CMS approved Hawai’i’s “Hawai’i QUEST Integration” Medicaid 1115 waiver on Jan. 8, 2025 effective through Dec. 31, 2029, which included an update of existing services as well as the addition of Health-Related Social Needs (HRSN) supports around housing and nutrition. Medical Respite/Recuperative Care is included as three separate supports:
- Short-term pre-procedure housing: Used by individuals needing accommodations to perform required medical preparation for up to three days before a scheduled procedure or treatment (e.g., colonoscopy).
- Short-term recuperative care: Reimbursement for Medicaid members who require post-acute medical respite care after a hospitalization or other institutional stay. For up to 90 days, the individual will receive ongoing medical and psychiatric support for the illness, injury, or diagnosis that required hospitalization. Hawai’i is unique in that a recuperative care facility can utilize the Kauhale site model, offering a more intentional communal living space.
- Short-term post-transition housing (e.g., post-hospitalization): Step-down level of care after discharge from a Recuperative Care program. Any Medicaid-eligible individual can utilize the above services for up to a combined six months out of a rolling 12-month period, through authorization with their managed care plan.
Next Steps: Hawaiʻi is exploring a tiered reimbursement structure for medical respite/recuperative care providers, allowing for programs that deliver a higher level of medical services on site to receive a higher rate of reimbursement.
Categories:
Financing a Medical Respite Care Program, Medical Respite
