What is Medicaid Managed Care?
Some 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.
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 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.
Med-QUEST is available to Hawaii residents of all ages. However, the financial requirements below are specific to Hawaiian residents age 65 or older or those who are 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, for March 2022-February 2023, an applicant cannot have more than $1,303 per month ($15,636 per year) in income. Married couples, with both spouses applying for benefits, are able to have income up to $2,606 per month ($31,272 per year). These amounts are readjusted annually in March.
Married applicants, when only one spouse is applying, will have their incomes considered separately. Furthermore, the applicant spouse is able to transfer a portion of his or her monthly income, up to $3,715.50 a month, to the non-applicant spouse as a monthly maintenance needs allowance.
Single applicants are permitted up to $2,000 in assets and married applicants up to $4,000. Married couples when only one spouse is applying are permitted notably higher countable resources. In 2023, the non-applicant spouse is permitted up to $148,620. (This is called a community spouse resource allowance).
One’s home, provided the home is owner-occupied and one’s equity interest is less than $1,033,000, is not considered a countable asset. Other assets that aren’t countable include but are not limited to home furnishings, personal items, and a single vehicle.
Please Note: 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.
Over the Financial Limits?
One can have a higher income and still 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.
After deductions for medical care, once their income 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.
Persons exceeding the income or asset limits have 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. 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.
Benefits and Services
Hawaii residents who qualify for Med-QUEST 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 Services
- Assisted Living Services
- Chore Services
- Home Health Services
- Homemaker Services
- Home Maintenance / Modifications
- Meal Delivery
- Moving Assistance
- Non-Medical Transportation
- Nursing Home Care
- Personal Care
- Personal Emergency Response Services (PERS)
- Respite Care
- Skilled Nursing
- 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.