Hawaii Medicaid (Medicaid and QUEST) Application Information

Hawaii Medical Assistance is separated into two medical insurance plans and those are called Medicaid and QUEST. In general, Medicaid can be used by senior citizens who are of age 65 and older, as well as disabled individuals. Low-income individuals with underage children can apply for QUEST health insurance.

There aren't actually many differences between these programs, since main differences are in core benefits provided by Medicaid and QUEST insurance plans. Benefits provided by Medicaid are aimed for potential health problems of senior citizens who might need more often and regular visits to a health care institution, while QUEST covers adults and underage children.

Benefits covered by both Medicaid and QUEST are:

  • Inpatient and outpatient hospital and clinical services
  • Physicians' services
  • Nursing home or home health services
  • Prescription drugs
  • Psychiatric/Psychological services
  • Diagnostic, screening, preventive and rehabilitative care
  • Prosthetic devices
  • Transportation services

Inpatient hospital services include 30 medical inpatient days, 30 behavioral inpatient days, maternity and prenatal care, preventative and physician services as well as urgent care. Outpatient services include visits to laboratory and imaging diagnostics, hospital and ambulatory surgical procedures, prescription medication, family planning services, immunizations and dental care.

QUEST also includes health care program for individuals under the age of 20, which is called Early and Periodic Screening, Diagnosis and Treatment (EPSDT). This is a separate QUEST program, called "QUEST-Keiki", while previously listed benefits are covered by "QUEST-Adult" program.

EPSDT is a set of medical services which include:

  • Complete medical and dental exams
  • Hearing and vision tests
  • Laboratory and diagnostic tests
  • mmunizations (vaccines)
  • Unlimited mental health services

After you've be successfully enrolled with Medicaid or QUEST program, you'll need to choose your own Primary Care Physician (PCP). This is highly advisable and mandatory since by having your own PCP your medical condition can be observed in a long period of time by a team of doctors who are familiar with your medical history. This is the safest and the most convenient way to get the help when you need it. This means that if you ever need a medical consultation about a certain problem, you'll need to make an appointment with your PCP, who might solve it or who might send you to a specialist. In case you don't choose your PCP, you'll be automatically assigned according to your place of living. You might be even able to use a Primary Care Physician whose services you've already used in the past, if that physician is on the list of health care providers for your medical assistance program.

After you've signed up for a PCP, you should get your own Medicaid/QUEST medical card, which you need to show each time you require medical attention. It's important to keep this card on a safe place and not lend it to someone else, since you can be excluded from a program. In case you lose your card, you should contact the Department of Human Services and report this situation.

Eligibility Requirements

There are slight differences on eligibility requirements for Medicaid and QUEST programs. These differences can be found both in general eligibility terms, as well as in asset and income limits.

Medicaid

In general, Medicaid enrollees must meet the following criteria:

  • You need to be a Hawaii resident
  • You need to have a U.S. citizenship or legal immigrant status
  • You need to have a Social Security Number
  • You need to be 65 years of age or older
  • In case you're blind or disabled, you don't need to meet previously set age criteria
  • You need to meet asset and income limits

Assset Limits:

  • Total worth of assets can be $2,000 for a household of one, $3000 for a household of two and $250 for each additional family member.
  • Pregnant woman and children under the age of 19 are excerpt from asset criteria.
  • Countable assets are: available cash, bank accounts, stock, bonds, additional real property and additional motor vehicles. This means that the house you're living in, as well as your primary and only motor vehicle are expert from the asset limits (they're not countable).

Income Limits:

  • Limits for income which make you eligible depend on several inputs like your age, household size, living arrangements as well as your disability status. These standards are based on the Federal Poverty Level. As of July 1, 2012, income limit is 133% of the Federal Poverty Level. This means that if your household has only one member, total income should not exceed $1,425. For a family of two, maximum total income can be $1,930. Click here for a detailed information on the current Federal Poverty Limit.
  • Countable income are wages, self-employment income, pensions, other financial benefits, etc. Non-countable income include welfare income, SSI benefits, food stamps and loans.

Quest

On the other hand, QUEST enrollees must meet the following criteria:

  • You need to be a Hawaii resident
  • You need to be a U.S. citizen or legal alien
  • You need to have a Social Security Number
  • You need to be under the age of 65
  • You must not be disabled or blind (otherwise you can use Medicaid, not QUEST)
  • You shouldn't be eligible for receiving health insurance from your employer
  • You must meet a certain asset and income limit

Asset Limits:

  • Total worth of assets can be $2,000 for a household of one, $3000 for a household of two and $250 for each additional family member.
  • Pregnant woman and children under the age of 19 are excerpt from asset criteria.
  • Countable assets are: available cash, bank accounts, stock, bonds, additional real property and additional motor vehicles. This means that the house you're living in, as well as your primary and only motor vehicle are expert from the asset limits (they're not countable).

Income Limits:

  • You income limit should not exceed 100% of the current Federal Poverty Level.
  • Underage children must not have countable income more than 200% of the FPL.
  • Pregnant woman must not have countable income more than 185% of the FPL.

Medicaid Application Instructions

In order to apply you'll need fill out the Medical Assistance application from and send it to appropriate Med-QUEST eligibility office.

There are several ways to find, fill out and turn in your Medical Assistance application form:

After you've filled out the MA application form, you'll need to send it to your local DHS office or turn it in personally.

Besides having properly filled out application form, you'll also need copies of documents which are used as a proof of your identity, your citizenship status as well as your income and your assets.

A proof of your identity can be your passport, ID card, driver license or any official document with your photo and identity information. You'll also need a proof that you're a U.S. citizen and that can be a U.S. passport, Hawaii ID card or Birth Certificate. If you're a legal alien, you'll need a Permanent Resident Card (I-551), foreign passport with I-94 or I-551 stamp or Employment Authorization Card.

Finally, you'll also need a proof for any income or asset information you've registered while applying for Medicaid or QUEST program. These can be bank statements regarding your current income, paystubs, documents regarding retirement pensions, unemployment insurance benefits, documents on any stocks, bonds or real estate you own (the house you're living in is excerpt from this list). There are also certain assets and income which could not be counted toward the limit for your eligibility status and those are:

  • Home property
  • Motor vehicles
  • Clothing, household furnishing and appliances
  • Welfare payments
  • Food stamps
  • Loans

After you've successfully applied for Medicaid or QUEST, you should receive a definite answer within the 45-day period. This period can be extended to 90 days in case a person with disabilities applied for enrollment.