The statewide body for Hawaii's licensed community care foster family home case management agencies. We speak with one voice to the Legislature, Med-QUEST, and the health plans — starting with the case-management rate.
What the council is dealing with. Anyone signed in can add and update.
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Legislative Deadline Tracker
White paper dates, bill season, named champions.
The Rate Case
Why the council is asking the state to fix the CCMA case-management rate — the evidence behind the white paper.
The state's own actuary said our rate was too low in 2022, priced the fix as the cheapest line in the entire study, and four years later it is still the only one unfunded.
1. What the state's own rate study says
Source: SR4 SD1 Report to the 32nd Legislature, DHS Med-QUEST / Milliman, December 30, 2022 — Figure 4, CCMA Services Rate Scenarios.
CCMA case management, per diem
Rate
vs. 2021 baseline
CY2021 average payment (studied)
$13.15
—
Milliman LOW scenario
$13.88
+5.6%
Milliman MEDIUM scenario
$15.06
+14.5%
Milliman HIGH scenario
$16.48
+25.3%
What we are actually paid in 2026
$14.60
FROZEN (QI-2604)
We are paid below the state's own medium scenario — and that scenario was built on 2021 cost data, now almost four years old. The 2025 adjustment before the freeze was +1.1% ($14.44 → $14.60).
2. What the fix costs the state
Statewide cost to fix CCMA rates
Total payment change
State general fund
Low scenario
$0.50M
$0.29M
Medium scenario
$1.30M
$0.76M
High scenario
$2.30M
$1.35M
All rate-study services combined
$37.9M – $72.9M
$22.2M – $42.7M
Case management is 1–3% of the entire rate study. Milliman's own summary: in-home services showed "the most significant differential from current rates," while "case management services had the least." We are the cheapest ask on the table.
3. The state has already said what we are saying
"… providers who have gone the longest without a rate update such as case management agencies, community care foster family homes, and adult day health and day care centers."SR4 SD1, LTC Working Group
"Case management provider reimbursement levels are not sufficient for all providers to be able to employ RNs, and most providers primarily rely upon contracted RNs."Milliman, provider feedback
"Providers strongly support formalized enhanced 'level 3' rates for individuals with high behavioral needs."Milliman, provider feedback
Milliman designed that Level 3 CCMA concept. It was never funded.
"Residential CCMA rate has remained the same over the past decade, while the acuity and complexity of the members being served have increased (particularly related to behavioral health)."MQD 2021 ARPA HCBS spending plan
4. Why this is a fairness problem, not just a funding problem
Caregiver rates rose an average of +32% for 2025 (HB2215, 2024 — funding Milliman's low scenario).
Case management agency rates rose +1.1% for 2025, then were frozen for 2026. Both raises were owed. Only one was paid.
Every CCFFH client is required by state law to be served by a licensed case management agency (HRS §321-481 et seq.). The CMA layer is not optional — it is the statutory oversight that makes the family-home model safe. It is the layer that got skipped.
Duties added since the study, with zero rate recognition: HOKU enrollment with fingerprinting and 5-year revalidation (QI-2429); HCBS Settings Rule attestations; HFA Section E home-environment assessments including water source and structural condition (QI-2416, eff. 01/01/2025); per-plan duplication across five QI health plans; and a 10-business-day Plan of Correction turnaround under fine authority of up to $500/day (HAR 11-800-3).
5. What we are asking for — proposed council positions for adoption
Submitted by one agency to MQD on 07/17/2026 — these become the council's asks only once this body adopts them.
Raise the base case-management rate. Floor: Milliman's own medium ($15.06) or high ($16.48) scenario. An inflation-parity reference point from a 2001 baseline is approximately $24.90/day — not yet documented in writing; do not cite this figure outside the council until a 2001-era contract or fee schedule is in hand.
Add a complex-case rate for agencies, mirroring the caregiver complex rate — this is Milliman's own "Level 3" concept, designed and never funded.
When a duty is added, add a billing code. The 6-month reassessment, post-hospitalization visits, annual TB clearance reads, and admissions are distinct service intensities absorbed into one flat per diem.
Automatic annual inflation adjustment for both agencies and caregivers, so the rate never falls a decade behind again.
State help with mandated insurance costs. HAR §11-800-33 requires GL, auto, and E&O coverage the frozen rate does not fund. Other states fund or provide it (Texas: $1.67/day nursing-facility liability add-on, 1 TAC §355.312; Minnesota: Minn. Stat. §245.814).
6. What this money protects
~3,000
clients served
1,295
certified foster homes
~26
licensed CMAs statewide
$9.3M
total statewide CCMA spend, CY2021
A nursing home runs roughly $280/day. A CCFFH placement runs roughly $2,500–$3,800/month. Federal Medicaid approved this program in 1984 precisely because it delivers nursing-home-level care at two-thirds or less of institutional cost. When agencies cannot cover costs, they slow or stop Medicaid admissions — and members who cannot be placed stay in hospital beds, the most expensive setting in the system. This ask protects the savings engine, not just the agencies.
7. Where this goes next
Pulled live from the Deadlines and Agenda & Calendar tabs, so this list and the Home page always agree — add or change a date there, not here.
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Legislative relationships: see the Home page's "Who we're connecting with" section.
All rate figures and quotations above are taken directly from the SR4 SD1 report and its attached Milliman study (12/30/2022), and from MQD's 2021 ARPA HCBS spending plan. The ~$24.90/day inflation-parity figure is a reference point derived from a 2001 baseline that is not yet documented in writing — it should not be cited to the Legislature until a 2001-era contract or fee schedule is in hand. Adapted from the briefing presented at the council meeting of August 27, 2026.
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