Hawaii Med-Quest Web site

QUEST Expanded Access (QExA) Roundtable, Request For Proposals (RFP) Summary, June 29, 2007

What is Hawaii QUEST?
It’s a program that provides health coverage through managed care plans for eligible lower income Hawaii residents.

• people who receive TANF or GA financial assistance;
• people whose income is less than the AFDC standard of assistance;
• pregnant women and children under age one with household income up to 185% of the Federal Poverty Level (FPL);
• children age one but under age six with household income up to 133% of the FPL;
• children under age 19 born after September 30,1983, with household income up to 100% of the FPL;
• foster children and children in subsidized adoptions up to age 21;
• people who lose their employer-sponsored coverage or extended coverage in a group health plan because of loss of employment within 45 days of their date of application;

When Hawaii QUEST enrollment is no more than 120,000 on December 31 of any calendar year, an open application period will be conducted in the following calendar year.

To be eligible for Hawaii QUEST, you must:

• be a Hawaii resident;
• be a U.S. citizen or qualified alien;
• have a Social Security number;
• not be certified as blind or disabled
• not be age 65 or over:
• not be living in a public institution;
• have income not more than 100% of the current FPL except for pregnant women and children up to age 6, who may have income up to the amounts listed above;
• not be eligible for health insurance from your employer (except for AFDC and GA recipients).
• have assets not exceeding the Hawaii QUEST asset limits.

What are the Hawaii QUEST asset limits?

• $2,000 for a household of one;
• $3,000 for a household of two; 
• $250 for each additional person.
• Asset limits do not apply to children under age 19 born after September 30, 1983 or to pregnant women for the duration of the pregnancy

How does Hawaii QUEST work?

If you are eligible for Hawaii QUEST, you will choose one medical plan and one dental plan to serve you and any family members who are in the program with you. All family members must enroll in the same medical and dental plan.

Some medical plans have a limit on the number of members they can accept. If the plan you want is already full, you will have to choose a different plan. If you do not make a choice, you will be assigned to a medical and dental plan.

Six medical plans are participating: AlohaCare. HMSA, Kaiser Permanente, Kapiolani HealthHawaii, Queen’s Hawaii and StraubCare Quantum. All six plans participate on Oahu, with at least two plans on each Neighbor Island.

Three dental plans, AlohaCare, DentiCare and HMSA, are available statewide, providing emergency dental care for individuals age 21 and older and full dental care for individuals under age 21.

Yes. After you are enrolled in a plan, you will choose a Primary Care Provider (PCP) who will provide most of your care. When you have a medical problem, make an appointment with your PCP If you need to see a specialist, your PCP will refer you to one who is participating with your plan.

For individuals under age 21, you will also select a Primary Care Dentist (PCD) who will provide your dental care. For individuals age 21 and older, dental emergency care will be obtained through your chosen dental plan.

If you do not choose your family’s doctor(s) and dentist(s), your plans will assign you providers. If the doctor or dentist you want is already full, you will have to choose another.

Your medical and dental plans will each send you a membership card and handbook. They will tell you how to get the care you need. Each plan has member services representatives to help you, plus toll-free telephone numbers for Neighbor Islands.

Only if you have an emergency or hospitalization occurring a maximum of 5 calendar days before the date we receive your application. Otherwise, you may not receive any benefits before the date your completed application is received by DHS.

There will be a one-month waiting period for non-urgent and non-emergent medically necessary services.

If you are self-employed and your income does not exceed 100% of the FPL, you and your spouse are each required to pay 50% of the Hawaii QUEST monthly premium.

If you want to end your coverage under Hawaii QUEST, you must send your eligibility worker written notice to stop your coverage. Until written notice is received, you will be responsible for your share of monthly premiums. Any premiums you owe when you leave the QUEST program must be repaid to the Med-QUEST Finance Office.

Will I have to pay co-payments for services under QUEST?

A self-employed adult and spouse will have to pay co-payments for some services. Services requiring co-payments are listed on page 5.

The basic medical benefits are the same for everyone, but individuals under age 21 receive some extra services, such as vaccinations and certain types of tests. Individuals under age 21 also receive full dental coverage, while individuals age 21 and older are covered for dental emergencies only.

There is also a "wraparound" mental health program for people who need special mental health care. This care is provided through a company called Community Care Services. Hawaii QUEST members must be evaluated to see if they are eligible for this special program.

No. You may change plans once a year during the "Plan Change Period," with changes effective July 1. Except for this annual change period and some exceptions, you must stay in your medical and dental plans once you have chosen them.

If you are in one of the groups who can apply for Hawaii QUEST in spite of the enrollment cap, your application will be processed and you will be scheduled for an interview with a State worker. If you have already turned in all the information and materials needed to show that you are eligible, your interview can be conducted by phone for your convenience.

• you have a question about eligibility:
• you get a job or change jobs;
• your income, assets or address change;
• 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 plan if:

• you have questions about how to get the care you need;
• you lose or misplace your medical or dental card;
• you need special assistance.

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Hawaii QUEST
Principal Health Care Benefits and Coverage
and cost to those members with Co-payments  

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