Hawaii
Hawaii’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.
At a glance
- Rate method
- Statewide price
- Case-mix level
- Facility average
- Classification
- PDPM
- Rate updates
- Twice a year
- Managed care (LTC)
- Yes
- Quality program
- NF Quality Pool
- Paid outside the rate
- Moderate
- Bed hold
- Leave only
- Published rates
- Rates only
- Assisted living
- Covered
- Personal needs allowance
- $75 / month
Overview
- Hawaii pays an 'acuity-based' price per home with three parts.
- Direct care = a statewide price x the home's average PDPM case mix; the price is $114.89 (100% of median) for homes under 3.5 nursing hours per resident day and $173.48 (112% of median) for homes at or above 3.5 (PBJ, Q1 2023), in CY2023 dollars.
- Admin & general ($140.64, 100% of median) and capital ($22.50, 120% of median) are flat statewide prices, not case-mix adjusted.
- Prices are inflated each rate period, then Hawaii general excise tax and the Medicaid share of the NF Sustainability Fee are added.
- QUEST Integration plans must pay the same rate.
- For 7/1-12/31/2026 the 36 acuity-based homes range $379.57-$566.58/day (median $502.66).
What matters in Hawaii
- Median posted rate $502.66/day for 7/1/2026 across 36 homes (range $379.57-$566.58); plans must pay exactly that rate.
- Direct care price is $173.48 for homes at 3.5+ nursing hours per day versus $114.89 below (CY2023 dollars).
- Case mix moved from RUG-III to PDPM on 1/1/2024; one all-resident average per home, updated January and July.
- State-owned HHSC homes get $215.99 (Oahu) or $389.07 (Hawai'i Island) extra per day; private homes do not.
- Sustainability fee exempts HHSC homes, homes with 28 or fewer beds and CCRCs; high-Medicaid homes pay less.
- No pay for hospital bed holds; therapeutic leave paid up to 24 days a year.
Frequently asked
How does Hawaii's nursing home staffing level affect its Medicaid rate?
Homes at 3.5+ PBJ nursing hours per resident day get a direct care price of 112% of median ($173.48, CY2023) versus 100% ($114.89) below. The tier was set from Q1 2023 data; a home can move up after four straight qualifying quarters.
Do Hawaii QUEST Integration plans pay nursing homes more than the fee-for-service rate?
No. Plans must pay 'rates equal to the current Medicaid fee schedule.' Extra money comes only through directed payments: a quality pool for all homes and $216-$389/day add-ons for state-owned HHSC homes.
Does Hawaii Medicaid pay the full Medicare SNF coinsurance for dual eligibles?
The state plan limits crossover payments to Medicaid rates only for hospital services; for other services, including SNF, it pays up to the full Medicare rate, so homes generally receive the full daily coinsurance.
How much is paid outside the posted rate in Hawaii?
Moderate, about 5% statewide ($20.66M directed payments), but 24-43% of cost for state-owned HHSC homes.
Does Hawaii require a minimum share of spending on care?
None; staffing affects only which direct care price tier a home gets.
How is the Hawaii nursing home provider tax charged?
Per resident day, under 6% of revenue; exempt for small, HHSC and CCRC homes; reduced for high-Medicaid homes. Amount not published.
