Hawaii and the ACA’s Medicaid expansion

Medicaid enrollment up 18%; Uninsured rate down to 4.2%

Where in your state to call or visit for Medicaid.How to apply

You can apply on-line at My Medical Benefits or by phone at 1-877-628-5076. Or, fill out an application.

Who is eligible in your state to get Medicaid?Who is eligible

Children with family income levels up to 308% of FPL. Pregnant women with family income up to 191% of FPL. Adults with family income up to 133% of FPL.

  • By
  • healthinsurance.org contributor
  • September 28, 2016

Medicaid expansion helps cement “healthiest state” status

Hawaii has a long history of supporting initiatives to make health insurance broadly available to residents. Hawaii was among the first six states that implemented a Medicaid program in January 1966, just six months after federal legislation authorizing the program was enacted. In 1974, Hawaii implemented its Prepaid Health Care Act, which mandated that most employers make health insurance available to employees who work at least 20 hours a week.

In conjunction with the Affordable Care Act (ACA), Hawaii implemented a state-run health insurance marketplace and adopted Medicaid expansion. The marketplace transitioned to a federally-supported state-run marketplace for 2016, and is transitioning again to a fully federally-run exchange for 2017. Nothing changed about Medicaid with the switch to Healthcare.gov though; the expanded Medicaid eligibility guidelines are still in effect in Hawaii.

Through its efforts, Hawaii consistently has low uninsured rates and high overall health scores. As of 2015, Hawaii is ranked the healthiest state in the nation.

A total of 340,829 people were enrolled in Medicaid/CHIP in Hawaii as of July 2016. That’s an increase of 18 percent since the end of 2013, largely attributed to the state’s acceptance of Medicaid expansion under the ACA.

Qualifying for Medicaid in Hawaii

Hawaii’s Medicaid eligibility levels for children are much higher than the national average and about average for pregnant women and parents.

  • Children ages 0-18 qualify with family income levels up to 308 of the federal poverty level (FPL)
  • Pregnant women qualify with family income up to 191 percent of FPL
  • Parents and other adults qualify with family income up to 133 percent of FPL

How to sign up for Medicaid

Hawaii’s Medicaid program is called MED-QUEST (MQD); QUEST stands for Quality care, Universal access, Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to recipients.

You can apply for MED-QUEST:

Medicaid expansion

Hawaii adopted Medicaid expansion through the Affordable Care Act, extending eligibility for Medicaid to adults with income up to 133 percent of the poverty level (138 percent with the automatic 5 percent income disregard).

Medicaid expansion took effect in January 2014. According to Hawaii’s proposed 1332 waiver (which would better align the ACA in Hawaii with the state’s existing healthcare reform laws), 23 percent of Hawaii’s residents are covered by Medicaid/CHIP.

According to the Kaiser Family Foundation, about 70,000 Hawaii residents were uninsured in 2015. With Medicaid expansion now covering low-income, nonelderly adults, 50 percent of Hawaii’s remaining uninsured population at that point was eligible for Medicaid – although they may not realize that they’re eligible. According to Gallup polling data, 4.2 percent of Hawaii residents were uninsured by the end of 2015 — down from 7.1 percent in 2013.

Significant developments in Hawaii’s Medicaid program

Hawaii implemented its Medicaid program in January 1966.

In the early 1990s, Hawaii implemented the State Health Insurance Program (SHIP) to cover people who weren’t eligible for Medicaid. Then, in 1994, CMS approved Hawaii’s section 1115 Medicaid waiver (one of the first in the nation) to wrap SHIP in with Medicaid in an effort to achieve universal insurance coverage (in combination with the state’s Prepaid Health Care Act). The result of the waiver was the creation of Hawaii’s MED-QUEST program, which initially covered low-income women and children, but has since expanded (as of 2009) to cover nearly all of Hawaii’s Medicaid beneficiaries.

Medicaid in Hawaii is separated into two different methods of providing services: the fee-for-service (FFS) program and the managed care program, called MED-QUEST or MQD. Under the FFS program, doctors and other healthcare providers bill Medicaid directly to be reimbursed for services provided to Medicaid beneficiaries. Under MED-QUEST, the state contracts with managed care plans who in turn provide healthcare services to Medicaid beneficiaries.

As of 2011, more than 98 percent of the people enrolled in Hawaii’s Medicaid program were covered through managed care. By March 2015, Kaiser Family Foundation reported that 335,007 Medicaid enrollees in Hawaii were covered under managed care programs. That’s higher than the August 2015 total Medicaid/CHIP enrollment count, but KFF notes that the managed care number includes people who are covered under Hawaii’s fully-state-funded Medicaid program, in addition to the majority of enrollees who are in regular Medicaid that’s funded partially by the state and partially by the federal government.