Med QUEST Integration Program: Managed Care from Hawaii Medicaid

 What is Medicaid Managed Care?
Many states are changing their long term care Medicaid programs by replacing their HCBS 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 aging Hawai’i residents remain in living in their homes.

Hawaii's Medicaid program for elderly, blind or disabled individuals is now called simply "Med QUEST." Med QUEST serves low income, elderly and disabled residents of Hawaii in 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. Meaning the program beneficiary has the flexibility to choose their care providers. Certain family members 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 and 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 2018. 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 they meet a different set.

Monthly Income – for Hawaiian residents aged 65 or older, or those who are officially disabled, the month income limit is set at 138% of the Federal Poverty Level. It should be noted that Hawaii has higher Federal Poverty Level limits than other states. In dollar terms for 2018, this means the applicant must have less than $1,605 per month in income. This amount is readjusted annually.

Alternatively, one can have higher income and be eligible through the Medically Needy pathway. The Medically Needy program allows aged individuals who have incomes over the limit and very high medical expenses to qualify for assistance with their long-term care costs once their income, after deductions for care, is at or below $470.40 per month. This amount was once set equal to 64% of the Federal SSI level, however, it does not readjust annually but requires a legislative change to readjust.

Married couples, unless both are applying for Medicaid, will have their incomes considered separately. One should contact a Medicaid planning consultant to better understand their eligibility status and how to qualify when married and over the individual income limits.

Countable Assets - Single applicants are permitted up to $2,000 and married applicants up to $3,000. Married couples with a single applicant are permitted notably higher countable resources. In 2018, that limit is approximately $123,600. Homes, provided the home is owner-occupied and valued less than $858,000, are not considered to be “countable assets”. This also applies to home furnishings, personal items and a single vehicle.

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

 

Benefits and Services

Hawaii residents who qualify for QExA are provided with a custom care plan that specifies precisely what care services are covered for them by the program.   In addition to medical care, in the area of long term care these might include:

  • Adult Day Care
  • Adult Day Health Care
  • Adult Foster Care
  • Assisted Living
  • Chore Services
  • Home Health Services
  • Homemaker Services
  • Nursing Home Care
  • Personal Care
  • Personal Emergency Response Services (PERS)
  • Respite Care

 

How to Apply / Learn More

One can read more about the QUEST Integration program on this website.  One can check eligibility and apply on at mybenefits.hawaii.gov. One can also phone the Med Quest office and speak to a benefits expert there. The number for Med QUEST 808-587-3521.