How the rate is set
How the method got here
| Effective | From | To | Change | Source |
|---|---|---|---|---|
| 1997-07-01 | Earlier Medicaid facility rates | Facility-specific prospective payment system (PPS): Basic PPS rates by acuity level (A/C) and peer group (freestanding vs hospital-based) from each home's base-year cost, with component ceilings and incentive adjustments | Hawaii set facility-specific prospective rates by acuity level from base-year costs (FY98 rebasing). | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
| 2003-09-01 | Facility-specific PPS rates by acuity level A/C, peer groups, own-cost components with ceilings | Price-based acuity system: statewide prices (direct 110%, A&G 103%, capital 100% of day-weighted median), direct care x facility RUG-III 34-group case mix | Hawaii phased in statewide price-based rates with facility-average RUG-III case mix from 2003, fully for all homes from 7/1/2005, with transition payments through 6/30/2008. | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
| 2012-07-01 | No nursing facility provider fee | NF Sustainability Fee per resident day; Medicaid share passed through in rates and fee funds enhancing MCO payments to private homes | Hawaii created the Nursing Facility Sustainability Program (Act 156, 2012). | https://www.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/H… |
| 2021-01-13 | MCO pass-through payments to private nursing facilities | 12% adjustment to all component prices for private nursing facilities | Pass-through payments that did not meet 42 CFR 438.6(d) were replaced by a 12% price adjustment for private homes (SPA 21-0006). | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
| 2023-06-22 | Sustainability fee with a sunset (repeal scheduled 2024); separate state nursing facility tax | Permanent sustainability fee; nursing facility tax repealed | Act 109 (2023) made the NF Sustainability Program permanent and repealed the nursing facility tax. | https://www.capitol.hawaii.gov/sessions/session2023/bills/GM1… |
| 2024-01-01 | RUG-III 34-group case mix; direct 110% / A&G 103% / capital 100% of median (2002-03 base, inflated) + 12% private adjustment | PDPM case mix; direct 100% or 112% of median by PBJ staffing tier, A&G 100%, capital 120% (CY2023 base); 12% adjustment dropped | SPA 23-0014 rebased all prices, switched case mix to PDPM, and tied the direct care price to 3.5 nursing hours per resident day. | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
Verified October 11, 2026
Cost basis
- Uses cost reports
Yes
- Cost report
Medicare cost report (CMS-2540) used to set day-weighted median component costs; MCO directed payments use FYE 2025 cost reports.
- Base year and rebasing
Last rebase effective 1/1/2024 (SPA 23-0014), with component prices tied to the 1/1/2023-12/31/2023 period. The state plan says 'Prices will remain constant for all future rate periods, except that the component prices will be updated for each subsequent rate period by the inflation adjustment factor.' No scheduled rebasing cycle. Previous base: prices for the 7/1/2002-6/30/2003 period (2003 acuity-based system), inflated forward.
- Components
Component Method Notes direct care Statewide price x facility average PDPM case mix. Price tier set by PBJ nursing hours per resident day in the quarter ending 3/31/2023: under 3.5 HPRD = 100% of that group's day-weighted median ($114.89, CY2023); 3.5+ HPRD = 112% of median ($173.48). A home moves up only after 4 consecutive quarters at 3.5+ HPRD, effective the next rate period; the plan has no move-down rule. Covers nursing salaries and benefits, nursing and medical supplies, maintenance therapy at nursing-cost level. administrative and general Statewide price at 100% of the day-weighted median ($140.64, CY2023). Not case-mix adjusted. Was 103% of median before 1/1/2024. capital Statewide price at 120% of the day-weighted median ($22.50, CY2023). Not case-mix adjusted. Was 100% of median before 1/1/2024. pass-throughs Hawaii general excise tax and county surcharge added to the component prices; Medicaid share of the NF Sustainability Fee added to the component prices. 4.19-D p.38a. - Inflation
CMS Nursing Home Without Capital Market Basket (Global Insight/successor), applied to the component prices each rate period (4.19-D definition DD; p.38). No inflation was applied for FFY2015 Q4-FFY2016 Q3.
Verified October 11, 2026
Case mix
- System
PDPM
- Applied at
Facility average
- How it works
One weighted-average case mix per home, from all residents on two point-in-time dates, multiplies the direct care price; every Medicaid resident in the home gets the same per diem (4.19-D p.38a).
- Classification
PDPM; the state plan does not say which PDPM component(s) or weights are used.
- Applies to
Direct care component only.
- Acuity measured from
All residents in the facility (not Medicaid-only), point-in-time: January 1 rates use the most recent May 1 and August 1 snapshots; July 1 rates use the most recent November 1 and February 1 snapshots.
- Updated
Semiannual (January 1 and July 1).
