Proposed Medicaid Eligibility & Benefits Changes
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The Department of Human Services Med-QUEST Division announced new eligibility and benefits guidelines that will affect certain QUEST programs.
The tentative effective date for the announced changes is April 1, 2012.
The announced changes come as a result of budget reductions enacted as a part of the Hawai‘i state budget for the 2011-2012 fiscal year and, to a greater extent, by the economic difficulties facing the state and the entire nation. These economic circumstances compelled the Department of Human Services to make difficult choices concerning Med-QUEST programs.
Prior to announcing the new eligibility and benefits guidelines for QUEST programs, the Department of Human Services engaged healthcare providers and members of the public through various community forums and discussions. Comments and suggestions proposed during this dialogue greatly influenced the decisions ultimately made by the Department. Even so, we are cognizant that any reductions made to medical assistance program eligibility and benefits have unavoidable negative impacts on the clients we are committed to serve.
In order to provide an adequate time period for affected consumers to prepare for the announced changes, the Department of Human Services has created a Frequently Asked Questions Guide in addition to a more comprehensive slide presentation that is also available online at:
The Frequently Asked Questions guide can be found below and is also available as a printable PDF (legal size pages), which can be posted by healthcare providers and at healthcare facilities.
Beginning in 2012, all medical assistance programs will be consolidated into the following three benefits packages:
QUEST Expanded Access (QExA)
All QUEST Expanded Access (QExA) program enrollees will continue to receive the same benefits package as currently provided, except for certain limitations on chore services and non-emergency ground transportation.
QUEST-Keiki
All QUEST program members age 20 and under will receive the QUEST-Keiki benefits package. With the exception of certain reductions in non-emergency transportation services, the QUEST-Keiki benefits package provides the same benefits package as currently provided to QUEST program members age 20 and under.
QUEST-Adult
All QUEST, QUEST-ACE, and QUEST-Net programs adult members will receive the QUEST-Adult benefits package.
Additional information regarding specific changes to program eligibility and benefits are explained in the frequently asked questions guide below.
QUEST ELIGIBILITY AND BENEFITS CHANGES FOR 2012
- Video of Community Presentation on Proposed Medicaid Changes from May 10, 2011
- Presentation on Addressing the Med-QUEST Division's Budget and Moving Forward
DHS Medicaid Presentation, Jul 29, 2011 - QUEST Eligibility & Benefits Changes for 2012 - Frequently Asked Question Guide
(Suitable for posting as a notice on legal-size paper) - PROPOSED PHASE-OUT PLANS SUBMITTED TO THE CENTER FOR MEDICARE AND MEDICAID SERVICES
FREQUENTLY ASKED QUESTIONS
1. Will these changes affect whether I am eligible to be covered under Medicaid?
2. What is the new QUEST-Adult benefits package?
3. How will the new QUEST-Adult benefit package affect me?
4. When will QUEST-Adult start?
QUEST ELIGIBILITY AND BENEFITS CHANGES FOR 2012
FREQUENTLY ASKED QUESTIONS
Q1: Will these changes affect whether I am eligible to be covered under Medicaid?
Eligibility changes will affect about 4500 adults in the QUEST-ACE and QUEST-Net programs. Income eligibility for adults in the QUEST-ACE and QUEST-Net programs will decrease from 200% to 133% of the Federal Poverty Level (from the pink to the green). However, asset eligibility will increase from $2000 to $5000 for an individual.
(NOTE: If you are eligible to receive coverage under QUEST-ACE or QUEST-Net, your coverage package will increase to the QUEST-Adult benefit package listed below.)
2011 FEDERAL POVERTY LEVEL (FPL) GUIDELINES for HAWAII
ANNUAL INCOME GUIDELINES
| FAMILY SIZE | PERCENT OF POVERTY GUIDELINE (FPL) 133% 200% | |
|---|---|---|
| 1 | $16,678.20 | $25,080.00 |
| 2 | $22,516.90 | $33,860.00 |
| 3 | $28,355.60 | $42,640.00 |
| 4 | $34,194.30 | $51,420.00 |
| 5 | $40,033.00 | $60,200.00 |
| 6 | $45,871.70 | $68,980.00 |
| 7 | $51,710.40 | $77,760.00 |
| 8 | $57,549.10 | $86,540.00 |
*For family units of more than 8 members, add $4,390 (annual)
MONTHLY INCOME GUIDELINES
| FAMILY SIZE | PERCENT OF POVERTY GUIDELINE (FPL) 133% 200% | |
|---|---|---|
| 1 | $1,389 | $2,090 |
| 2 | $1,876 | $2,822 |
| 3 | $2,363 | $3,554 |
| 4 | $2,850 | $4,286 |
| 5 | $3,336 | $5,018 |
| 6 | $3,823 | $5,750 |
| 7 | $4,309 | $6,480 |
| 8 | $4,795 | $7,212 |
*For family units of more than 8 members, add $365.83 (monthly)
Q2: What is the new QUEST-Adult benefits package?
The new QUEST-Adult Inpatient benefits package includes:
- 30 medical inpatient days
- 30 behavioral inpatient days
- Maternity care
- Pregnancy-related services
- Physician and other practioner services
- Preventative services
- Behavioral health services
- Smoking cessation services
- Limited home health services
- Urgent care
- Limited vision services
The new QUEST-Adult outpatient benefits package includes:
- Outpatient visits laboratory and imaging associated with covered visits
- Outpatient hospital procedures or ambulatory surgical center procedures
- Prescription medications
- Family planning/contraceptives
- Diabetes supplies
- Vaccines (pneumonia, influenza, tetanus/diphtheria)
- Limited non‐emergency transportation
- Emergency medical
- Emergency dental
- Language access services
Additionally, exceptions to the QUEST-Adult benefits package limitations are available for:
- Pregnancy-related services
- Cancer treatment
Q3: How will the new QUEST-Adult benefit package affect me?
Eligible adults currently receiving benefits through the QUEST, QUEST-ACE, or QUEST-Net programs will now have access to the new QUEST-Adult benefit package.
- Pregnancy-related medical care will not be affected.
- Medical care for eligible adults over the age of 65 will not be affected.
- Medical care for eligible adults who are blind and/or have been diagnosed with a disability will not be affected.
- Individuals with end-stage renal disease requiring chronic dialysis will be enrolled in QUEST Expanded Access (QExA)
Q4: When will QUEST-Adult start?
No earlier than April 1, 2012. The Department of Human Services (DHS) will notify those affected before the changes go into effect.
