Going Home Plus

Frequently Asked Questions

The Going Home Plus (GHP) project helps residents who have been living in hospitals, nursing facilities, and ICF/ID facilities move back into the community. For those residents who choose to live in the community, the GHP project will assist in finding housing (if the resident does not have a home to return to) and services (for example, help with cooking and bathing). GHP is funded by a federal demonstration grant from the Centers on Medicare and Medicaid Services (CMS) called Money Follows the Person. Hawai‘i’s GHP began in 2008 and will continue through 2020.

Hawai‘i’s GHP project will help residents who have been living in a hospital, nursing facility, or ICF/ID for a long time. These residents may have lost their previous housing or are not aware that care and services in the community are available if they choose to move out of the facility.

The federal grant was given to the Hawai‘i Department of Human Services (DHS). DHS partnered with the University of Hawai‘i Center on Disability Studies (UH-CDS) to assist with the design and evaluation of the GHP project. Other government agencies and community organizations are helping in the design and development of the GHP project.

Residents who have lived in a hospital, nursing facility, and/or ICF/ID at least 90 continuous days are eligible. They must be Medicaid eligible and meet nursing home level of care. Residents from all islands can participate in the GHP project.

To make a referral, please download, complete, and fax this referral form to Madi Silverman, Project Director at 808-692-8087.

A QUEST Integrated health plan service coordinator will help to determine the resident’s preference to return to the community. This service coordinator will also assess the resident’s health, locate housing (if the resident does not have a home to return to), and arrange for home and community-based services.
The service coordinator will interview the resident, family, and/or guardian and ask whether the resident wants to leave and is able to leave. The service coordinator will also make sure that the resident is aware of the housing and service options available in the community before asking about the resident’s preference.
If the resident does not have a home to return to, the service coordinator will help the resident find a suitable home, which may be an adult foster home, senior housing, public housing, or his/her own apartment.

A range of services are available to help the resident live in the community, including assistance such as personal care, home-delivered meals, medical equipment and supplies, transportation and a personal emergency response system.

The service coordinator will make every effort possible to help the resident, but returning to the community is not guaranteed.
The service coordinator will help the resident, family members, and/or guardian make an informed decision prior to leaving the facility. This includes understanding what the new home will look like. If the participant does not like the new home, the participant is not obligated to stay.

Admission to the Going Home Plus project does not affect the participant’s access to health care. The participant can return to the facility temporarily because of a health or medical problem. However, be aware that if a resident leaves a nursing facility or ICF/ID, there is no guarantee that he/she will be able to move back into the same facility or that a nursing facility bed will be immediately available.

Based on the resident’s income he/she may still be responsible to pay for a share of his/her medical and home and community based services when living in the community.

If you would like to participate in the program, or know someone (living in a nursing facility, hospital or ICF/ID) who might be interested please contact:

Madi Silverman, Project Director
Phone: (808) 692-8166
Email: msilverman@dhs.hawaii.gov