Categorized | Health

Approval for Med-QUEST eligibility changes


The Centers for Medicare and Medicaid Services (CMS) have approved Hawaii’s request to reduce the eligibility income limit for its QUEST-ACE and QUEST-Net programs to 133 percent of the federal poverty level (FPL), or $16,678 per year for a single adult.

Currently, the state Department of Human Services (DHS) Med-QUEST Division (MQD) administers health coverage for 285,000 clients, which is an increase of 35 percent since July 2008 when 211,000 people received services.

The MQD has begun sending a series of letters to QUEST-ACE and QUEST-Net enrollees informing them of their status. Individuals enrolled in the QUEST-ACE and QUEST-Net programs not losing eligibility will receive a notice reassuring and informing them that no further action is required to maintain their eligibility.

QUEST-ACE and QUEST-Net are optional expansion programs that currently offer limited healthcare benefits to non-pregnant adults. CMS is the federal agency that oversees Medicaid.

A separate notice will be sent to individuals who, based on their current MQD records, may lose eligibility. A description of those eligibility changes are posted on our website.

“We have options for those who lose eligibility,” said DHS Director Patricia McManaman. “Affected individuals can purchase an individual health policy or receive services on a sliding scale from a federally qualified health center.”

A list of options has been provided to those individuals who may lose eligibility. That list also is posted on the DHS website at

As a result of the eligibility reduction, an estimated 3,500 people may lose their health coverage on July 1, 2012. However, with the concurrent increase in QUEST-ACE asset limits from $2,000 to $5,000 for a single adult, as many as 12,000 individuals will receive a significant increase in benefits, including unlimited outpatient visits and unlimited prescription drugs.

All adult QUEST, QUEST-ACE, and QUEST-Net members will receive the QUEST-Adult benefits package beginning July 1, 2012.

Individuals who receive notice that they may lose eligibility should contact MQD if their circumstances have changed. This includes becoming pregnant or disabled, or experiencing an increase in household size or decrease in income. MQD will re-determine eligibility based on the updated information.

Adults affected by the eligibility change but who did not respond to the first notice will receive a second MQD notice in mid-May 2012. It will remind them to contact the MQD if their circumstances have changed.

A third notice will be mailed in mid-June to notify recipients who did not respond to the first two notices that their healthcare coverage will be terminated as of July 1, 2012.

The MQD received substantial public input from two forums and an open comment period earlier this year. That feedback was carefully reviewed and incorporated into the plan to address a $150 million budgetary reduction over the biennium.

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