The Developmental Disabilities Division of the Hawaii Department of Health implemented a pilot project, 'Owau Ke Alaka'i (I am the Leader) to support change in the long-term care service delivery system for people with developmental disabilities, from one that is provider-driven to one that is consumer-directed.
The project was part of the Robert Wood Johnson Foundation's (RWJF) national program, Self-Determination for People with Developmental Disabilities.
Hawaii chose two communities as pilot sites: the island of Kauai (a small rural island community on the western side of the state) and West Hawaii (a cluster of communities on the island of Hawaii that were changing from rural to urban).
The project achieved the following:
- By the end of the project, 28 individuals with developmental disabilities in West Hawaii and 40 in Kauai engaged services using person-centered plans, individual budgets, independent support brokers and a fiscal intermediary.
- In some cases where the project could not match project participants with a job, participants used their funding to hire people who could help them start a business.
- The division and Hawaii's Department of Human Services incorporated plans to support self-determination into a new Home and Community-Based Services waiver, and in 2002 submitted it to the Centers for Medicare & Medicaid Services for approval. (States can receive federal Medicaid reimbursement for services by applying for a Home and Community-Based Services waiver by specifying the types of services they wish to offer and the populations that will receive them. The cost of such services may not exceed the cost of institutionalization.)