Med-QUEST: Health, Insurance & Long-Term Care

Med-QUEST Division (MQD)

The State of Hawaii Med-QUEST Division (MQD) helps low-income adults and children obtain health coverage through managed care plans.

Effective October 1, 2013

MEDICAL APPLICATIONS will be accepted:

The Hawaii Department of Human Services (DHS) and the Affordable Care Act

 

Medicaid and the Affordable Care Act

Medicaid is a federal/state partnership with shared authority and financing. The program covers nearly 50 million low-income Americans, including more than 285,000 Hawai‘i residents. States must meet minimum federal requirements such as covering families with children and offering certain benefits. States also may provide optional expanded coverage.

With the Affordable Care Act (ACA) Medicaid expansion beginning in 2014, any adult under 65 years of age with qualified residency or citizenship and income under 138% federal poverty level (FPL), will be eligible for Medicaid irrespective of their assets.

The below chart is a guideline to income categories.  To learn where you fall and to see if you are eligible for Med-QUEST coverage, please use the eligibility determination tool (Am I Eligible?) at www.mybenefits.hawaii.gov.

2013 Federal Poverty Level (FPL) for Hawaii

ANNUAL GUIDELINES

FAMILY PERCENT OF POVERTY GUIDELINE
SIZE 100% 120% 133% 135% 150% 175% 185% 200% 250%
1 13,230.00 15,876.00 17,595.90 17,860.50 19,845.00 23,152.50 24,475.50 26,460.00 33,075.00
2 17,850.00 21,420.00 23,740.50 24,097.50 26,775.00 31,237.50 33,022.50 35,700.00 44,625.00
3 22,470.00 26,964.00 29,885.10 30,334.50 33,705.00 39,322.50 41,569.50 44,940.00 56,175.00
4 27,090.00 32,508.00 36,029.70 36,571.50 40,635.00 47,407.50 50,116.50 54,180.00 67,725.00
5 31,710.00 38,052.00 42,174.30 42,808.50 47,565.00 55,492.50 58,663.50 63,420.00 79,275.00
6 36,330.00 43,596.00 48,318.90 49,045.50 54,495.00 63,577.50 67,210.50 72,660.00 90,825.00
7 40,950.00 49,140.00 54,463.50 55,282.50 61,425.00 71,662.50 75,757.50 81,900.00 102,375.00
8 45,570.00 54,684.00 60,608.10 61,519.50 68,355.00 79,747.50 84,304.50 91,140.00 113,925.00
For family units of more than 8 members, add $4,620 for each additional member.

MONTHLY GUIDELINES

FAMILY PERCENT OF POVERTY GUIDELINE
SIZE 100% 120% 133% 135% 150% 175% 185% 200% 250%
1 1,102.50 1,323.00 1,466.33 1,488.38 1,653.75 1,929.38 2,039.63 2,205.00 2,756.25
2 1,487.50 1,785.00 1,978.38 2,008.13 2,231.25 2,603.13 2,751.88 2,975.00 3,718.75
3 1,872.50 2,247.00 2,490.43 2,527.88 2,808.75 3,276.88 3,464.13 3,745.00 4,681.25
4 2,257.50 2,709.00 3,002.48 3,047.63 3,386.25 3,950.63 4,176.38 4,515.00 5,643.75
5 2,642.50 3,171.00 3,514.53 3,567.38 3,963.75 4,624.38 4,888.63 5,285.00 6,606.25
6 3,027.50 3,633.00 4,026.58 4,087.13 4,541.25 5,298.13 5,600.88 6,055.00 7,568.75
7 3,412.50 4,095.00 4,538.63 4,606.88 5,118.75 5,971.88 6,313.13 6,825.00 8,531.25
8 3,797.50 4,557.00 5,050.68 5,126.63 5,696.25 6,645.63 7,025.38 7,595.00 9,493.75
Produced by: CMCS/CAHPG/DEEO

Regulations and guidance are used to implement many of the ACA provisions that address both private and public health insurance.  There will be a few eligibility changes under Affordable Care Act.

Also beginning in 2014, the ACA requires states to provide Medicaid coverage for former foster youth who are under age 26.  Hawai’i successfully sought federal approval to begin covering this group of former foster youth a year early, in 2013.

More information about ACA implementation in Hawaii

 

Integration of DHS and DOH Behavioral Health Services

To reduce fragmentation of services, the Department of Health (DOH) and DHS are  consolidating the behavioral health service provision within the MQD Community Care Services (CCS) program.  The MQD contractor for the CCS program is ‘Ohana Health Plan.   Transitioning QExA members with SMI/SPMI receipt of specialized BH services from AMHD to CCS, and expanding eligibility and benefits begins September 1, 2013.

 

Community Input on State Preparations for 2014 Affordable Care Act (ACA) Implementation  (Power Point August 2012)

Brief Summary of ACA provisions and updates on the 1115 demonstration waiver.