This article is a collection of the best answers to Hawaii Medicaid’s most frequently asked questions.
Medicaid is a government-sponsored healthcare program for low-income families and individuals who fulfill specific income and resource requirements. Only the aged, blind, or disabled can access resources within the defined restrictions.
We have scoured the internet to provide all you need to know about the Hawaii Medicaid Benefits.
You will learn everything you need to know about Hawaii Medicaid in this article.
Table of Contents
What is the Hawaii Medicaid Fee-For-Service Program?
Medical aid is health insurance offered to qualify citizens of low income in Hawaii. Hawaii offers Medicaid Fee-For-Service and Hawaii QUEST as its two medical assistance programs.
In general, coverage is offered via Hawaii’s Medicaid Fee-For-Service Program, where providers are paid directly for covered services for qualified individuals 65 years of age or older or certified blind or disabled.
Hawaii QUEST, a managed care program, provides insurance for all other eligible people.
Your coverage group would determine the income threshold used to assess your eligibility. The Department will identify your coverage group when you apply for Medicaid and use the income requirement for that group to determine your eligibility.
Who is eligible for Hawaii Medicaid?
Your coverage group would determine the income threshold used to assess your eligibility. The Department will identify your coverage group when you apply for Medicaid and use the income requirement for that group to assess your eligibility.
You must be a resident of Hawaii, a national or citizen of the United States, a permanent resident, or a legal alien, in need of health care or insurance help, and have a low or very low income in order to qualify for Hawaii Medicaid. You also need to fit one of the following criteria:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability.
- Be 65 years of age or older.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $20,787 |
| 2 | $28,010 |
| 3 | $35,232 |
| 4 | $42,454 |
| 5 | $49,676 |
| 6 | $56,898 |
| 7 | $64,120 |
| 8 | $71,342 |
*For households with more than eight people, add $7,222 per additional person.
How do I contact Medicaid in Hawaii?
Phone
800-316-8005 (Fee-For-Service Program)
1-877-628-5076 (Hawaii Quest)
Website
What are the Medicaid plans in Hawaii?
Hawaii has contracts with five insurance providers, including two QExA and three QUEST providers.
A combination of (1) national, for-profit plans (Kaiser Permanente Hawaii, Evercare (United), and Ohana Health Plan (WellCare)) and (2) regional, non-profit plans make up the participating plans (AlohaCare and Hawaii Medical Services Association).
- QUEST provides acute, primary, and behavioral health care services for low-income children, families, expectant mothers, and people without children.
- Children and adults who are blind or impaired, as well as those who are dual-eligible, can get services from QUEST Expanded Access (QExA). Long-term institutional, residential, and community-based services and supports are also included.
- Instead of using the managed care plan, people with intellectual or developmental disabilities (IDD) in QExA receive home and community-based waiver services and case management services from a state agency.
- To make QUEST compliant with the standards of the Affordable Care Act, the QUEST Integration program made improvements, including the addition of the state plan’s childless adults category and the adoption of the modified adjusted gross income methodology.
- While QUEST and QExA plans cover specific behavioral health services for people without SMI/SPMI, the state Department of Health (DOH) covers behavioral health services for people with a serious mental illness (SMI) or severe and persistent mental illness (SPMI) diagnosis on a fee-for-service basis.
What is covered by Hawaii Medicaid?
The following services are covered by Hawaii Medicaid
| Behavioral health services | Laboratory services |
| Dental | Maternity and newborn care |
| Dialysis | Non-emergency transportation |
| Durable medical equipment | Nutrition counseling |
| Emergency medical services | Physician services |
| Family planning | Podiatry |
| Home health | Prescription drugs |
| Hospice services | Rehabilitation services |
| Hospital services | Smoking cessation |
| Imaging services | Urgent care |
| Immunizations | Vision and hearing services |
Copayments?
The majority of medical expenses are free of charge. You might be responsible for some fees if you obtain long-term care services or medical treatment that is not covered by a QUEST integrated plan (“fee-for-service”). There are typically no copays or premiums for enrollees.
How many types of Hawaii Medicaid are there?
Hawaii offers Medicaid Fee-For-Service and Hawaii QUEST as its two medical assistance programs.
How do I apply for Hawaii Quest?
For a quick and easy way to apply for Medicaid, go to the Medicaid OnLine Eligibility Application (KOLEA). Create a personal user account and follow the on-screen instructions when ready to use..
The Med-QUEST Division accepts applications at eligibility offices spread out across Hawaii. Most hospitals and some medical facilities have also planned to send your medical application to us.
Your caseworker can handle the processing of your medical application if you are currently receiving food stamps.
Fill out the application and mail it to the Med-QUEST office if you decide to apply that way. They might contact you to arrange a meeting to determine your eligibility.
You can then be asked to present documentation of your birthdate, citizenship, Social Security number, earnings, and possessions. You may select a representative if you are unable to speak for yourself.
This might be your partner, an adult kid, a sibling, other family members, a friend, or anyone who knows your circumstances.
Who can get Hawaii Quest?
You must be a resident of Hawaii and fulfill the following requirements to be eligible for this benefit program:
- 18 years of age or younger, a primary caretaker of a child or children under 18,
- A citizen of the United States, a national of another country, or an alien lawfully admitted to the country, and
- Uninsured (and ineligible for Medicaid).
Individuals under the age of 19 and pregnant women for the entire 60-day pregnancy are exempt from asset limits.
What are the income limits for Medicaid in Hawaii?
The income restrictions are determined by your family size and the federal poverty level. Fill out an application at MyBenefits – Hawaii to be sure if you are eligible.
As a general rule, if there are four members in your family, your income cannot be more than $3,208 per month to be eligible for Medicaid in Hawaii. Depending on the size of your family, that sum varies.
What documents do I need to apply for Medicaid?
Depending on your resident status, you may require some, all, or none of the following documents to apply for medical aid.
If you don’t yet have everything, don’t panic; you can still begin the application process. For each member of your family seeking health insurance, including you, kindly submit the details below:
-Date of Birth
-Social Security Number
-If neither you nor the person you seek health insurance for is citizens
- Certification of naturalization (that includes alien number and naturalization certificate number)
- Citizen identification document (that contains alien number and citizenship certificate number)
- Green Card, or Permanent Resident Card (I-551)
- Arrival and Departure Log (I-94 card, form, electronic copy)
- Refugee travel authorization (I-571)
-Form 1040 or 1040EZ from the prior year’s federal income taxes or the current gross monthly income of the household.
Can I have both Hawaii Medicaid and Medicare?
Having both Medicare and Medicaid is possible if you are dually eligible. They will cooperate to minimize your expenses and offer you health insurance.
Does the disabled person get Hawaii Medicaid?
Medicaid covers those under 18 years old, pregnant women, parents, and other relatives, adults, the aged (65 and older), the blind, and people with disabilities.
What is the best Medicaid in Hawaii?
The Mid-Atlantic States’ Kaiser Foundation Health Plan, Inc. received the best overall score among Medicaid plans for HPR 2021. The project showed that high-quality preventive treatment is possible, with five stars for almost all of the preventative measures for which it provided data.
