Med-QUEST

• 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

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.

Individuals subject to the asset test are not eligible if their countable assets exceed the asset standard. 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.

Individuals must have countable income within the appropriate 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.

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.

An enrollment cap will be in effect when QUEST enrollment exceeds 125,000 individuals. Under the cap, single childless adults cannot be enrolled in QUEST, even if they meet all other requirements. The cap is lifted when enrollment is below 125,000 individuals on the last day of the year.

The QUEST health plans pay contracted health care providers for medical services received by enrollees. Dental services for QUEST recipients are covered by on a fee-for-service basis. The QUEST covered services include, but are not limited to:

• Inpatient and outpatient hospital and clinical services (including X-ray and laboratory examinations)
• Physicians’ services
• Nursing facility and home health services
• Drugs
• 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.