Department of Human Services Med Quest Division

Medicaid Fee-For-Service Program Medicaid Fee-For-Service Program - Long Term Care Medicaid Fee-For-Service Program - Long Term Care - Liens Medicaid Fee-For-Service Program - Pregnant Women Hawaii QUEST Program (QUEST) Hawaii QUEST Program (QUEST) - Pregnant Women QUEST-Net Program QUEST Adult Coverage Expansion Program (ACE) Home and Community Based Waiver Program	Transitional Medical Assistance Program (TMA) State Medical Assistance for Immigrant Children Program State Medical Assistance for Pregnant Legal Immigrant Women Program Basic Health Hawaii Medicare Savings Program

BASIC HEALTH HAWAI�I

Eligibility Coverage Enrollment How To Apply

Eligibility

Basic Health Hawai�i is a health insurance program. It is for non-pregnant adults, age 19 or older. You must live in Hawai�i. You must be an immigrant legally residing in the United States for less than five years or a non-immigrant. You must not be eligible for Federal Medicaid programs.

Coverage

12 Outpatient physician visits per year
(6 of these visits can be used as mental health visits)
6 Additional mental health visits per year
10 Inpatient hospital days per year
10 inpatient physician visits for medically necessary medical care, surgery, psychiatric care
or substance abuse treatment
4 prescriptions per month, either brand or generic to include insulin and chemotherapy, plus
specific contraceptives and diabetes supplies
Emergency room services

Other Covered Services

Dental Services only for emergencies to eliminate dental pain, infection and acute injuries
Dialysis

Do I Have To Pay For These Services?

Enrollment

Enrollment procedures are the same as with QUEST.

How To Apply

Using the link below print out and complete the application form and mail or fax it to the nearest Med-QUEST office listed on page 12 in the application.

Click here for the Medical Assistance Application � DHS 1100