MEDICAID

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Medicaid is a program that includes the Medicaid Fee-for-Service Program and Hawaii QUEST.  It provides health coverage to some low-income Hawaii residents and covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid.  Non-citizens who do not have immigration documents cannot enroll in Medicaid.

The Medicaid Fee-for-Service program provides coverage for residents who are over the age of 65 or are blind or disabled.  Hawaii QUEST is a managed care program that provides coverage for all other eligible persons. 

  • In Hawaii you may be eligible for Medicaid if you are an infant, a child, a pregnant woman, or a parent of a child and your family income meets the Medicaid income standards.

Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the Hawaii Department of Human Services for more information.

  • Families who get cash benefits from TANF can get Medicaid.

Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.

Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for 12 months.  Or, they may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.  (See below.)

Low income persons eligible for Medicaid in Hawaii*

Category                       Income eligibility (as percent of federal poverty level)
Child 1-18                       200% (monthly income of about $2,612 for a family of 3)
Parent (non-working)        100%
Parent (working)              100%
Pregnant woman              185%
Medically Needy
    -Individual                        51%
    -Couple                           51%

* Eligibility information was compiled from State Health Facts Online, the Kaiser Family Foundation, and may have changed since this guide was published. Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level*, use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2004:

Size of Family Unit                       Poverty Guideline (annual income)
              1                                                   $   9,310
              2                                                   $ 12,490
              3                                                   $ 15,670
-For larger families add $3,180 for each additional person
-So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $31,340, or a monthly income of $2,612.

  • Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.

  • People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you are a child, parent or a dependent child, pregnant, elderly, or disabled and have high medical expenses that, when subtracted from you income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
  • Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.

If your household income is below the poverty level and your assets are within the established limits, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance.  This is called the Qualified Medicare Beneficiary (QMB) program. 

If your household income is below 120% of the poverty level and your assets are within established limits, Medicaid will pay for your monthly Medicare premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.

Contact the Hawaii Department of Human Services for more information about other eligibility requirements.

  • There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the Hawaii Department of Human Services.


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