- Move to PDPM
SPA 23-0014, effective 1/1/2024: moved from RUG-III 34-group case mix to PDPM because CMS ended RUG support 10/1/2023, rebasing all component prices at the same time.
Verified October 11, 2026
Low-acuity residents
None found. The acuity-based rate is one per-home rate for Acuity Level A (former ICF) and Level C (former SNF) residents alike; HRS 346D-1.5 requires reimbursement based on level of care, not location. Residents not at NF level of care are not paid a reduced NF rate; they are served in community settings (CCFFH/E-ARCH/ALF). Checked: 4.19-D (rev. 02/2024 incl. SPA 23-0014), memo QI-2614 Attachment B, Provider Manual ch. 12.
Verified October 11, 2026
Capital
Statewide price at 120% of the day-weighted median ($22.50/day in CY2023 dollars, inflated each period); not case-mix adjusted; no fair rental value system.
Verified October 11, 2026
Budget adjustment factor
No across-the-board factor. (1) Per-home UPL cap: if acuity-based rates push aggregate FFS payments above the federal NF upper payment limit, each home paid above its own UPL share is cut to its UPL (4.19-D p.38a). (2) The 12% private-NF price adjustment (1/13/2021-12/31/2023) ended on 1/1/2024. (3) No inflation was applied for FFY2015 Q4-FFY2016 Q3.
Verified October 11, 2026
Add-ons and money outside the rate
Paid outside the posted rate
- Level
moderate
- Estimate
About 5% of base statewide, at the low edge of 'moderate'; concentrated in public homes. Derived: CY2026 NF directed payments total $20.66M versus an estimated ~$400M base Medicaid NF spending (about 36 homes, median rate ~$503/day; base not published). For HHSC non-CAH homes the LTC Access Payment adds 23.77% of cost on Oahu and 42.59% on Hawai'i Island; for private homes, only the quality pool (~0.70% of cost). The sustainability fee money is inside the posted rate.
- Components
LTC Access Payments (HHSC, MCO uniform increase) + NF Quality Pool: $20.66M combined CY2026. FFS public NF cost-reconciliation supplemental (4.19-D (L)): amount not found, likely small since few residents are FFS.
Verified October 11, 2026
Payments by owner type
- Applies
yes
- Detail
HHSC (state-owned) non-CAH homes get MCO LTC Access Payments of $215.99/day (Oahu) or $389.07/day (Hawai'i Island) on top of the rate, lifting them from about 50% to about 74% (Oahu) and 49% to 92% (Hawai'i Island) of cost. Public NFs also get FFS cost-reconciliation supplemental payments (4.19-D (L)) and are exempt from the sustainability fee. Private homes: base rate ~90.2% of cost + ~0.7% quality pool. Public and private quality pools are separate.
- Funding
State long-term care facilities may make IGTs and certified public expenditures support their own payments (HRS 346F-4(d)); while the fee is in effect, those certified expenditures cannot support private-home payments. Payments flow through HHSC to its facilities. No lease or management route for private operators found.
Verified October 11, 2026
Quality program
- Active
Yes
- Program
Nursing Facility Quality Pool: a 42 CFR 438.6(c) state directed payment paid through QUEST Integration MCOs (approved CY2021-2025; renewal for CY2026 in Appendix P2-A).
- Funding
Separate capitation add-on to MCOs. Non-federal share from the NF Sustainability Fee (provider tax) and other sources per the preprint.
- Size
Separate pools for private and public homes, each up to 1% of the class's historical Medicaid managed care revenue, capped at the CY2025 pool amount. For private homes it adds about 0.70% of cost (base 90.20% of cost).
- Paid as
Lump-sum pool distribution by the MCOs (separate payment term).
