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 2017 for those aged (65+) or blind or disabled persons between the ages of 18 – 64.

Income – Income limits for Medicaid in Hawaii are rather complicated. Fortunately, the state offers multiple pathways for elderly or disabled individuals to qualify for Medicaid. The most straight-forward option is for a single applicant to have monthly income less than 138% of the Federal Poverty Level (actually 133% + 5% disregard). It should be noted that Hawaii has higher Federal Poverty Levell limits than other states. In dollar terms for 2017, this means the applicant must have less than $1,594 per month in income. This amount is readjusted annually.

The state also offers a Medically Needy option. 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.

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 2017, that limit is approximately $120,900. Homes, provided the home is owner-occupied, are considered exempt assets up to a value of $840,000. 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.

 

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.