Med-QUEST Division (MQD): Health Insurance & Long-Term Care for Low-Income Adults and Families

The State of Hawaii Med-QUEST Division (MQD) provides eligible low-income adults and children access to health and medical coverage through managed care plans.   The QUEST program is designed to provide Quality care, Universal access, Efficient utilization, Stabilizing costs, and to Transform the way health care is provided to recipients.  MQD  Accomplishments 2010-2014

Nov. 20, 2014 Human Services and Housing, and Health Committees Briefing

  • KOLEA System Update
  • Medicaid Coverage of School-based Healthcare Services
  • Adult Dental Benefits
  • Affordable Care Act’s Health Home Provision and Hawaii’s Patient Centered medical Home Initiative

Nov. 19, 2014 Human Services and Housing, and Health Committees Briefing

  • COFA Plan following November 2014 SCOTUS Action
  • Quest Integration
  • Provisions for Kupuna Care Services
  • Working Disabled Adults

2014 Hawaii Med-QUEST Health Plans

2014 Federal Poverty Guidelines

Resources for Providers

Grievance Hotline 692-8094.  Leave a message along with your name and contact phone number.  A staff person from our Med-QUEST Division will call you back within 24 hours or the next business day.

Med-QUEST Division and Implementation of the Affordable Care Act

Effective October 1, 2013

MEDICAL APPLICATIONS are accepted:

 

To be eligible for Hawaii QUEST, you must:

  • be a Hawaii resident;
  • meet citizenship status requirements;
  • 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;
  • 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 to serve you and any family members who are in the program with you. All family members must enroll in the same medical plan.  If you do not make a choice, you will be assigned to a medical plan.

Do I get to choose my own doctor?

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.

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

Your medical plan will 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.

Does Hawaii QUEST cover medical and bills I already have?

If you utilized medical services occurring a maximum of 5 calendar days before the date we receive your application, those services will be covered if a medical provider provided the medical service.

Are Hawaii QUEST’s benefits the same for everyone in the program?

The basic medical benefits are the same for everyone.  However, individuals under age 21 receive some extra services, such as vaccinations and certain types of tests.  The QUEST health plans pay contracted health care providers for medical services.  Standard QUEST Coverage for Medically Necessary Services are provided free of charge to the client (no cost-sharing.)

 Inpatient Care
Room and board for semi-private room Medical and surgical No charge
Intensive care and cardiac units No charge
Operating room and specialized treatment rooms No charge
Rehabilitative services and physical therapy No charge
Surgical and anesthetic supplies, drugs and medicines No charge
Organ and tissue transplant services, cornea, kidney and allogenic bone marrow No charge
Physician’s and surgeon’s visits No charge
Laboratory, pathology, and radiology No charge
Outpatient Care
Physician office visits No charge
Diagnostic x-ray examinations, laboratory, tests, radiation therapy and chemotherapy No charge
Drugs and chemicals for chemotherapy No charge
Allergy testing and treatment (compounds/serum) No charge
Therapeutic servicePhysical therapy No chargeNo charge
Speech and occupational therapy No charge
Audiology No charge
Preventive Services
Routine physical examinations No charge
Breast/pelvic examinations and pap smear No charge
Routine immunizations No charge
Mass and new immunizations No charge
Well baby care No charge
Voluntary family planning including sterilizations No charge
Pregnancy and Maternity Care
Prenatal care No charge
X-ray and laboratory tests No charge
Treatment of missed, threatened and elective abortions No charge
Delivery of infant No charge
Post-partum care No charge
Emergency Services
Emergency Room services No charge
Emergent Condition No charge
Urgent care No charge
Ambulance Services Ground and air ambulance No charge
Other Facility Services
Skilled nursing facility (for 60 days) No charge
Hospice No charge
Outpatient or ambulatory surgery No charge
Rehabilitation facility No charge
Other Services
Air transportation to or from a provider in the service area No charge
Home health services
Skilled nursing and home health aides No charge
Medical supplies and equipment No charge
Other medically necessary home health services No charge
Other practitioner services (e.g., Nurse Midwife, etc.) No charge
Prescription Drugs
Prescribed medication including over-counter prescribed drugs, supplies No charge
Vision
Eye examinations (refractions) No charge
Every 12 months for members under 21
Every 24 months for members 21 and older
Eyeglasses (every 24 months) No charge
Lost, broken or significantly damaged eyeglasses may be replaced if the loss, breakage or damage was beyond member’s control
Behavioral Health Services
Inpatient care (psychiatric and detoxification)
Room and board No charge
Diagnostic services No charge
Physician and other practitioner services No charge
Ambulatory and crisis services No charge
Day treatment and hospitalization No charge
Methadone treatment services No charge
Diagnostic and laboratory services No charge
Physician services No charge
Therapeutic services No charge

 

After I choose my medical plan, will I have to stay in that plan forever?

No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.

How do I know when to contact the State and when to contact my plan? You should contact the State if:

  • 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 card;
  • you need special assistance.