Hawaii Medicaid Office

Hawaii Medicaid office (Med-QUEST Division)

Med-QUEST is the public-facing name for Hawaii Medicaid, run by the Med-QUEST Division (MQD) of the Department of Human Services (DHS). What makes Hawaii's intake network distinct is that MQD operates Eligibility Branch offices on every populated island rather than centralizing intake in a single statewide call center, and one statewide phone line — 1-800-316-8005 — and one fax — 1-800-576-5504 — route to whichever branch is closest to where the member lives.

Nine island Eligibility Branch offices

Customer Services Call Center

• Oahu direct line — (808) 524-3370.
• Neighbor Islands toll-free — 1-800-316-8005.
• TTY / TDD — 711.
• Provider enrollment — email HCSBInquiries@dhs.hawaii.gov or call 808-692-8099.

The Call Center handles address changes, income / asset / household-size reports, application status checks, worker contact lookups, health plan contact phone numbers, plan choice and enrollment, lost Medicaid ID card replacement, and out-of-state travel reports. The administrative mailing address is State of Hawaii: DHS/MQD, 1001 Kamokila Blvd, 301, Kapolei, HI 96707.

Who qualifies for Med-QUEST?

Hawaii is one of the few state Medicaid programs that runs every eligibility category through the same 1115 demonstration: QUEST Integration. The demonstration first launched on August 1, 1994 as QUEST (families and children), then ran a parallel QUEST Expanded Access (QExA) program for aged, blind, and disabled members starting in 2009; the two were combined into a single unified QUEST Integration program in January 2015. The practical consequence: when a Med-QUEST member turns 65 and transitions into Medicare, or develops a disability, they can stay in the same health plan rather than transitioning to a different MCO — a continuity feature that's unusual across state Medicaid programs.

The four-step Med-QUEST flow

Categories Med-QUEST covers

• Children under 19 — covered through Medicaid and the state's combined CHIP enrollment with income thresholds above the adult standard.
• Pregnant individuals — pregnancy coverage continues through the postpartum period.
• Parents and caretaker relatives — state family income standard.
• Adults age 19 through 64 — Medicaid expansion category (Hawaii adopted ACA expansion in 2014); MAGI-based budget at the federal standard of 138% FPL.
• Aged (65+), blind, or disabled — non-MAGI budgets with income and resource tests; this group used to sit in the separate QExA program and is now folded into QUEST Integration.
• Long-term services and supports — members who meet a nursing-facility level of care receive LTSS through their QUEST Integration MCO rather than a separate waiver.
• Going Home Plus (GHP) — distinct HCBS program MQD operates for members transitioning out of institutional care.

Med-QUEST income standards

MQD does not publish a single combined Med-QUEST income chart on the medquest.hawaii.gov consumer pages. Instead, the agency directs every applicant to the online screening tool at medical.mybenefits.hawaii.gov, which calculates eligibility based on the household's income, size, and category in real time. The percentage standards below are stable from year to year; dollar amounts shift each January when the federal poverty level updates.

FPL standards by category

Where to confirm the current dollar figures

Run the screening tool at medical.mybenefits.hawaii.gov, or call the Customer Services Call Center at 1-800-316-8005 (or (808) 524-3370 on Oahu) to ask about a category-specific budget. The Hawaii Medicaid State Plan and the QUEST Integration 1115 Demonstration documents are the source of record for the income standards MQD applies — both are published on medquest.hawaii.gov under About → Hawaii Medicaid State Plan.

How to apply for Med-QUEST

Med-QUEST accepts applications through online, phone, mail, and fax channels — and uses a single combined application (DHS 1100) for Medicaid health coverage plus help paying costs. Most people apply online through the state's medical eligibility portal, which the agency promotes as the fastest channel.

Three official ways to apply

• Apply online (fastest) — medical.mybenefits.hawaii.gov. The portal is the same one MQD links from "Are You Eligible?" on its Get Started page.
• Apply by phone — call Med-QUEST Customer Service at 1-800-316-8005 (toll-free). TTY users call 1-855-889-4325 or 711.
• Apply on paper — complete the DHS 1100 "Application for Health Coverage and Help Paying Costs", then mail or fax to the Eligibility Branch office on your island (see office section above).

Supplemental paper forms MQD requires for some applicants

• Applicants who need Long Term Care Services — DHS 1100, DHS 1100B, DHS 1167, DHS 1169, DHS 1169A, DHS 8003, and DHS 8004.
• Applicants with a disability — DHS 1100, DHS 1100B, DHS 1127, and DHS 1128.

Federal decision deadlines

Federal rules give MQD up to 45 days to decide a non-disability application, and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window.

Two unusual continuity rules to know

• Newborn auto-enrollment — if you're pregnant and enrolled in a QUEST Integration health plan on the date you deliver, your newborn is automatically enrolled in your health plan for at least 30 days. MQD then mails an enrollment packet and lets you change the newborn's plan after the first 30 days.
• Six-month plan lookback — if your Medicaid eligibility ends and you reapply within six months, MQD will assign you back to your former QUEST Integration health plan. After six months, you pick fresh.

What Med-QUEST covers

Most Med-QUEST members receive care through one of five QUEST Integration managed care organizations under capitation contracts with MQD. Hawaii bundles physical health, behavioral health, pharmacy, and long-term services and supports into the same MCO contract — a single-plan model that's less common than carve-outs. A smaller share of members stay in fee-for-service Medicaid where the state pays providers directly.

The five QUEST Integration health plans

All five plans cover the same core Medicaid benefits but maintain different provider networks. The Decision Booklet that ships with the enrollment choice packet is the most direct comparison tool — pick a plan that includes your existing primary care provider in network before enrolling.

Core Medicaid benefits in QUEST Integration

• Doctor visits, specialist care, urgent care, and emergency services
• Hospital inpatient and outpatient care, including surgery
• Prescription drugs through the plan pharmacy benefit
• Lab work, X-rays, and diagnostic imaging
• Pregnancy care: prenatal, delivery, postpartum, and continued postpartum coverage
• Behavioral health: outpatient counseling, crisis services, inpatient psychiatric care, and substance use disorder treatment
• Family planning and reproductive health services
• Non-emergency medical transportation to covered appointments — important across the inter-island delivery network
• Long-term services and supports under the same plan, both nursing facility and home and community-based

EPSDT for members under 21

Members under 21 receive Early and Periodic Screening, Diagnostic, and Treatment benefits, the federal mandate that covers any medically necessary preventive, dental, vision, hearing, or behavioral health service for a child — broader than what adult Medicaid covers.

Going Home Plus (GHP)

GHP is MQD's transition program for Medicaid members moving out of institutional settings into community-based care. It has its own eligibility requirements (separate from QUEST Integration MCO enrollment) and supports relocation and the wraparound services that make community placement work.

Other state Medicaid pages