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.

[note note_color=”#e6e6de” text_color=”#333333″ radius=”3″]

TO VISIT THE FULL Med-QUEST WEBSITE CLICK HERE

Applications for Health Care Coverage are accepted:

• • On-line at www.mybenefits.hawaii.gov
  • Over the phone at 1-877-628-5076
  • By mail delivered to Med-QUEST Division Eligibility Offices

[/note] 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

Resources for Providers

Special Enrollment Periods

2015 Annual Plan Change Deadline Extended to October 30, 2015

MQD  Accomplishments 2010-2014

[note note_color=”#e6e6de” text_color=”#333333″ radius=”3″]

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.

QUEST Integration Program

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:

• Keep seeing your current doctors.
• Go to the hospital, care facility, or pharmacy you prefer.

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:

1. Tell Med-QUEST Enrollment Services Section of your new choice within fifteen days of receiving a choice notice from them.
2. Your new health plan will start on the first day of the following month. Until then, you’ll stay with the health plan you were assigned.

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:

• Aloha Care
• HMSA
• Kaiser Permanente (Oahu and Maui only)
• ‘Ohana Health Plan
• United Healthcare Community Plan

Get Started With Your New Plan

After you choose a QUEST Integration health plan, your plan will mail you:

• ID cards for each family member.
• Instructions to choose a primary care provider (PCP).
• Health plan responsibilities, services, and benefits handbook with information on:
  • Interpretation and translation services.
  • Prior approval for care and other services.
  • Services the plan doesn’t cover because of moral or religious reasons.
  • The grievance and appeal process.

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.

Learn About Your QUEST Integration Benefits

Primary & Acute Care Services
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

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:

• Complete medical and dental exams;
• Developmental, autism, and lead screening;
• Hearing, vision, and laboratory tests; and
• Immunizations and tuberculosis skin tests.

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.

Services That Aren’t Covered by Your Health Plan

Call 1-800-316-8005 toll-free for more information about these services.

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

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.

• Oahu: 792-1070
• Neighbor Islands: 1-888-792-1070 toll-free

If you’re under age 21, you get:

• Diagnostic and preventive services once every six months.
• Non-emergency care that includes:
  • Endodontic therapy
  • Periodontic therapy
  • Resotrations
  • Prosthodontic services
  • Oral surgery
  • Emergency services

If you’re 21 or older, you get:

• Emergency services that include:
  • Eliminating dental pain
  • Eliminating dental infection
  • Treating acute injuries to the teeth and supporting structures

Who to Call for Which Services

Call your health plan if you have:

• Problems with a doctor or other provider.
• Problems accessing health care services.
• A disagreement about your health plan.
• A grievance or appeal to file.

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.

• Hawaii: 333-3053
• Kauai: 240-0485
• Maui and Lanai: 270-1536
• Molokai: 660-0063
• Oahu: 791-3467
• Online: hilopaa.org

Important QUEST Integration Contact Information

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.

• Provider Resources: www.med-quest.us
• Mailing address: Med-QUEST, P.O. Box 700190, Kapolei, HI 96709-0190

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:

• • Income
  • Address
  • Living arrangement
  • Marriage or divorce
  • Pregnancy
  • Birth
  • Death
  • Health insurance coverage
  • Getting or changing a job
  • Injuries from accidents
  • Receipt or sale of any asset
  • Receipt of a Social Security number

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
[/note]

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

 

Med-QUEST Division Legislative Briefings

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

• KOLEA System Update
• Medicaid Coverage of School-based Healthcare Services
• Adult Dental Benefits (Will NOT be implemented)
• 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