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Hawaii and the ACA’s Medicaid expansion

Medicaid enrollment up 41% since 2013

ACA’s Medicaid eligibility expansion in Hawaii

Hawaii adopted Medicaid expansion through the Affordable Care Act, extending eligibility for Medicaid to adults with income up to 138% of the poverty level (133% plus an automatic 5% income disregard). Medicaid expansion took effect in Hawaii in January 2014.

According to the Kaiser Family Foundation, about 70,000 Hawaii residents were uninsured in 2015. With Medicaid expansion now covering low-income, nonelderly adults, about half of Hawaii’s remaining uninsured population at that point was eligible for Medicaid – although they may not realize that they’re eligible.

According to U.S. Census data, only 3.5% of Hawaii residents were uninsured as of 2016, down from 6.7% in 2013. Although the state’s uninsured rate was reduced by nearly half from 2013 to 2016, it was already less than half of the national average uninsured rate even in 2013, before the bulk of the ACA’s provisions had taken effect. Hawaii’s Prepaid Health Care Act, which has been in place since the 1970s, had already resulted in nearly all of the state’s population having insurance coverage, even before the ACA took effect.

Medicaid expansion helped cement top-ranking health scores

Federal poverty level calculator

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 initially implemented a state-run health insurance marketplace and adopted Medicaid expansion. The marketplace transitioned to a federally-supported state-run marketplace for 2016, and transitioned again to a fully federally-run exchange for 2017, largely in an effort to take advantage of the economies of scale that the federally-run exchange could bring to a state with low overall enrollment in the individual market (because of Hawaii’s Prepaid Health Care Act, nearly all non-elderly Hawaii residents get coverage from an employer, and relatively few need coverage under individual market plans). 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. In 2018, Hawaii was ranked the healthiest state in the nation for the 7th year in a row according to the Gallup Healthways Physical Wellbeing Index, and the state consistently scores at or near the top in other ranking systems (number 1 in the America’s Health Rankings 2020 survey, and number 1 in the Commonwealth Fund’s 2020 Scorecard on State Health System Performance).

Hawaii has accepted federal Medicaid expansion

  • 441,676 – Number of Hawaiians covered by Medicaid/CHIP as of September 2021
  • 153,319 – Increase in the number of Hawaiians covered by Medicaid/CHIP fall 2013 to September 2021
  • 47% – Reduction in the uninsured rate from 2010 to 2019
  • 41% – Increase in total Medicaid/CHIP enrollment in Hawaii since late 2013

Who is eligible 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% of FPL
  • Parents and other adults qualify with family income up to 138 percent of FPL

Hawaii also uses Medicaid funds to help cover premium costs for Hawaii residents who aren’t U.S. citizens but who are citizens of nations that have entered into the Compact of Free Association (COFA) with the U.S.

How does Medicaid provide financial help to Medicare beneficiaries in Hawaii?

Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Hawaii includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

How do I enroll in Medicaid in Hawaii?

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:

  • Online at My Medical Benefits or at Healthcare.gov (only apply through Healthcare.gov if you don’t have Medicare)
  • Over the phone at 1-877-628-5076
  • By mail. Download an application or call the appropriate eligibility office to have an application mailed to you. Complete the application and return it by mail to the office.

Hawaii Medicaid enrollment numbers

More than 441,000 people were enrolled in Hawaii’s Medicaid and CHIP programs as of September 2021. This figure is a 41% increase over 2013 (pre-ACA) enrollment, when about 288,000 people were enrolled.

Hawaii Medicaid history

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. The MED-QUEST waiver is subject to renewal every five years.

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.

Virtually all of the people enrolled in Hawaii’s Medicaid program are covered through managed care. Hawaii only uses fee-for-service Medicaid (ie, without managed care) for a handful of limited Medicaid programs. Hawaii Medicaid managed care members include 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.

In August 2017, Hawaii submitted a waiver amendment to CMS in order to gain federal approval to use Medicaid funding to provide housing services to qualified Medicaid enrollees who are homeless and also have behavioral health and/or substance abuse problems. That waiver request was approved in October 2020.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Hawaii

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

Eligibility: 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 138% of FPL.

Hawaii section

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