- Measures
Measure Source Weight How points are earned Long-stay urinary tract infections MDS QM (CMS 5-star data) 20-100 points National quintile; target 2.20% Long-stay antipsychotic use MDS QM (CMS 5-star data) 20-100 points National quintile; target 7.10% Long-stay high-risk pressure ulcers MDS QM (CMS 5-star data) 20-100 points National quintile; target 5.05% PointRight Pro 30 rehospitalizations PointRight (MDS-based) 20-100 points National quintile; target 9.12% PointRight Pro long-stay hospitalizations PointRight (MDS-based) 20-100 points National quintile; target 8.10% AHCA/NCAL National Quality Award (bonus) AHCA/NCAL bronze 30 / silver 60 / gold 100 points Award level - Scoring period
Annual; measures 'collected annually' from national data; exact data periods not stated in the preprint.
- Payment formula
Initial allocation = each home's share of the class's historical managed care revenue. Total points set the tier: Tier 1 >= 450, Tier 2 400-449, Tier 3 350-399, Tier 4 < 350. A home earns 100% (Tier 1) down to 75% (Tier 4) of its allocation; the unearned share of Tiers 3-4 is redistributed to Tiers 1-2.
- Eligibility
Private and public (CAH and non-CAH) homes with Medicaid managed care use; swing-bed-only facilities excluded.
- Cadence
Annual (one-year preprint approvals).
- Scores published
Not found.
- Notes
Separate from the MCO-level P4P (memo QI-2616), which scores health plans, not homes.
Verified October 11, 2026
Provider tax
- Charged
per resident day (all resident days, including paid bed-hold days; HRS 346F-3, 346F-5)
- Standard amount
Current dollar amount not published. Set prospectively each fiscal year by DHS with agreement of the NF trade association (HRS 346F-6); must not exceed 6% of net patient service revenue. Paid monthly, due 60 days after month end. Program permanent since Act 109 (6/22/2023). History from the session laws: the statute once fixed the fee at $13.46 per resident day (reduced tier $5.85); Act 163 (2019) changed this to caps of $20.00 and $9.00; Act 24 (2021) removed the caps, so the amounts are now set administratively and are not in statute.
- Tiers
Who Test Amount Nursing facilities with 28 or fewer licensed beds size exempt Homes owned, operated by or affiliated with Hawaii Health Systems Corporation (HHSC) public exempt Continuing care retirement communities ccrc exempt Homes with high Medicaid resident days (HRS 346F-5(d)(2)); the statute sets no numeric threshold and leaves it to DHS to meet the federal redistributive test (42 CFR 433.68(e)(2)) under the CMS waiver approved 3/9/2020 medicaid_utilization reduced daily fee (current amount not published; statutory $5.85 before 2019, capped at $9.00 2019-2021, cap removed 2021) - Lower for high-Medicaid homes
yes
- Returned in the rate
The Medicaid share of the fee is added to the acuity-based rate component prices (4.19-D p.38a), and plans pay that rate. By statute, at least 88% of fee revenue (with federal match) must go to private NFs through enhanced MCO capitation or quality incentives; 12% may go to other DHS uses (HRS 346F-4(c)). Act 109 appropriated $27M a year from the fund for FY2024 and FY2025. If DHS cuts private NF rates to supplant fee money, collection stops (HRS 346F-13).
Verified October 11, 2026
Provider tax notes
Nursing Facility Sustainability Fee (HRS ch. 346F, since 7/1/2012; made permanent by Act 109, 2023). A per-resident-day fee on non-governmental NFs, capped at 6% of net patient service revenue. Exempt: 28 or fewer beds, HHSC-affiliated homes, CCRCs. Reduced fee for high-Medicaid homes. The Medicaid share is added to each home's rate. The per-day amount was not found.
Verified October 11, 2026
Supplemental payments
(1) LTC Access Payments (MCO directed payment, uniform per-diem increase) for government-owned non-CAH homes (HHSC): +$215.99/day on Oahu and +$389.07/day on Hawai'i Island for CY2026, capped at CY2025 levels and at 100% of cost. Paid through HHSC. (2) NF Quality Pool (above). Total of both: $20.66M for CY2026 ($12.33M federal). (3) FFS: public hospital-based and freestanding NFs get a cost-reconciliation supplemental payment equal to allowable Medicaid FFS routine cost minus FFS payments (4.19-D (L), since 7/1/2008), paid quarterly in interim amounts and reconciled. (4) Pass-through payments to private NFs through MCOs were phased out (SPA 21-0006, 2021) in favor of a 12% price adjustment, itself dropped at the 1/1/2024 rebase.
