IDD Medicaid rates in Hawaii are set by the Department of Health's Developmental Disabilities Division (DOH DDD) through a single I/DD waiver rate sheet. Hawaii pays $6.13 per 15 minutes for community integration on code T2021, or $24.52 an hour. That ranks 14th of 22 states and is 8.2% below the national median of $26.70.
Hawaii's ranked IDD rates are both below the national median, and residential habilitation is in the bottom five. At the same time, the state has reworked its I/DD waiver repeatedly since 2023, with new rate sheets, new service codes and modifiers, and a CMS-approved waiver amendment effective 2026-01-01. This page covers what Hawaii pays, how it compares, and what has changed. Rates are compiled from official state Medicaid publications and link to their source documents.
Hawaii Medicaid IDD reimbursement in 2026
| Service | Code | Hawaii rate | Rank | vs national median |
|---|---|---|---|---|
| Community integration | T2021 | $24.52 / hour | 14 of 22 | -8.2% |
| Residential habilitation | S5140 | $164.17 / day | 27 of 31 | -41.4% |
Both rates have been effective since 2025-07-01, when the current I/DD Waiver Rate Sheet took effect. Hawaii's other IDD services, such as in-home supports, day habilitation, supported employment and behavior support, are not included in the national rankings in our data.
Community integration on T2021 in Hawaii
Hawaii bills community integration on T2021 with the UQ and UA modifiers. At $24.52 an hour, it sits close to the middle of the 22 ranked states, 8.2% below the median.
The range around it is wide. Virginia pays $140.64 an hour, Indiana $104.56 and Maryland $68.44. At the bottom, Wyoming pays $16.60, Louisiana $16.00 and Georgia $14.60. Hawaii is far closer to the bottom of that range than the top in dollar terms.
The rate does not cover one-on-one support at the median wage. Hawaii's median direct support professional wage was $20.39 an hour in May 2025 federal data. Loaded with payroll taxes and benefits, that wage is 115.0% of the $24.52 rate, a loss of more than $3 for every hour of individual support. Community integration in Hawaii is financially viable mainly as a group service.
Residential habilitation rate in Hawaii
Residential habilitation on S5140, with the TF and UA modifiers, pays $164.17 a day. That ranks 27th of 31 states and is 41.4% below the $280.27 national median.
Only four ranked states pay less, and the lowest three are Iowa ($140.81), Illinois ($108.00) and Oklahoma ($88.66). At the top, Minnesota pays $999.00 a day, the District of Columbia $567.62 and New York $564.22. Alaska, the other non-contiguous state, pays $483.15 on T2016.
For residential providers, the S5140 rate has to cover round-the-clock staffing, supervision and administration. Hawaii's median residential advisor wage was $17.76 an hour in May 2025, below the $20.31 national figure, which narrows the gap between the low daily rate and staffing costs.
Coverage records show 3 prior authorization rules on S5140, while T2016 and T2021 carry none. No unit limits are recorded.
Wages for Hawaii IDD providers
May 2025 federal occupational data for Hawaii shows a mixed picture against the national medians:
- Direct support professional: $20.39 vs $22.08 nationally (based on the closest comparable occupation)
- Residential advisor: $17.76 vs $20.31
- Home health / personal care aide: $18.32 vs $17.21
- Licensed practical nurse: $34.20 vs $30.96
The aide wage sits above the national median, while the direct support and residential advisor wages sit below it. IDD agencies compete for workers with home care and nursing facilities, where aides are paid more than the IDD direct support median suggests.
Hawaii I/DD waiver changes since 2023
DOH DDD has issued several rate and coding updates:
- CRB-FY2024-06 (1/10/2024): Updated I/DD Waiver Rate Sheet effective November 1, 2023.
- CRB-FY2025-05 (5/14/2025): updated service codes and modifiers, effective 2025-07-01.
- CRB-FY2026-02 (7/8/2025): Updated I/DD Waiver Rate Sheet effective July 1, 2025. This is the rate sheet behind the figures on this page.
- CMS approval HI 0013.R08.12: I/DD waiver amendment 12, approved 2025-11-14 and effective 2026-01-01.
The 2025 code and modifier changes matter for billing. Claims must use the current code and modifier combination, such as T2021 with UQ and UA, or they will not match the rate sheet.
How Hawaii's Med-QUEST plans pay for IDD services
Hawaii Medicaid operates as Med-QUEST, with QUEST Integration plans including AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan and UnitedHealthcare Community Plan. The IDD sheet counts 9 plan listings.
The I/DD waiver is operated by DOH DDD. For home and community-based services more broadly, our managed-care classification for Hawaii is that plans negotiate their own rates and the published rate applies out of network. Providers who serve the same person under both the waiver and a QUEST Integration plan should confirm which payer and rate apply to each service. Details are on the Hawaii managed care page.
Where Hawaii fits nationally
Hawaii is a below-median state on both IDD services it ranks, and in the bottom five for residential habilitation. For national medians on all eight IDD services, see the IDD rates by state hub. For all other Hawaii service lines, see the Hawaii Medicaid rates page. Our methodology explains how 15-minute units are converted to hourly rates.
Updated 2026-10-05