Paying for Senior Care Logo
Our goal is to help families find the means to pay for senior care by providing objective information and interactive tools on our ad-free, easy-to-use and comprehensive website.  Read More

Med QUEST Integration Program: Managed Care from Hawaii Medicaid

Page Reviewed / Updated - October 07, 2020

What is Medicaid Managed Care? Many states are changing their long term care Medicaid programs by replacing their HCBS (Home and Community Based Services) Waivers with Medicaid Managed Care Organizations (MCO). For the elderly, this means they work with a single administering organization for all of their health and personal care needs. It also means the elimination of the enrollment caps and wait lists for those wishing to receive care and services outside of nursing homes.

Program Description

This program pays for multiple types of residential care, as well as provides assistance to help Hawaii's aging residents remain in living in their homes.

Hawaii's Medicaid program for elderly, blind or disabled individuals is now called simply "Med QUEST." It serves these low income residents of Hawaii in a variety of ways. While the program pays for nursing home care, most readers will be interested in the alternatives to nursing home care that the program offers. These include Extended Care Adult Residential Care Homes (abbreviated as EC-ARCH), Community Care Foster Family Homes (CCFFH), and to a lesser extent, Assisted Living Facilities. In assisted living, Med QUEST will pay for care services, but not for monthly rent and meal costs.

Outside of residential care, Med QUEST also pays for home health care, adult day care, personal care, and respite care. Of these four, consumer direction is available for personal and respite care. This means the program beneficiary has the flexibility to choose his or her care providers. An added bonus is that family members, including spouses, and friends can be paid for their personal caregiving work.

Med QUEST is an acronym that stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and to Transform. It is a managed care program that replaces two older Hawaii Medicaid Waivers: Residential Alternative Community Care and Nursing Home without Walls. It also replaces the QUEST Expanded Access (QExA). This was completed in 2014 through the QUEST Integration project.

Eligibility Guidelines

The following eligibility information is accurate for 2020. Also, the reader should be aware that Hawaii offers multiple pathways for elderly or disabled individuals to qualify for Medicaid. This means someone may not meet one set of eligibility criteria, but can still be eligible because he or she meets a different set.

Monthly Income – for Hawaiian residents aged 65 or older, or those who are officially disabled, the monthly income limit is set at 100% of the Federal Poverty Level (FPL). It should be noted that Hawaii has higher Federal Poverty Level limits than do the other states, with the exception of Alaska. In dollar terms, as of March 2020, an applicant must have equal or less than $1,224 per month ($14,688 per year) in income. Married couples, with both spouses applying for benefits, are able to have income up to $1,653 per month ($19,836 per year). These amounts are readjusted annually.

Alternatively, one can have higher income and be eligible through the Medically Needy pathway. Also called the Medically Needy Spenddown program, it allows aged individuals who have income over the limit and very high medical expenses to still qualify for assistance with their long-term care costs. Simply stated, once their income, after deductions for care, is at or below $469 per month, they are eligible for Medicaid the remainder of the medically needy period. Married applicants, with both spouses applying for benefits, must spend their income down on care/medical expenses to $632 per month. These amounts were once set equal to 64% of the Federal Social Security Income (SSI) level. However, it does not readjust annually, but instead requires a legislative change to readjust.

Please note: Married applicants, unless both spouses are applying for Medicaid, will have their incomes considered separately. Furthermore, an applicant spouse may be able to transfer his / her monthly income, up to $3,216 / month, to his / her non-applicant spouse as a monthly maintenance needs allowance. One should contact a Medicaid planning consultant to better understand his or her eligibility status and how to qualify when married and / or over the individual income limits.

Countable Assets - Single applicants are permitted up to $2,000 and married applicants up to $3,000 in assets. Married couples with a single applicant are permitted notably higher countable resources. In 2020, the non-applicant spouse is permitted up to $128,640. (This is called a community spouse resource allowance). Homes, provided the home is owner-occupied and one’s equity interest is less than $893,000, are not considered to be “countable assets”. This also applies to home furnishings, personal items, and a single vehicle. Please note that persons over Medicaid’s asset limit should not gift assets or sell them under fair market value in an effort to reduce their countable assets. Doing so is a violation of Medicaid’s look back period and can result in Medicaid disqualification.

Persons exceeding these limits may very likely still be able to gain Med QUEST eligibility by working with a Medicaid planning professional. There are a variety of strategies and techniques that can be employed to help a candidate lower his or her countable assets to the point of eligibility. Learn more.

Benefits and Services

Hawaii residents who qualify for QExA (QUEST Expanded Access) are provided a custom care plan. This plan specifies precisely what care services are covered for them via the program.   In addition to medical care, in the area of long-term care, these benefits might include:

  • Adult Day Care
  • Adult Day Health Care
  • Adult Foster Care
  • Assisted Living Services
  • Chore Services
  • Home Health Services
  • Homemaker Services
  • Home Modifications
  • Meal Delivery
  • Non-Medical Transportation
  • Nursing Home Care
  • Personal Care
  • Personal Emergency Response Services (PERS)
  • Respite Care
  • Specialized Medical Equipment

How to Apply / Learn More

One can read more about the QUEST Integration program on this website. You can check eligibility and apply online at mybenefits.hawaii.gov. One can also phone the Med Quest office and speak to a benefits expert. Find the contact information for your local Med Quest office here.