Hawaii Medicaid Eligibility

This page provides general guidelines for the Hawaii Medicaid eligibility requirements. This is an assistance program that provides medical coverage for low-income people of all ages. The department that handles the Medicaid program is Hawaii Department of Human Services. The name of the state program is Med-QUEST. If you have questions or issues about the Medicaid application or the eligibility requirements, contact the Hawaii Medicaid office.


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 Requirements - Non Income

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


Documents Needed For Hawaii Medicaid Application


Hawaii Medicaid Benefits

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.


Hawaii Medicaid & CHIP Eligibility Levels

Below is the modified adjusted gross income (MAGI) eligibility levels for Hawaii Medicaid and Children's Health Insurance Program (CHIP).

Eligibility Levels - By Percentage Of Federal Poverty Level (FPL)

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
Yes
Age 0-1: 308%
Age 1-5: 308%
Age 6-18: 308%
N/A Medicaid: 191%
CHIP: N/A
133% 133%

Eligibility Levels - Individual By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
Yes
Age 0-1: $3,444
Age 1-5: $3,444
Age 6-18: $3,444
N/A Medicaid: N/A
CHIP: N/A
$1,487 $1,487

Eligibility Levels - Family Of Two By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
Yes
Age 0-1: $4,643
Age 1-5: $4,643
Age 6-18: $4,643
N/A Medicaid: $2,879
CHIP: N/A
$2,005 $2,005

Eligibility Levels - Family Of Three By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
Yes
Age 0-1: $5,842
Age 1-5: $5,842
Age 6-18: $5,842
N/A Medicaid: $3,623
CHIP: N/A
$2,523 $2,523

Eligibility Levels - Family Of Four By Monthly Income

Medicaid Expansion Medicaid Children Separate CHIP Pregnant Women Parents Other Adults
Yes
Age 0-1: $7,040
Age 1-5: $7,040
Age 6-18: $7,040
N/A Medicaid: $4,366
CHIP: N/A
$3,040 $3,040