Verified October 11, 2026
Other add-ons
(1) Hawaii general excise tax + county surcharge pass-through. (2) Medicaid share of the NF Sustainability Fee pass-through. (3) No ventilator, behavioral or dementia add-ons found in the acuity-based system; higher-need residents are paid at separate subacute rates.
Verified October 11, 2026
Units paid separately
(1) Subacute Level I and Level II per diems by facility (e.g. Hale Nani $723.68; others $502.08-$1,321.89 for 7/1-12/31/2026), plus acute hospital subacute rates. (2) Critical access hospital NF beds: interim cost-based per diems under Medicare reasonable-cost principles (HRS 346-59): $645.95-$1,256.87 for 7/1/2026-6/30/2027. (3) Hospital patients waitlisted for NF placement: $486.44/day ($478.20 at Leahi). (4) ICF/ID: separate methodology. (5) Hospice room and board in a NF: 95% of the NF rate.
Verified October 11, 2026
Payment rules
Managed care for long-term care
- Status
yes
- Detail
QUEST Integration MCOs (RFP-MQD-2021-008 contracts) cover long-stay nursing facility care with no day limit (QI RFP §7.2.C.1.g; 1115 demonstration). Rate memos (QI-2614) are addressed to the QI health plans. Plans in 2026: AlohaCare, HMSA, Kaiser, 'Ohana (leaving 1/1/2027), UnitedHealthcare.
Verified October 11, 2026
Who pays
managed_ltss (QUEST Integration): nearly all Medicaid NF residents are enrolled in QUEST Integration (QI) MCOs under the 1115 demonstration; fee-for-service covers pre-enrollment and retroactive periods. Five QI plans in 2026 (AlohaCare, HMSA, Kaiser, 'Ohana, UnitedHealthcare); 'Ohana does not renew its QI contract from 1/1/2027 (memo QI-2608).
Verified October 11, 2026
Managed care rate floor
Yes, an exact match. QI RFP-MQD-2021-008 SC7 §7.2.C.1.g: 'The Health Plan shall reimburse nursing facilities in accordance with HRS §§346E and 346D-1.5 utilizing an acuity-based system at rates equal to the current Medicaid fee schedule.' Plans must also join the NF quality payment program and pay HHSC public homes a uniform increase (Appendix P2-A). Critical access hospital NF beds are paid at least the DHS cost-based prospective rate (HRS 346-59). Source: https://medquest.hawaii.gov/content/dam/formsanddocuments/res…
Verified October 11, 2026
Included in the daily rate
Included: room and board, nursing, respiratory services by nursing/RT staff, therapeutic diets, basic supplies, non-customized DME (wheelchairs, walkers), activities, social services, pharmacist drug review, maintenance therapy, OBRA 87 costs. Billed separately: physician services, drugs, lab, x-ray, EKG, non-facility transport, dental, optical, audiology, podiatry, PT/OT/speech (except maintenance), customized DME. Homes that cannot bill ancillaries itemized may get an 'ancillaries payment' per diem (Provider Manual ch. 12 §12.2).
Verified October 11, 2026
Bed hold
- Hospital stays
Not paid: 'Payments shall not be made for a reserved bed when the recipient's absence is due to acute hospitalization stays' (4.19-C item 2).
- Leave days
Paid for non-hospital absences in the physician-approved plan of care: up to 3 consecutive days per absence (longer with prior approval) and 24 days per calendar year, at the 4.19-D rate (4.19-C, TN 14-009 eff. 10/1/2014; Provider Manual ch. 12 §12.3).
- Occupancy rule
None.
- Notes
Billed with revenue code 0180, one line per day. The 2019 baseline's 12 days/year limit is out of date; 24 days applies. Paid bed-hold days count as resident days for the sustainability fee.
