Hawaii Med-QUEST, also known federally as Medicaid, is a government health insurance program that helps certain people get health care services at a lower cost. This includes people who are older, blind, or living with a disability.

What does Hawaii Med-QUEST (Medicaid) cover?

Hawaii Med-QUEST pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the program serves those with limited income and resources, people with Hawaii Med-QUEST pay few to no out-of-pocket costs. Check with the Med-QUEST Eligibility Branch Office located on your island to learn more about the coverages provided.

How do I know if I qualify for Hawaii Med-QUEST (Medicaid)?

In general, to be eligible, you must:

• Be a Hawaii resident
• Be a U.S. citizen or a qualified non-citizen
• Meet the income and (if applicable) asset limits for your coverage group

If you need help with your health care coverage and costs, you should apply for Med-QUEST even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance. For example, if you have Medicare, you may qualify for a Medicare Savings Program (MSP).
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for the Medically Needy Spenddown Program.

What are the different Med-QUEST programs in Hawaii?

You may be able to get health coverage if you fall into one of the following categories:

QUEST Integration Program

The Hawaii QUEST Integration Program covers people who are age 65+, blind, or living with a disability who also have limited income and resources.

Medically Needy Spenddown Program

If your income puts you over the limit to qualify for Med-QUEST, you may still be able to get coverage if you have very high medical expenses. You would “spend down” your income on your medical expenses until you qualify for Med-QUEST. The amount you pay depends on your income and household size.

Examples of health care-related expenses you can use to spend down your income include:

• Medications
• Paid medical bills
• Unpaid medical bills (if they were outstanding 3 months prior to the date of your Medicaid application)
• Nursing home care
• Health-related home renovations, such as wheelchair ramps or chair lifts
• Transportation to medical appointments

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Hawaii Med-QUEST. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Med-QUEST coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Med-QUEST you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Med-QUEST:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP). This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Hawaii Med-QUEST (Medicaid)?

When you apply for Med-QUEST, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for Hawaii Med-QUEST (Medicaid)?

In Hawaii, Medicaid is administered by the Hawaii Department of Human Services (DHS) – Med-QUEST division. To get coverage once you are enrolled, you must go to health care providers that take part in the Medicaid program.

There are a few different ways you can apply for Hawaii Med-QUEST. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for Med-QUEST is online through the Med-QUEST portal. All your personal information is kept 100% confidential and protected by special security technology. 

Apply in Med-QUEST Portal

You can download and print a paper medical benefits application, complete it, and mail or fax it to your nearest Med-QUEST Eligibility Branch Office. You can also drop it off in person.

How can I get help with my application?

• Contact a community partner.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.