Health Insurance For Low-Income
Medicaid is a federal and state partnership to provide health coverage to very low-income children and adults. In Hawaii, it is administered by the Department of Human Services, Med-QUEST Division and is jointly financed by the State of Hawaii and the Federal Centers for Medicare and Medicaid Services.
Through the Medicaid program, most medical costs are covered at no cost to patients unless you receive services outside the QUEST integrated plan or you’re receiving long-term care services. With the introduction of Obamacare (the Affordable Care Act), Hawaii opted to expand their Medicaid programs on October 1, 2013. If you were denied Medicaid coverage in Hawaii previous to this expansion, you may now qualify for coverage as it has been expanded to include children, pregnant women, parent and caretaker relatives, adults, seniors (age 65 and older), and the blind or disabled.
The health plans participating in QUEST Integration are AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan (Oahu & Maui only), ‘Ohana Health Plan, and UnitedHealthcare Community Plan.
Hawaii Medicaid Plan Options
Quest
The Department of Human Services Med-QUEST Division (MQD) has launched. Through QUEST Integration, a more patient-centric Medicaid program to better serve recipients was implemented. The benefits of QUEST Integration include more health plan choices for aged, blind or disabled individuals, and a greater ability for a beneficiary to remain with the same health plan upon turning 65 or developing a disability. Additionally, eligible beneficiaries will gain expanded access to home and community-based services to prevent decline to the institutional level of care.
The Early Periodic Screening, Diagnostic, and Treatment (EPSDT)
The EPSDT program provides well-child care visits to a doctor that includes shots to prevent diseases and regular check-ups to make sure children are developing normally for individuals under 21 years of age.
Long Term Services and Support (LTSS)
The LTSS program provides assists to those needing care in a nursing facility or residential care (i.e., community care, foster family homes, expanded adult residential care home). Individuals must meet financial as well as medical criteria to qualify. LTTS also provides services and support for home and community-based programs.
Medicaid Fee-for-Service - Long Term Care
The Medicaid Fee-For-Service Program provides coverage for long-term care services to eligible recipients. Long-term care consists of the nursing home level of services provided in a nursing home or other medical institution and home and community-based waiver services. There are special eligibility, coverage, and recovery provisions that only apply to long-term care applicants and recipients.
Former Foster Care
Former Foster Care – Provides coverage to young adults under age 26 who were on Medicaid when they left foster care at age 18 or later. This group is eligible for Medicaid regardless of income.
Pregnant Women
Medicaid provides services to pregnant women who meet income and resource limits as well as general eligibility guidelines.
Breast and Cervical Cancer Program
The Breast and Cervical Cancer Program covers uninsured women who need treatment for breast or cervical cancer. There are specific guidelines regarding the screening process to qualify.
State Children’s Health Insurance Program (SCHIP)
CHIP is a Hawaii program that supports families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
Other Programs
Other programs provided by Medicaid include:
- Developmentally Disabled Mentally Retarded Program
- Going Home Plus (GHP)
- Quest Net
- Quest Spenddown
- Transitional Medical Insurance
- Immigrant Children
Premium Assistance Program (PAP)
PAP is a state benefits program that covers a share of premium cost for qualifying individuals. The program is available to residents that are in families under 100% of the U.S. Federal poverty level but do not qualify for Medicaid. Qualified residents include very low-income Hawaii residents from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. It also includes Hawaii residents that do not qualify for Medicaid. This is a state program that combines federal health insurance tax credits and state financial assistance so that qualified residents do not have to pay monthly bills from their health plan. The program only covers the cost of monthly premiums or bills from their health plan.
Hawaii Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following groups qualify for Hawaii Medicaid:
- Children with a household income less than 208% of Federal Poverty Limit (FPL);
- Pregnant women with a household income less than 191% of FPL;
- Adults with a household income less than 133% of FPL.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in Hawaii, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of Hawaii's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
- What is Med-QUEST?
Med-QUEST is the Medicaid option that provides the majority of coverage for Hawaii residents.
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