Verified October 11, 2026
Personal needs allowance
- Per month
75
- Effective
2024-10-01 (SPA 24-0012, Attachment 2.6-A p.4a; HRS 346-53)
- Notes
Raised from $50 ($100 couples) to $75 ($150 couples) for all institutionalized persons. The same $75 applies to CCFFH, E-ARCH and ALF residents (memo QI-2604A). Not COLA-indexed.
Verified October 11, 2026
Medicare coinsurance days
- Method
full
- Rule
Supplement 1 to Attachment 4.19-B p.3: payments of Medicare Part A/B deductibles and coinsurance are limited to state plan rates only for inpatient and outpatient hospital services; 'For all other services, payments are up to the full amount of the Medicare rate.' SNF coinsurance (days 21-100) therefore falls under the full-amount rule. Treatment of Medicare Advantage cost-sharing was not found.
- Effect
The home should receive the full Part A daily coinsurance for dual eligibles, not a lesser-of amount capped at the Medicaid rate.
Verified October 11, 2026
Required care spending
- Applies
no
- Rule
No rule requiring homes to spend a share of revenue on care or staff was found. Related but different: (1) the direct care price tier depends on PBJ staffing (3.5+ HPRD earns 112% of median); (2) MCOs must pass 100% of fee-funded enhancements to private NFs (HRS 346F-10(a)(7)), which binds plans, not homes.
Verified October 11, 2026
Occupancy rules
- Applies
no
- Rule
None found: the acuity-based prices are statewide medians with no minimum occupancy adjustment. Checked 4.19-D (rev. 02/2024).
Verified October 11, 2026
MDS accuracy penalties
None found in the 4.19-D or Provider Manual ch. 12.
Verified October 11, 2026
Published rates and changes
How often rates change
- A home's rate changes
semiannual
- When
January 1 and July 1: each home's case mix is refreshed (snapshots May 1 + Aug 1 for January; Nov 1 + Feb 1 for July) and component prices are inflated. A direct-care price tier upgrade (after 4 consecutive quarters at 3.5+ HPRD) takes effect at the next rate period. CAH NF interim rates are set annually (July 1).
Verified October 11, 2026
When rates change
January 1 and July 1 (e.g. memo QI-2614: acuity-based rates effective 7/1/2026-12/31/2026).
Verified October 11, 2026
Posted rates
- Home-level rates published
Yes
- Format
pdf (memo attachments: A waitlisted, B long-term care acuity-based rates, C subacute, D hospice NF, G CAH NF interim)
- Cadence
Semiannual memo to QUEST Integration plans.
- History
The memo page currently posts the 7/1/2026 NF rate memo (QI-2614) and NF rate memos from 2015-2017; NF rate memos for 2018-2025 were not found on the page.
- Home identifier
Hawaii Medicaid provider number (6 digits) plus name; no CCN or NPI.
Verified October 11, 2026
Rate build-ups
- Published
No
- Where
Not found. Memos list only the final per diem per home.
- What they show
Final per diem only; no case mix, price tier, or pass-through detail.
- Format
pdf
Verified October 11, 2026
Recent changes
| Effective | Change | Headline | Direction | Size | Source |
|---|---|---|---|---|---|
| 2024-01-01 | Rates were rebased to CY2023 prices, case mix moved from RUG-III to PDPM, the direct care price was split by PBJ staffing (100% vs 112% of median), capital rose to 120% of median, and the 12% private-home adjustment ended. | PDPM rebase with staffing-tiered direct care price | increase | Est. federal impact to managed care $28.6M FFY2024 and $28.8M FFY2025; 'minimal' FFS effect | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
| 2024-10-01 | The personal needs allowance for nursing home residents rose from $50 to $75 a month ($100 to $150 for couples). | Personal needs allowance raised to $75 monthly | structural | $50 -> $75/month | https://medquest.hawaii.gov/content/dam/formsanddocuments/med… |
| 2026-01-01 | MCO directed payments were renewed for CY2026: LTC Access Payments for HHSC homes ($215.99/day Oahu, $389.07/day Hawai'i Island) and the NF Quality Pool, both capped at CY2025 levels. | Nursing facility directed payments renewed, capped at 2025 levels | structural | $20.66M total ($12.33M federal) for CY2026 | https://medquest.hawaii.gov/content/dam/formsanddocuments/res… |
| 2027-01-01 | 'Ohana Health Plan will not renew its QUEST Integration contract, leaving four plans on Oahu and Maui and three on Hawai'i and Kauai; MQD froze its enrollment for 2026. | Ohana Health Plan exits QUEST Integration in 2027 | structural | https://medquest.hawaii.gov/content/dam/formsanddocuments/pro…)%20-%20signed.pdf |
Verified October 11, 2026
Assisted living
Medicaid assisted living
- Covered
yes
- Program
QUEST Integration home and community-based services under the section 1115 demonstration: Assisted Living Facility services (T2031), Community Care Foster Family Homes (CCFFH) and Expanded Adult Residential Care Homes (E-ARCH), delivered through the MCOs.
