MEDICAID WAIVER PROGRAM

Medicaid Program - Title XIX of the Social Security Act is a program that provides medical assistance for certain individuals and families with low income and resources. The program, known as Medicaid, became law in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist States in the provision of adequate medical care to financially eligible needy persons.  

Administering State Agency - Department of Human Services (DHS) is the single state agency responsible for administering the Medicaid program for the State.

Operating State Agency – Department of Health (DOH) is the State agency responsible for providing services to individuals with developmental disabilities and/or intellectual disabilities.  The Developmental Disabilities Division (DDD) with DOH has the responsibility to develop, lead, administer coordinate, monitor, evaluate and set directions for a comprehensive system of supports and services.  The DDD operates the Home and Community Based Services (H&CBS) Medicaid Waiver Services Program for persons with developmental disabilities and intellectual disabilities (DD/ID Medicaid Waiver Services Program).

Eligibility Determination - Individuals seeking to receive services from the Medicaid Waiver Services Program must be eligible for medical assistance under the Federal reimbursement Hawaii Medicaid program, meet ICF/MR level of care, and have a developmental or intellectual disability.  DHS-MQD determines Medicaid and initial ICF/MR level of care eligibility.

Individualized Service Plan (ISP) - All PARTICIPANTS admitted into the Medicaid Waiver Services Program shall have an Individualized Service Plan (ISP) authorizing services by the DOH-DDD Case Manager (CM).  The ISP is the written plan required by HRS § 333F-6 that is developed by the PARTICIPANT, with the input of family, friends, and other persons identified by the PARTICIPANT as being important to the planning process.  The plan shall be a written description of what is important to the person, how any issue of health or safety shall be addressed, and what needs to happen to support the PARTICIPANT in his/her desired life.  The ISP is operationalized as the form used by the DOH-DDD CM to document the information above and includes an "action plan" which describes the services and supports, both paid and unpaid, to meet the goals and outcomes identified by the PARTICIPANT.  

Individual Plan (IP) - The PROVIDER shall develop an Individual Plan (IP) based on the goals outlined in the ISP.  The IP shall identify the specific measurable goals and objectives that will be implemented with the PARTICIPANT.  Through on-site and quarterly reports from the PROVIDER, the DOH-DOD CM will monitor the PARTICIPANT'S achievement of these goals and objectives.

SECOH is an authorized Medicaid Waiver Service Provider.

 

 

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