Hawaii I/DD Waiver Services: PAB, ResHab, and What's Covered
What the I/DD Waiver Actually Pays For
Hawaii's 1915(c) Home and Community-Based Services (HCBS) Waiver for individuals with intellectual and developmental disabilities covers a specific set of services — and understanding exactly what's included determines how effectively you can use it.
The waiver currently serves over 3,000 residents statewide with no structural waiting list for enrollment. Once your child has DDD eligibility, Med-QUEST ABD coverage, and an ICF-IID Level of Care certification, the case manager develops an Individualized Service Plan (ISP) that authorizes specific services based on the SIS-A assessment results.
Core Waiver Services
Personal Assistance and Habilitation (PAB) — The most commonly used waiver service. PAB provides one-on-one support for daily living activities: bathing, dressing, meal preparation, medication management, community access, and skill building. PAB workers help your child develop and maintain independence in their daily routine. The 2026 rate increase raised PAB reimbursement to make it financially viable for agencies to recruit and retain direct support professionals.
Residential Habilitation (ResHab) — Covers 24-hour supervised living in a community setting. ResHab providers operate group homes and supported living arrangements where your child receives around-the-clock support while living outside the family home. This is the most resource-intensive waiver service, and authorization depends on assessed support needs. For neighbor island families, ResHab options are limited by the local provider landscape.
Adult Day Health (ADH) — Structured daytime programming that includes health monitoring, therapeutic activities, socialization, and skill-building in a community setting. ADH programs operate during business hours and provide an alternative to staying home during the day.
Individual Support Services (ISS) — Flexible support that helps your child participate in community activities, develop social connections, and build skills for independent living outside of a structured day program setting.
Specialized Services
Vehicle Modification — The waiver covers modifications to a vehicle used for transporting your child, up to $70,000 per modification. This includes wheelchair lifts, ramps, hand controls, and other adaptive equipment. The $70,000 limit was increased in the most recent waiver amendment.
Environmental Modification — Home modifications that enable your child to live more independently or safely, such as grab bars, wheelchair ramps, bathroom modifications, and widened doorways.
Assistive Technology — Devices and equipment that help your child communicate, navigate their environment, and perform daily tasks. This can include communication devices, adaptive switches, and mobility equipment not covered under the regular Med-QUEST benefit.
Discovery and Career Planning (DCP) — A time-limited service that helps your child explore career interests and develop an employment path. The current waiver renewal proposes reducing the DCP authorization from 24 months to 12 months to accelerate the transition from exploration to actual competitive integrated employment.
Free Download
Get the Hawaii — SSI at 18 Checklist
Everything in this article as a printable checklist — plus action plans and reference guides you can start using today.
How Service Levels Are Determined
Your child's ISP budget isn't arbitrary. The SIS-A assessment produces a standardized support needs profile across multiple domains, and the case manager uses those results to authorize a specific dollar amount and service mix. The assessment helps inform the authorized hours and service mix.
The case manager issues all service authorizations through the INSPIRE case management system. Providers then deliver services within those authorizations and bill Med-QUEST directly.
The 2026 Rate Updates
A major waiver amendment effective January 1, 2026, implemented targeted rate increases based on a comprehensive provider rate study. The increases were designed to address the direct care workforce shortage that left many families — especially on the neighbor islands — with approved service authorizations but no available providers.
These rate adjustments directly affect PAB and ResHab reimbursement, making it more economically feasible for agencies to operate on the neighbor islands and recruit DSPs at competitive wages.
Choosing a Provider
After the ISP is finalized, your family selects from authorized waiver providers. Major statewide providers include Full Life Hawaii, The Arc in Hawaii, Lanakila Pacific, and Easter Seals Hawaii — though availability varies significantly by island.
The Hawaii SSI at 18 & Adult Disability Benefits Guide includes a provider selection checklist and a breakdown of each waiver service with authorization thresholds, so you can prepare for the ISP planning meeting knowing what to ask for.
Get Your Free Hawaii — SSI at 18 Checklist
Download the Hawaii — SSI at 18 Checklist — a printable guide with checklists, scripts, and action plans you can start using today.