- What is paid
Services only; room and board are paid by the resident. For SSI members, room and board is $1,748/month ($1,823 SSI domiciliary standard minus $75 PNA), supported by Hawaii's optional state supplement (domiciliary care Level I $784/month, Level II $892/month in 2024, SPA 24-0013). For cost-share members it is $418/month.
- Rate
FFS rates (MCOs may differ). ALF, effective 7/1/2026 and 'pending funding approvals': Oahu Level 1 (at risk) $164.88/day cost-share or $127.79 SSI; Level 2 (NF level of care) $269.33 cost-share or $232.24 SSI; neighbor islands +$5. CCFFH/E-ARCH effective 1/1/2026, Oahu: Level 1 $67.33 (cost-share) / $30.24 (SSI); Level 2 $108.40 / $71.31; neighbor islands +$5.
- Limits
Level 2 requires NF level of care; Level 1 covers at-risk members. No enrollment cap or waitlist found.
Verified October 11, 2026
Sources
- Hawaii Medicaid State Plan Attachments 4.19-C, 4.19-D, 4.19-E (Rev. 02/2024, incl. SPA 23-0014 pp.38-38a) · state plan
- SPA 23-0014 Nursing Facility Payment Methodology Change: public notice and 4.19-D pages (eff. 1/1/2024) · state plan
- SPA 21-0006 Nursing Facilities and Pass-Through Phaseout public notice · state plan
- Memo QI-2614: Medicaid FFS Rates Effective July 1, 2026 (Attachments A-G) · rate file
- QUEST Integration RFP-MQD-2021-008 SC7 Appendix P2-A: 438.6(c) preprint, Nursing Facilities Payment Model (CY2026) · agency page
- QUEST Integration RFP-MQD-2021-008 SC7 (contract terms §7.2.C) · agency page
- HRS chapter 346F Nursing Facility Sustainability Program Act (§§346F-3 to 346F-13) · statute
- HRS §346F-4 special fund uses · statute
- HRS §346F-10 enhanced rates to Medicaid managed care plans · statute
- Act 109, SLH 2023 (HB1369 CD1) Relating to Nursing Facilities · statute
- HRS §346D-1.5 Medicaid reimbursement equity · statute
- Hawaii Medicaid Provider Manual Chapter 12 Long Term Care (rev. July 2021) · agency page
- State Plan Attachment 4.19-B (Rev. 8/2025), Supplement 1 (Medicare deductible/coinsurance) · state plan
- SPA 24-0012 Attachment 2.6-A p.4a (personal needs allowance, eff. 10/1/2024) · state plan
- SPA 24-0013 Optional State Supplemental Program Increase (domiciliary care) · state plan
- Memo QI-2604A: FFS Rates for HCBS Effective January 1, 2026 (ALF, CCFFH, E-ARCH) · rate file
- Memo QI-2608: Auto Assignment Algorithm (Ohana non-renewal) · agency page
- Med-QUEST provider memo index · agency page
- MACPAC 2019 nursing facility payment policies compendium (baseline only) · secondary
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