Hawaii QUEST Program (QUEST)
The Hawaii QUEST Program (QUEST) is a Medicaid managed care program where the State pays health plans to provide coverage of medical and mental health services. Dental Services are provided on a fee-for-service basis.
- Be a Hawaii resident
- Be a U.S. citizen or legal immigrant
- Provide proof of their citizenship status
- Provide proof of their identity
- Provide a Social Security Number
- Not reside in a public institution
- Be under age 65
- Not blind or disabled
- Not be eligible for to receive health insurance from their employer (except for individuals covered under Section 1931 of the Social Security Act, the General Assistance Program, or the Transitional Medical Assistance Program)
- Meet an asset test (except for pregnant women and individuals under age 19)
- Meet an income test
Adults must not have countable family income that is more than 100% of the current Federal Poverty Level (FPL). Children under age 19 must not have countable family income that is more than 200% FPL. Pregnant women must not have countable family income that is more than 185% FPL (her household size includes the unborn child(ren).
Individuals should contact the Med-QUEST Division to obtain the current income standards.
- Inpatient and outpatient hospital and clinical services (including X-ray and laboratory examinations)
- Physicians’ services
- Nursing facility and home health services
- 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
Individuals under age 21 also 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.
- QUEST recipients can choose a health plan that provides services on the island they live. The Department will assign recipients who fail to choose a plan within 10 days to a plan.
- The health plan will mail a handbook and health plan card to new enrollees. The handbook will explain plan benefits, providers, service procedures, and important phone numbers.
- The health plan will ask each enrollee to choose a doctor from their plan network to provide or arrange for heath care. This doctor is called a PCP (Primary Care Provider). Enrollees who fail to select a PCP will be assigned one by the plan.