Hawaii Executive Office on Aging’s No Wrong Door (NWD) Initiative

In 2014, HCBS Strategies worked with Hawaii on its proposal and fulfillment of the objectives under a one-year planning grant from the Administration for Community Living (ACL) to develop a plan and vision for how the No Wrong Door effort, referred to as the ADRC Network in Hawaii, would be implemented. As a result of this planning effort, HCBS Strategies worked with the Executive Office on Aging (EOA) and the Office of the Governor to develop a successful application for a highly competitive ACL grant that funds the implementation of the ADRC Network. HCBS Strategies is now working with EOA and the other State partners on the three-year plan to implement the ADRC Network.

Under the ADRC Network effort, HCBS Strategies has led the development and implementation of a comprehensive implementation plan that includes six State agencies, four local agencies, and two contracting partners. Agencies involved in this effort include:

  • Adult Mental Health Division (AMHD)
  • Adult Protective Services (APS)
  • Assistive Technology Resource Center (ATRC)
  • Center for Independent Living (CIL)- Access to Independence
  • Center for Independent Living (CIL)- Aloha Independent Living Hawaii
  • Children with Special Health Needs Branch (CSHNB)
  • Developmental Disabilities Division (DDD)
  • Division of Vocational Rehabilitation (DVR)
  • Med-QUEST Division (MQD) with links to all Health Plans
  • Office of Veterans Services (OVS)
  • Veterans Health Administration (VHA)
  • The four county Area Agencies on Aging (AAA) which operate the Aging and Disability Resource Centers (ADRCs).

Thus far in implementation, HCBS Strategies has worked with EOA and the other agencies to develop:

  • An automated referral tool that allows the agencies (Doors) to send common referral information across Doors to reduce 1) the need for the participant to tell their story multiple times and 2) the number of individuals who are not contacted after being referred to another agency. The referral tool includes the ability to “close the feedback loop”, which requires the agency receiving the referral to mark that they are acting on the referral, after which the system sends a notification to the agency who generated the referral to let them know the referral has been acted upon. HCBS Strategies is currently leading the pilot effort of this tool within the City and County of Honolulu.
  • An advisory group that consists of individuals with disabilities, providers, family members, and advocates;
    A framework and plan for the initiatives that will continue or begin after the initial three year grant period;
  • Draft person-centered standards to meet the CMS rules;
  • FFP claiming methodology, including the completion of two time studies;
  • Interviews with five states on potential methods for implementing managed LTSS in Hawaii; and
  • Interviews with each of the State agencies and other partners to collect information on organization structure, service offerings, intake and assessment procedures, and training efforts. This information will be translated into living documents to improve the understanding of the functions of each agency across partners.

To monitor progress of the initiative and allow stakeholders to review documents and provide additional feedback, we have developed a website. It can be found at

Supporting Systems Change in Hawaii

HCBS Strategies is currently working with EOA and its partners in order to realize the goals and objectives laid forth in the 5-year plan for implementing ADRCs. HCBS Strategies is working with EOA to implement core pieces of the ADRC operational infrastructure that includes:

  • Automating protocols for referrals, intake, assessment, and support planning
  • Developing Options Counseling competencies and protocols
  • Creating procedure, approval, and documentation requirements for drawing down Medicaid administrative federal financial participation (FFP) to support core ADRC functions
  • Establishing memorandum of understandings (MoUs) with other partner agencies
  • Determining policies and procedures that incorporate evidence-based approaches for targeting services, determining whether case management is needed, and establishing support plans (utilizing the interRAI framework)
  • Developing provider agreements between Veterans Health Administration Medical Center and the ADRCs

Systems Change Developer

HCBS Strategies was contracted to fulfill the role of the Systems Change Developer (SCD). The objective was to create a five year strategic plan that guided the development of a streamlined operations infrastructure for Hawaii’s ADRC, Community Living Program, and Person-Centered Hospital Discharge Planning efforts. The SCD effort built an infrastructure that streamlined access to HCBS, helped target scarce resources to individuals at greatest risk of institutionalization and Medicaid spend down, and provided a participant-directed option under the state-funded Kupuna Care program.

While the main thrust of the effort was to develop the five year plan, we also engaged in building infrastructure to develop and sustain collaboration among the stakeholders. As part of this effort, we facilitated the two ADRC recharge conferences.

Hawaii Strategic Five-Year Plan

Download the strategic plan:

ADRC Recharge Conference

Download the strategic plan:

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