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.
TO VISIT THE FULL Med-QUEST WEBSITE CLICK HERE
Applications for Health Care Coverage are accepted:
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- On-line at www.mybenefits.hawaii.gov
- Over the phone at 1-877-628-5076
- By mail delivered to Med-QUEST Division Eligibility Offices [/box]
Updated Notice – Services for children under 21, including autism services
Fee-For-Service – Long Term Care
2015 Hawaii Med-QUEST Health Plans
2020 Hawaii Federal Poverty Level (FPL) Guidelines
2015 Annual Plan Change Deadline Extended to October 30, 2015
MQD Accomplishments 2010-2014 Grievance Hotline Call 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. The Department of Human Services Med-QUEST Division (MQD) has launched, QUEST Integration, a more patient-centric Medicaid program to better serve clients. QUEST Integration effectively combines and replaces the QUEST and QUEST Expanded Access (QExA) programs. The benefits of QUEST Integration include more health plan choices for aged, blind or disabled individuals, and a greater ability for a beneficiary to remain with the same health plan upon turning 65 or developing a disability. Additionally, eligible beneficiaries will gain expanded access to home and community-based services to prevent decline to institutional level of care. QUEST Integration also reduces administrative burden by creating a single managed care program. Step 1: Learn About Your Choices
Choosing a health plan is important. You’ll get all your health care services from a single health plan. The health plan can help you find doctors, hospitals, and pharmacies. When you’re choosing a health plan, it’s a good idea to see if you can: Health Care Provider Network The health plans participating in QUEST Integration are AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan (Oahu & Maui only), ‘Ohana Health Plan and UnitedHealthcare Community Plan. (See below for contact information). If there’s a specific provider you want to see, visit the QUEST Integration health plans’ websites, or call to ask if the provider is in their network. If your current provider doesn’t accept QUEST Integration (Medicaid) health insurance, call your health plan to help you find another doctor or provider. Health Plans Phone Website AlohaCare 1-877-973-0712 alohacare.org HMSA 1-800-440-0640 hmsa.com Kaiser Permanente 1-800-651-2237 kpinhawaii.org ‘Ohana Health Plan 1-888-846-4262 ohanahealthplan.com United Healthcare Community Plan 1-888-980-8728 uhccommunityplan.com Step 2: Choose a Health Plan When you become eligible for Medicaid, the Department of Human Services assigns you to a health plan right away. You can stay with the health plan that Med-QUEST assigned to you or you can choose a different health plan. If you stay with your assigned health plan, you don’t have to do anything. If you choose a different health plan, you must: If you stay with your assigned health plan or choose a different health plan, you can change plans once within 60 days of the day you are enrolled in QUEST Integration. Once the 60-day period ends, you can change your health plan only during open enrollment. How many health plans can I choose from? Your five choices for a QUEST Integration health plan are: After you choose a QUEST Integration health plan, your plan will mail you: Make sure you carry your QUEST Integration health plan ID card and Medicaid ID card at all times. You’ll need your ID cards to get health care services. Getting care before you receive your health plan member ID card You’ll get a notice in the mail that tells you about the health plan you’re enrolled in. Take the notice with you to your doctor or other service provider to get medical care. Once you get your health plan ID card, you can use your card to get services. Choosing a primary care provider (PCP) Your health plan will mail you a welcome packet. Inside the packet you’ll find a form asking you to choose a primary care provider (PCP). Your PCP will see you for regular checkups or when you’re sick. When you need a specialist or other medical services, your PCP will arrange it for you. If you need help finding a PCP or specialist, ask your health plan for help. If you received services before you got the Med-QUEST enrollment notification, tell your PCP or other service provider. Your health plan may cover some of these services. You’ll have 15 days to choose your PCP. If you don’t let your health plan know of your choice within that time, they’ll assign you a PCP. You can change your PCP at any time. Primary & Acute Care Services Does QUEST Integration cover medical and bills I already have? If you utilized medical services occurring a maximum of 10 calendar days before the date we receive your application, those services will be covered if a medical provider provided the medical service. Make sure that you check off the box asking about outstanding medical bills when you submit your application. 