Medicaid Fee-For-Service

The Medicaid FFS Program is the traditional Medicaid Program that has provided medical coverage to low-income Hawaii residents since January 1966. The program provides coverage for individuals who are age 65 and over, or under age 65 who are blind or disabled. All other individuals are covered by QUEST.

Eligibility

Medicaid FFS Program recipients must meet the following requirements:

  • Be a Hawaii resident
  • Be a U.S. citizen or legal immigrant and
  • Provide proof of their citizenship
  • Provide proof of their identity
  • Provide a Social Security Number
  • Not reside in a public institution
  • Be age 65 and older
  • If under age 65, must be certified to be blind or disabled by the State or the Social Security Administration
  • Meet an asset test
  • Meet an income test

Financial Responsibility for Support

Spouses and parents of minor children living together are responsible to support the family. Adult children are not responsible to support their parents, even if they live together.

Asset

Individuals who fail to pass the asset test are not eligible for assistance. Pregnant women and children under age 19 are not subject to the asset test. Countable assets include cash, bank accounts, stocks, bonds, real property and other personal property. Exempt assets include the home property, motor vehicles, clothing and household furnishing and appliances.
 
The asset standard is $2,000 for a household of one, $3000 for two, and $250 for each additional family member.

Income

Individuals must have countable income within the applicable income standard. Countable income includes wages, earning from self employment, retirement pensions, unemployment insurance benefits, Social Security benefits, annuities, interest, royalties, etc. Exempt income includes SSI benefits, welfare payments, food stamps, and loans.
 
The income standards depend on factors such as age, blindness, disability, pregnancy, living arrangements, and household size. The standards are based on the Federal Poverty Levels (FPL) and the payment levels of the SSI or the Temporary Assistance to Needy Families (TANF) programs. Since the FPL, SSI and TANF levels may be adjusted annual cost of living increases, individuals should contact the Med-QUEST Division to obtain the current income standards.

Covered Services

The FFS program makes direct payments to Medicaid providers for services provided to eligible individuals. Covered services include:

  • Inpatient and outpatient hospital and clinical services (including X-ray and laboratory examinations)
  • Physicians’ services
  • Nursing facility and home health services
  • Drugs not covered by Medicare Part D
  • Biological and medical supplies (medical equipment and appliances)
  • Podiatry (foot care)
  • Whole blood
  • Eye examinations, refraction and eyeglasses
  • Dental services (individuals age 21 and older have an annual payment limit for non-emergency services.)
  • Family planning services
  • Psychiatric/psychological services
  • Diagnostic, screening, preventive and rehabilitative services
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services
  • Prosthetic devices, (including hearing aids)
  • Transportation to, from, and between medical facilities, (including inter-island or out-of-state air transportation, food, and lodging as necessary)
  • Respiratory care services
  • Hospice care services

In addition to the coverage listed above, blind or disabled individuals under age 21 receive Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) health services. These services include:

  • Complete medical and dental exams;
  • Hearing and vision tests, laboratory tests;
  • Immunizations and skin tests for tuberculosis (TB);
  • Assistance with necessary scheduling and transportation upon request.
  • Unlimited mental health benefits