How to start a skilled nursing facility in Hawaii

Hawaii requires a Skilled nursing facility license from Hawaii State Department of Health, Office of Health Care Assurance (OHCA) to operate a skilled nursing facility.

License required

Yes

License

Skilled nursing facility license

Issuing agency

Hawaii State Department of Health, Office of Health Care Assurance (OHCA)

Certificate of need

Required

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

Hawaii Administrative Rules Title 11, Chapter 94.1 (nursing facilities); HRS Chapter 323D (CON)

1. Apply to the State Health Planning and Development Agency for a Certificate of Need (required for a Medicare/Medicaid facility; SHPDA issues a no-CON-needed letter if federal certification is not sought)
2. Send OHCA the SHPDA response with a written request for licensure
3. Meet licensing requirements (written policies and procedures, qualified staff) and pass the OHCA licensure survey
4. For Medicare/Medicaid, complete the federal certification survey and enroll with Med-QUEST

Program

Hawaii Medicaid — Med-QUEST Division (QUEST Integration)

Enrollment portal

HOKU provider enrollment system

Fiscal agent

Med-QUEST's 2010 general-information manual names Affiliated Computer Services (ACS), a Xerox company, as fiscal agent; we found no newer Med-QUEST statement

Application fee

Med-QUEST's HOKU FAQ describes an application fee ($500 at the time it was written) charged at initial enrollment and at revalidation, temporarily waived during the COVID-19 emergency. The provider-type list shows which types need a site visit and/or fee (e.g., home health agencies need both). Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Med-QUEST runs fingerprint-based criminal history record checks (state repository and FBI), combined with Adult Protective Services and Child Abuse and Neglect registry checks, for certain provider requirements. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Med-QUEST's provider-type requirements list says which provider types get a site visit (for example, home health agencies). Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Med-QUEST began revalidating all providers in 2017 and requires revalidation every five years. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Hawaii Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Hawaii State Health Planning and Development Agency (SHPDA)

Services covered

• hospitals
• extended care and rehabilitation centers
• nursing homes / skilled nursing facilities
• intermediate care facilities
• hospices requiring state licensure or certification
• kidney disease treatment centers / freestanding hemodialysis
• outpatient clinics and organized ambulatory health care facilities
• emergency care facilities
• home health agencies
• health maintenance organizations

Hawaii certificate of need details →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $18.00 on 2028-01-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Skilled nursing facilities — active organization NPIs (NPPES)

57 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

43 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

391,710 (as of Jun 1, 2026)

All Hawaii Skilled nursing Medicaid rates, ranked →