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. Are you under 21 years of age? Get free physical exams! The Early Periodic Screening, Diagnostic, and Treatment (EPSDT) program lets children and young adults under 21 get free: The notice here will provides more information about other covered services that you may take advantage of, including autism services. You’ll also get help setting up appointments and arranging transportation. Call your health plan for more information. Urgent care centers If you can’t get an appointment with your PCP, you can go to an urgent care center. Urgent care centers can treat you for an illness or injury that requires immediate care, but isn’t serious enough to visit an emergency room. You don’t need an appointment to be treated at an urgent care center. After-hours care nurse line Each health plan has its own after-hours care nurse line, where you can get medical advice and guidance. The lines operate 24 hours a day, seven days a week. Call your plan’s nurse line if you have questions about a medical condition or you’re not sure if you should visit an emergency room. Traveling off-island or out of state Your QUEST Integration health plan covers medically necessary off-island and out-of-state emergency services and post-stabilization services. For non-emergency off-island, out-of-state, and out of network services, you’ll need prior authorization. Medical services in foreign countries are not covered. Other Health Coverage You must notify MQD is you have additional health insurance. Call 1-800-316-8005 toll-free for more information about these services. About dental services and benefits The Medicaid Fee-For-Service program provides dental services. This means you must get dental care from a dentist who sees Medicaid patients. Call Community Case Management Corp (CCMC) to find a dentist who accepts Medicaid. If you’re under age 21, you get: If you’re 21 or older, you get: Call your health plan if you have: Call Med-QUEST Enrollment Services Section at 1-800-316-8005 toll-free if you have health plan enrollment and eligibility questions. TTY users, call 1-800-603-1201 toll-free. Member complaints and grievances All health plans have a member grievance and appeals process to help address any problems. If you’re concerned about your medical care or services, contact your health plan’s customer service department. The phone number is printed on the back of your membership card. If you can’t work things out with your health plan, you can contact the state-designated QUEST Integration Ombudsman in your county. The ombudsman can help if you have problems with your health plan or don’t agree with the health plan. Have health plan enrollment questions? Call Med-QUEST Enrollment Services Section at 1-800-316-8005 toll-free, 7:45 a.m. to 4:30 p.m., Monday-Friday, except state holidays. TTY users, call 1-800-603-1201 toll-free. Have changes to report or health plan eligibility questions? Call the Med-QUEST Division Eligibility Offices to report all changes within 10 days of learning of them. If you don’t report changes, it may affect your eligibility for medical assistance. Changes include: You must also report when you enter a hospital or public institution or move out of the state of Hawaii. Oahu PHONE FAX Applications 587-3521 587-3543 Ongoing 587-3540 587-3543 Kapolei Unit 692-7364 692-7379 Hawaii Island Hilo (East Hawaii) 933-0339 933-0344 Kona (West Hawaii) 327-4970 327-4975 Maui 243-5780 243-5788 Kauai 241-3575 241-3583 Molokai 553-1758 553-3833 Lanai 565-7102 565-6460 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 should contact your plan if: Nov. 20, 2014 Human Services and Housing, and Health Committees Briefing Nov. 19, 2014 Human Services and Housing, and Health Committees Briefing QUEST Integration Program
Get Started With Your New Plan
Learn About Your QUEST Integration Benefits
Dialysis
Medical transportation services
Durable medical equipment and medical supplies with prosthetics and orthotics
Outpatient hospital services
Emergency and post stabilization services
Physician services
Family planning services
Pregnancy-related services
Fluoride varnish for children
Prescription drugs
Habilitation services
Preventive services
Home health services
Radiology, laboratory, and other diagnostic services
Hospice services
Rehabilitation services
Inpatient hospital medical and surgical services
Smoking cessation services
Inpatient hospital maternity and newborn care services
Urgent care services
Medical services related to dental needs
Vision and hearing services
Behavioral Health Services
Acute inpatient hospital for behavioral health services
Services from qualified professionals like psychiatrists, psychologists, counselors, social workers, registered nurses, and others
Ambulatory mental health services
Substance abuse treatment programs
Prescribed drugs including medication management and patient counseling
Methadone treatment services, which include the provision of methadone or a suitable alternative (e.g., LAAM)
Psychiatric or psychological evaluation
Long Term Services & Support (LTSS)
Nursing facility
Home- and community-based services including:
Chore
Adult day health
Personal care
Adult day care
Personal emergency response system
Skilled nursing
Residential care like Community Care Foster Family Home or Expanded Adult Residential Care Home
Services That Aren’t Covered by Your Health Plan
Service
Who provides it?
Dental
Medicaid Fee-For-Service
School health
Department of Education (DOE)
Zero to Three program
Department of Health (DOH)
Behavioral health services for adults enrollees with serious mental illness (SMI)
Adult Mental Health Division (AMHD) in DOH or Community Care Services (CCS)
Behavioral health services for children under 21 years old with serious emotional disturbances (SEBD)
Child and Adolescent Mental Health Division (CAMHD) in DOH
Services for developmental or intellectual disabilities
Developmental Disabilities Division (DDD) in DOH
Who to Call for Which Services
Important QUEST Integration Contact Information
Med-QUEST Division Legislative Briefings