MEDICAID

Adults

Pregnant Women

Individuals receiving General Assistance

Individuals who lose employer-sponsored coverage or extended coverage in a group health plan because of a loss of employment within 45 days of date of application

Families/Children

Infants Under Age 1

Children Age 1 to 6

Children Age 6 to 19

Foster children eligible for Title IV-E maintenance payments and children in subsidized adoptions up to age 21

Immigrant Children’s Program

QUEST-Net

Hawaii Breast and Cervical Cancer Program

Documented and Undocumented Aliens

Income 185% of FPL or less.
No asset test.

Not automatically eligible for Medicaid.  Must meet income and asset requirements (Income limit is 100% of FPL; see next column for asset limits).

Income 100% of FPL or less.
Note:  These individuals are only eligible for QUEST managed care Medicaid program and are not eligible for the Medicaid Fee-For-Service program. 

Income 185% of FPL or less.
No asset test.

Income 133% of FPL or less.
No asset test.

Income 100% of FPL or less.
No asset test.

Automatically eligible for medical assistance.

Must meet income requirements of the Medicaid (QUEST/FFS) or S-CHIP look-a-like eligibility category.

Income 300% of FPL or less.  Must have been a recipient of QUEST or Medicaid FFS in order to “fall out” into QUEST-Net.
Asset limits:  See next column.

Income 250% of FPL.
Asset limits:  $2,000 for one person or $3,000 for two people.

Must qualify through any eligibility category.

The State of Hawaii Department of Human Services, Med-QUEST Division, administers the state’s Fee-For-Service Medicaid program and its managed care program, called Hawaii QUEST.  The Medicaid Home and Community Based Services (HCBS) waiver programs are administered by the Adult and Community Care Services Branch of DHS.

To qualify for either fee-for-service or managed care Medicaid programs, individuals/families must have assets not exceeding $2,000 for a household of one or $3,000 for a household of two.  For each additional person beyond two, the limit increases by $250.  These limits do not apply to children under age 19 and pregnant women.

Individuals who are self-employed whose income does not exceed 100% of FPL are required to pay 50% of the Hawaii QUEST monthly premium.

Individuals who are age 65 or older, are blind or have disabilities receive Medicaid services through the Fee-For-Service (FFS) program.  All other eligibles, including pregnant women, children, TANF and GA recipients, must receive Medicaid services through Hawaii QUEST, the state’s managed care program.

In order to qualify for QUEST, individuals must not be eligible for health insurance from their employer (except Section 1931, TMA, and GA recipients).

The State-funded Immigrant Children’s Program is a QUEST and Medicaid Fee-for-Service look-a-like program.  Children who are legal immigrants, refugees and citizens of the Marshall Islands, Federated States of Micronesia, and Palau can get coverage under these programs if their household income meets eligibility guidelines.

Pregnant women remain eligible for medical assistance following childbirth for a 60-day period until the end of the month in which the 60-day period ends.  The woman’s eligibility is re-determined for the first month following the month in which the 60-day period ends.

QUEST-Net is a program for people who no longer qualify for QUEST or Medicaid Fee-For-Service due to income or assets limits.  A person must already be enrolled in one of the two programs (FFS or QUEST) and have monthly income below 300% of FPL to be eligible.  The monthly fee for QUEST-Net for an enrollee is about $64.  Adults receive a limited benefits package and children are provided the same benefits as a child in QUEST or Medicaid FFS.

Undocumented aliens are entitled to emergency services, including labor and delivery, only.

TANF

Children and caregivers

Transitional Medical Assistance (TMA)

Not automatically eligible for Medicaid based on their eligibility for TANF. Must meet all Section 1931 criteria.
Household income must be less than the income standard for household size, which is 100% of Hawaii’s FPL or countable net income must not exceed the financial assistance payment standard established in 1993.  For 2002, the dollar amount is approximately $1,735 for a family of four (100% of FPL).

Individuals who have been receiving Medicaid through Section 1931 but are no longer eligible due to an increase in earnings or because of receipt of child support or alimony.  The number of months of continuation is 4 if receiving child support or alimony and up to 12 for increased earnings.

Children must be under 18 or may be 18 if a full-time student.  A caretaker relative may either have a blood relationship (see specific regulations) or be an adoptive parent, spouse of divorced or deceased caretaker relative, or “hanai” father or mother.

