD waiver currently operates on an annual budget of approximately $150 million, according to DDD. 

In an online briefing to DDD stakeholders in late May, Stephen Pawlowski, managing director at Burns and Associates under Health Management Associations, said when the division plans what types of investments it makes, they should be intentional and future-looking: 

“The division is going to be working through both internally and then with the stakeholder community, to think about how targeted investments [can] be made that will leave the program in a better place three years from now than it is today, without creating any sort of what we call ‘funding clips,’ where we do good things and then the money runs out and we revert to where we were. We want to avoid those sorts of outcomes.” 

Upon the briefing, DDD released a survey to the community asking for input on what issues the funds should address. Based the on the survey responses from program participants, providers, and other stakeholders, DDD outlined five goals if the spending plan is approved:

  1. Supports for participants and families: creating a new coverage option for individuals with serious behavioral challenges, implementing a peer family mentoring service, and hosting participant and family forums.
  2. Strengthen provider capacities and system infrastructure: to combat the state provider shortage, funding would increase provider payment rates, invest in quality management, and advance competitive, integrated employment.
  3. Workforce development
  4. Improve protections for health, safety, and well-being: to develop positive approaches for individuals with challenging behaviors and use analytics to improve critical incident responses
  5. Strengthen system evaluation and accountability: Implement evaluations of the agency and strengthen provider monitoring. 

DDD is currently waiting for a response from CMS on the approval of its HCBS spending plan. At the briefing, DDD administrator Mary Brogan reinforced the importance of long-term funding for HCBS that will last even after ARPA.

“As we consider these options, we have to have an eye on sustainability. Some of these things are projects that can be implemented and completed in the next three years, but depending on the options that we choose, some will need much longer term strategies to be put into place. That has to be part of our planning.”