Hawaii Medicaid Eligibility Requirements

If you are looking to apply for Medicaid in Hawaii** then read the information below. Though we try to provide accurate information please note this is for informational purposes. We recommend you contact your Hawaii Medicaid Office to verify these eligibility requirements.

Hawaii Medicaid Overview
If you can't afford health insurance, Medicaid (Med-QUEST) provides coverage for working families with low incomes. There are various plans: QUEST, QUEST-Expanded, QUEST-ACE, and QUEST-Net. There is a QUEST enrollment cap of 125,000. Single childless adults cannot be enrolled, even if they meet all other requirements. Cap is lifted when enrollment is below 125,000 individuals on Dec. 31 of any year.

Hawaii Medicaid Eligibility
All programs: The enrollee must be a U.S. citizen or legal immigrant and Hawaii resident and not be in a public institution.

Medicaid Income Requirements In Hawaii
This information is based on the Federal Poverty Level (FPL). These income guideline standards were effective starting January 1st, 2014.
Age 0-1 308% FPL
Age 1-5 308% FPL
Age 6-18 308% FPL

Pregnant Women
191% FPL

Parents 133% FPL
Other Adults 133% FPL
Is Medicaid Expanding? Yes

Documents You May Need
Proof of Social Security Number
Proof of Citizenship
Verification of other information may be requested

Medicaid Coverage In Hawaii
All programs: 1-month waiting period for all services (except emergency and urgent care) unless under age 21.

QUEST: It covers inpatient and outpatient hospital and clinical services (including x-rays and lab exams); physician, nursing facility and home health services; prescription drugs; biological and medical supplies and equipment; vision and dental; family planning and maternity; psychiatric and psychological services; diagnostic, screening, preventive and rehabilitative services; medical transportation, respiratory and hospice care; emergency and urgent care; Early Periodic Screening, Diagnosis and Treatment (EPSDT) available for enrollees under age 21.

QUEST-ACE & QUEST-Net: It covers limited prescription drugs, medical, surgery, psychiatric and substance abuse services (cataract and heart surgeries not covered). 10 inpatient, 12 outpatient, and 6 mental health visits. ER for actual emergencies. Preventive and restorative dental care. No maternity benefits for adults ages 21 or older, unless income of pregnant woman's family is at or below 185% FPL.

QeXA: Same coverage as QUEST, plus home/community-based care, institutional services, and services of health care coordinator and primary care doctor.

**The information provided above is a general guideline when applying for Hawaii Medicaid. These guidelines can change from time to time, because of that we recommend that you contact your local Medicaid office in Hawaii to verify the latest eligibility requirments for Medicaid coverage in Hawaii.