Pregnant women with no other eligible children may be eligible for TANF from the first of the month in which the women begins her ninth month of pregnancy, if certain criteria are met.

In Hawaii, two-parent households may qualify for a parallel program that has the same payment and eligibility requirements as TANF.  The program is called Temporary Assistance to Other Needy Families (TAONF) and is funded exclusively with state dollars.  Households that contain at least one needy, minor child who has both parents living in the same household may be eligible for TAONF, if certain criteria are met.

Non-U.S. Citizens are not eligible for TANF but may be eligible for TAONF.  Persons who are citizens of the Marshall Islands, Micronesia, and Palau may receive medical coverage.  Children who are permanent resident aliens may be eligible for coverage.

There are certain earned income disregards that apply.  See TANF regulations.

Transitional Medical Assistance (TMA) is NOT based on past AFDC/TANF eligibility.  TMA is based on previous Section 1931 eligibility. 

Medically Needy (Spend Down)

Aged, blind, individuals with disabilities, whose monthly income exceeds the eligible income levels but is insufficient to pay for medical care.

QUEST families whose monthly income exceeds the eligible income levels but is insufficient to pay for medical care.

No income limit.

Income cannot exceed 300% of FPL.

Applicants or recipients have monthly countable income that exceeds limits of the appropriate eligibility category but also have medical expenses that when applied against income, can be used to “spend down” to the income level for the appropriate eligibility category.

Medically Needy individuals are responsible for the monthly spenddown amounts.

Elderly/Disabled

Aid to the Aged, Blind or Disabled Program

Qualified Medicare Beneficiaries (QMBs)

Specified Low-income Medicare Beneficiaries (SLMBs)

Qualified Individual (QI-1)

Qualified Individual (QI-2)

Qualified Working Disabled Individuals (QWDIs)

Long Term Care (Nursing Home) and Community Long-Term Care Services (1915c waivers)

Income 100% of FPL or less.
Asset limits: $2,000 for one person or $3,000 for two people.

Income 100% of FPL or less.
Asset limits:  $4,000 for one person or $6,000 for two people.

Income between 100% and 120% of FPL.
Asset limits:  $4,000 for one person or $6,000 for two people.

Income between 120% and 135% of FPL.
Asset limits:  $4,000 for one person or $6,000 for two people.

Income between 135% and 175% of FPL.
Asset limits:  $4,000 for one person or $6,000 for two people.

Income 200% of FPL or less.
Asset limits:  $4,000 for one person or $6,000 for two people.

Income does not exceed monthly medical expenses.
Asset limits:  $2,000 for one person, $3,000 for a couple

To qualify for Community Long-Term Care Services, individuals must:
·         Be eligible for Medicaid;
·         Be certified for admission to an intermediate care or skilled nursing facility, or facility for the mentally retarded;
·         Be able to obtain in-home care at no more than the cost of institutional care which assures the individual’s well-being; and
·         Require treatment for more than 30 days.

For QMBs, Medicaid pays Medicare premiums, coinsurance and deductibles.

For SLMBs, Medicaid pays the Medicare Part B premium.

For QI-1s, Medicaid pays the Medicare Part B premium.

For QI-2s, Medicaid reimburses a portion of the Medicare Part B premium.

QWDIs are eligible for Medicare due to a disability but lose their Part A (premium-free) entitlement because they return to work.  Medicaid pays the Medicare Part A premium (if applicable).

S-CHIP

Children Age 0 to 19

Income 200% of FPL or less.

The State of Hawaii Department of Human Services, Med-QUEST division, administers the program.  The Med-QUEST division also determines eligibility.
The program uses the same managed care program (Hawaii QUEST) as Medicaid, or provides services to disabled children under the Medicaid FFS program.

The Hawaii Covering Kids program, which is a private non-profit program, advocates for S-CHIP coverage.  Applications can be downloaded from www.coveringkids.org.  

The S-CHIP program in Hawaii is a Medicaid expansion program, not a separate program.

Federal regulation requires that children be uninsured in order to qualify for the S-CHIP program.

Household Size

Income Level at 185% of FPL

Income Level at

200% of FPL

1

$1,572

$1,700

2

$2,118

$2,290

3

$2,664

$2,880

4

$3,209

$3,470

5

$3,755

$4,060

6

$4,301

$4,650

7

$4,847

$5,240

8

$5,392

$5,830

9

$5,938

$6,420

10

$6,484

$7,010