ʻOhana Health Plan is WellCare’s (Centene’s) QUEST Integration plan in Hawaii, and it is leaving. Med-QUEST’s March 4, 2026 memo QI-2608 says ʻOhana "does not intend to renew its QI contract beginning January 1, 2027," and ʻOhana’s provider FAQ confirms members move to another QUEST plan on January 1, 2027, after a special open enrollment on October 1–20, 2026. Until then ʻOhana delivers the Med-QUEST ABA benefit (memo QI-2431: under 21, ASD) and prior-authorizes every ABA code from 97151 through 97158.
Note the spelling: the plan writes its name with a leading ʻokina. pVerify lists it as "Ohana Health Plan (WellCare of Hawaii)", and the payer name follows that spelling.
ʻOhana’s FAQ (approved August 14, 2026): members were to be notified in early September; the special open enrollment runs October 1–20, 2026; members who don’t choose are assigned; enrollment and transition-of-care files move to the new plans from mid-November; new coverage starts January 1, 2027. Providers should keep treating ʻOhana members through December 31, 2026. On prior authorizations, "Existing QUEST transition of care policies will apply," and members "may continue receiving those services through their new health plan without prior authorization and regardless of provider network status, consistent with applicable QUEST transition of care requirements." Claims for services through December 31, 2026 are due by December 31, 2027, and the call center stays open through then.[1][6]
For intake: an ʻOhana family starting ABA this fall should know which plan they are moving to. Get ʻOhana’s authorization for the current period, check your contract with the family’s new plan, and plan the first reauthorization with the new plan in mind.[1][6]
ʻOhana’s CMS-0057-F prior-authorization list (effective 12/31/2025) names ABA Services 97151 through 97158, and separately lists neuropsychological and psychological testing (96112–96146). The fastest route is the WellCare provider portal; fax is also accepted, and phone only for urgent requests, which are decided within 72 hours. ʻOhana’s published 2025 QUEST metrics show 97.8% of standard requests approved, with an average of 3 days and a median of 1. The clinical rules come from Med-QUEST’s memo: diagnosis by the memo’s listed providers, a treatment plan with standardized goal measurement, 26-week periods, supervision at 1–2 hours per 10 RBT hours, and concurrent 97153/97155 billing allowed.[2][3][7]
The questions that decide whether a family can start with Ohana Health Plan (WellCare of Hawaii), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21 — the Med-QUEST benefit ʻOhana delivers (MQD memo). ʻOhana coverage itself ends December 31, 2026.[7][1]
Expedited requests: "a determination within 72 hours" (ʻOhana). Standard: the federal managed-care limit of 7 calendar days for rating periods from January 1, 2026 (extendable by 14). ʻOhana’s 2025 QUEST standard average was 3 days, median 1. Continuation requests are due at least two weeks before the period ends (MQD memo).[3][9][2][7]
The MQD memo lets plans require a PCP referral for the diagnostic evaluation. ʻOhana’s behavioral health page lists psychiatric and psychological evaluations as not needing prior authorization; ABA itself is controlled by PA.[7][4][2]
Ask the plan: ʻOhana Provider Services 1-888-846-4262 — ask whether a PCP referral is required.
Medicaid is secondary to all other insurance (MQD memo), so ʻOhana pays after any commercial plan. Whether ʻOhana requires its own PA when secondary is not stated. TRICARE pays after other coverage except Medicaid; CHAMPVA pays last.[7][10][13][14]
Ask the plan: ʻOhana Provider Services 1-888-846-4262 — confirm PA requirements when ʻOhana is secondary.
No recency window in the MQD memo; no ʻOhana rule found.[7]
Blocked on: ʻOhana Clinical Coverage Guidelines or Provider Services 1-888-846-4262.
MQD memo list: developmental-behavioral or developmental pediatrician, neurologist, pediatrician, psychiatrist, psychologist, or other licensed practitioner with ASD expertise. No ʻOhana variation found.[7]
Blocked on: ʻOhana Clinical Coverage Guidelines or Provider Services 1-888-846-4262.
MQD memo: "evidence-based assessments," no instrument named. No ʻOhana requirement found.[7]
Blocked on: ʻOhana Clinical Coverage Guidelines or Provider Services 1-888-846-4262.
MQD’s telehealth memo QI-2527 applies (audio-video, modifier 95/GT/GQ); ʻOhana is listed there as the contact for plan billing rules. No ʻOhana ABA telehealth rule found.[12]
Ask the plan: ʻOhana Provider Services 1-888-846-4262.
Coverage decides whether Ohana Health Plan (WellCare of Hawaii) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
ʻOhana publishes no ABA supervision rule of its own that we could find; the MQD memo sets it: 1–2 hours of case supervision per 10 RBT hours, at least one direct, direct supervision at least 5% of BCaBA and RBT hours, per BACB guidelines.[7]
Blocked on: ʻOhana Clinical Coverage Guidelines (client-rendered list did not load), or Provider Services 1-888-846-4262.
The MQD memo allows 97153 and 97155 concurrently when both codes’ criteria are met and they carry different modifiers. Med-QUEST’s 2024 rate-study meetings recorded that "one MCO allows billing for RBT + BCBA concurrent services; other MCOs do not" — confirm ʻOhana’s edit.[7][11]
Ask the plan: ʻOhana Provider Services 1-888-846-4262 — ask whether its claim edits allow 97153 + 97155 for the same time.
No ʻOhana unit cap published; hours are authorized per request. The MQD memo sets no daily cap and approves hours per week for up to 26 weeks.[7][2]
Ask the plan: ʻOhana utilization management through the WellCare provider portal or 1-888-846-4262.
Not verified — neither the MQD memo nor ʻOhana’s published authorization material sets session-note signature rules.[7]
Blocked on: ʻOhana provider manual or Provider Services 1-888-846-4262.
Per the MQD memo: clinic, home or community settings named in the treatment plan; school ABA through DOE under the IEP; nothing outside Hawaii. No ʻOhana-specific setting rule found.[7]
Blocked on: ʻOhana Provider Services 1-888-846-4262.
Per the MQD memo: payment goes to the licensed practitioner or employing agency, with HO/HN/HM modifiers. ʻOhana requires provider and facility NPIs on authorization requests; its own ABA billing rules were not found.[7][3]
Blocked on: ʻOhana Provider Services 1-888-846-4262.
Yes. ʻOhana leaves the QUEST program on December 31, 2026. Members pick a new plan during the October 1–20, 2026 special open enrollment or are assigned one, and new coverage starts January 1, 2027. QUEST transition-of-care rules let ongoing services continue with the new plan.
Yes — its prior-authorization list names 97151 through 97158, including the 97151 assessment.
Yes — it is WellCare’s Hawaii plan, part of Centene. Payer directories list it as "Ohana Health Plan (WellCare of Hawaii)".
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo