Frequently Asked Questions
WHAT ARE YOU LOOKING FOR?
Med-QUEST (Quality, Universal Access, Efficiency, Sustainability, Transformation) is a division of the Department of Human Services that provides healthcare benefits to Hawai’i residents who are eligible for Medicaid.
Medicaid started in 1965 along with Medicare as a safety net program for low income women, children and people with disabilities as a federal and state endeavor and evolved to one of the largest health insurance programs in every state. Medicaid is funded jointly by state and federal government.
The Children’s Health Insurance Program (CHIP), provides health coverage to eligible children through both Medicaid and separate CHIP programs. CHIP is administered by states according to federal requirements. CHIP was created in 1997 and is funded jointly by states and the federal government. In Hawai'i, the CHIP program was implemented in July 2000, and is part of the Medicaid program.
In Hawaii, a little over 350,000 people were assisted with Medicaid in 2016. This represents nearly a quarter (25%) of the 1.4 million people in Hawai'i. Additionally, forty five percent (45%) of all children in Hawai'i were assisted with Medicaid.
People whose Medicaid eligibility is based primarily on their income will be eligible under the following Federal Poverty Level (FPL) thresholds:
- Children – up to 313% FPL
- Pregnant Women – up to 196% of the FPL
- Parent/Caretaker relatives – up to 105% of the FPL
- Adults under the age of 65 (not receiving Supplemental Security Income or Medicare)– up to 138% of the FPL
People who are 65 and over, or blind or disabled, may have eligibility determined using the following income and asset thresholds:
- Income up to 100% of the FPL and up to $2,000 in assets for a single person household or up to $3,000 for a household of two; or
- If income is greater than 100% of the FPL and assets up $2,000 for a single person household or up to $3,000 for a household of two, may be eligible for medical assistance under the Medically Needy Spenddown program, provided he or she has medical expenses greater than the determined spenddown amount.
The best way to see if you or your household members qualify for Medicaid is to apply. There are three simple ways to apply for benefits.
- Submit an on-line application at www.mybenefits.hawaii.gov ; or
- Apply over the phone by calling Med-QUEST’s Call Center (1-800-316-8005; TTY/TDD users call 1-800-603-1201 or 711 ; or
- Apply using the Medicaid application form which can be downloaded from the Department of Human Services (DHS) website.
There are currently five choices for QUEST Integration health plans:
‘Ohana Health Plan
UnitedHealthcare Community Plan
You should contact the Med-QUEST Division if:
- You have a question about your Medicaid eligibility;
- You get a job or change jobs;
- Your income or assets change;
- You have a name or address change; or
- You have a change in your family, such as a birth, a death, a divorce, a marriage or someone moves into or out of your home.
You should contact your health plan if:
- You have questions about how to get the care you need;
- Need a Primary Care Physician (PCP);
- You lose or misplace your health plan member card;
- You need special assistance; or
- You have a name or address change.
No, you will need to contact the health plan on how to become their participating provider.
Criminal history record checks are an authorized noncriminal justice finger print-based search of the State criminal history record repository and the FBI system. A combination of criminal history record, Adult Protective Services (APS) and Child Abuse and Neglect (CAN) registry checks are used to determine employment suitability and meet other Medicaid provider requirements.
Dental services are provided by dentists who are enrolled to see Medicaid patients. You can call the Community Case Management Corp (CCMC) to find a dentist who accepts Medicaid:
- Oʻahu: 792-1070
- Neighbor Islands: 1-888-792-1070 toll-free
If you’re under age 21, your coverage includes:
- Diagnostic and preventive services once every six months.
- Non-emergency care that includes:
- Endodontic therapy
- Oral surgery
- Periodontic therapy
- Prosthodontic services
If you’re age 21 or older, you are covered for emergency services that include:
- Eliminating dental infection and pain.
- Treating acute injuries to teeth and supporting structures.
The following are a few examples of covered benefits under QUEST Integration Health Plans:
- Inpatient hospital medical and surgical services
- Inpatient hospital maternity and new-born care services
- Doctor visits and services
- Emergency and urgent care services
- Durable medical equipment and medical supplies
- Prescription drugs
If you have a serious mental illness, you may be able to receive services through a specialized plan. This includes such services as:
- Acute inpatient hospital for Substance abuse treatment programs
- Ambulatory mental health services
- Psychiatric or psychological evaluation
- Prescription drugs
- behavioral health services
Yes, there are 2 times you can change your health plan enrollment:
- When you first become eligible with Medicaid and enroll with a health plan. You have up to 15 days to change your health plan enrollment. You can call the Med-QUEST Customer Services Call Center at 524-3370 on Ohau or 1-800-316-8005 on neighbor islands. TTY/TDD, call 711.
- During Annual Plan Change period. You will be mailed a packet with a form to fill out.
There are additional assessments needed in order to receive Long Term Services and Support (LTSS) benefits. You must complete an application and work with your physician to have your required level of care evaluated. These home and community-based services may include, but are not limited to:
- Adult day care
- Personal care
- Skilled nursing
- Residential care like Community Care Foster Family Home (CCFFH) or Expanded Adult Residential Care Home (EARCH).
Medicaid may be able to help with outstanding medical bills that are up to ten (10) days prior to the date of application, or up to three (3) months prior to the date of application for individuals requesting long-term care services.