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I want to be a Medicaid I/DD Waiver Provider

DDD accepts applications on an ongoing basis to help in achieving the goals of the Medicaid I/DD Waiver:

  1. To provide necessary supports to participants in the waiver to have full lives in their communities and to maximize independence, autonomy and self-advocacy; and
  2. To evaluate and continuously improve the quality of services to participants, including measuring the satisfaction of the benefits and services the participants receive, to improve them.

Application for participation as a Medicaid I/DD Waiver Provider

  • Any prospective waiver provider (individual, business, or organization) wishing to become a Medicaid I/DD Waiver provider must complete and submit a Medicaid I/DD Waiver Proposal Application. Providers may be for-profit or non-profit.
  • DDD must determine whether the applicant meets all Medicaid I/DD Waiver Standards and send a recommendation to the Department of Human Services, Med-QUEST Division (MQD) to become a Medicaid I/DD Waiver provider.
  • New provider applicants must meet the Centers for Medicare and Medicaid (CMS) HCBS Final Rule for Community Integration to deliver services in fully integrated community settings prior to approval to become a Medicaid I/DD Waiver provider. New provider applicants should review the most recent Medicaid Waiver Standards and the CMS Guidance.
  • An individual, business, or organization is prohibited from providing any service until the applicant has signed a Medicaid Provider Agreement with MQD, has received an approval letter from MQD, and has received an Employee Validation Approval Letter from DDD.
  • Once approved to be a Medicaid I/DD Waiver provider, the provider must have capacity to serve the geographic area for every service authorized by DDD on the rate sheets.

How to become a provider

Step 1: Contact DDD-Community Resources Branch (CRB) or download the application

Download the Medicaid I/DD Waiver Proposal Application (application) or contact DDD-CRB to obtain the application.

Mail the completed application to:

Department of Health, CRB
3627 Kilauea Avenue, Room 411
Honolulu, HI 96816
Telephone: 733-2135

Step 2: New Provider Application Process

  • DDD will send acknowledgement of receipt of the application.
  • The application will be reviewed for programmatic and fiscal requirements.
  • During the review process, the applicant may be asked to provide additional documentation.
  • A site visit to the Applicant’s setting(s) may be scheduled as needed to assist in the review process.
  • DDD will notify the applicant of its findings within ninety (90) days of submission.
  • If DDD recommends the applicant to Med-QUEST to become a Medicaid Waiver Provider, the applicant must submit the Medicaid Application/Change Request Form (DHS 1139) with a $500 application fee to DDD-CRB to be forwarded to MQD.

Application fee of $500 should be in the form of a money order or cashier’s check (no personal or business checks), payable to:

State Director of Finance
c/o Med-QUEST Division
Health Care Services Branch, Provider Enrollment
PO Box 700190
Kapolei, HI 96709-0190

Along with the DHS 1139 and the check for $500, the applicant must also submit the following:

  • Certificate of Liability Insurance
  • Certificate of Vendor Compliance (CVC) with the Hawaii Compliance Express
  • GE Tax License
  • Form W-9
  • If the application is determined to not meet Medicaid I/DD Waiver Standards, the applicant may submit one revised application within the fiscal year. DDD will follow the same review process and timelines.


If you are a prospective waiver provider and have questions, you may contact the DDD CRB at 808-733-2135 or [email protected].