Medicaid FAQs – Updated
Who does Medicaid cover?
Children, pregnant women, parent and caretaker relatives, adults, including the elderly (age 65 and older), blind, and disabled individuals are covered by Medicaid.
What do I need to do to get Medicaid?
Complete and submit an application. There are three options. 1) Medicaid applications can be downloaded from the Department of Human Services (DHS) website
. To locate USPS mailing addresses and fax numbers for the Med-QUEST offices that accept applications, click here
. This same contact information is printed on the Hawaii Medicaid application. Individuals also can 2) submit an on-line application at www.mybenefits.hawaii.gov; or 3) contact the Hawaii Connector Call Center (1-877-628-5076; TTY/TDD users call 1-855-585-8604) to receive assistance over the phone. This process takes an estimated 30-40 minutes to complete.
What are the income limits for Medicaid?
The income limits are based on the federal poverty limit and the size of your family. To know for certain if you qualify, fill out an application at mybenefits.hawaii.gov. As a general guideline, in Hawai‘i to qualify fo Medicaid if there are four people in your family your income cannot be higher than $3,208. That amount changes based on the number of people in your family.
What do I need to get started?
Based on your residency status you will need some, or all, of the below documents to apply for medical assistance. Don’t worry if you don’t have everything yet, you can still start the application process. Please provide the following information for every person in your family seeking health coverage, including yourself.
Date of Birth
Social Security Number
If you and/or the person you want health coverage for is a non-citizen:
- Naturalization certificate (that includes alien number and naturalization certificate number)
- Certificate of citizenship (that includes alien number and citizenship certificate number)
- Permanent Resident Card (“Green Card,” I-551)
- Arrival/Departure Record (I-94 card, form, electronic copy)
- Refugee Travel Document (I-571)
Last year’s Federal income tax form (forms 1040 or 1040EZ) or household’s current gross monthly income.
What if I don’t have a social security number (SSN) or can’t remember my number?
Immediately, go to the nearest Social Security Administration office and apply for a new SSN or a duplicate SSN. If you are eligible for Medicaid and the only missing item on your application is a social security number, you may still be able to be covered by Medicaid.
What if I am not a permanent resident alien (non-citizen)?
If emergency services are necessary, you may be eligible for coverage of that emergent (specific) service
I arrived in Hawaii yesterday, when would my Medicaid start?
There is no required residency period. But the applicant must intend to reside in the State of Hawaii
Will the amount of money that I have in the bank be counted?
Assets (savings, checking, stocks, bonds, IRA) are not counted to determine financial eligibility for children, pregnant women, parent or caretaker relatives, or adult groups when applying for Medicaid. Assets are counted only when an individual is being evaluated for the elderly (age 65 and older), blind, or disabled programs.
Will my income be counted?
Yes. An individual’s or family’s countable income must not exceed the applicable Medicaid income standard. An income standard depends on one or more factors including age, blindness, disability, pregnancy, living arrangement, tax filing unit, and household size. Income standards are based on the Federal Poverty Levels (FPL), which is usually adjusted annually
Do I have to pay for a service?
Most medical costs are covered at no cost. If you receive medical care outside of a QUEST integrated plan (“fee-for-service”) or are receiving long-term care services, there may be some costs to you. Except for Medicaid Fee-For-Service (FFS) and long-term care (LTC), Medicaid coverage is provided at no cost to eligible individuals.
Can I get help with medical bills that I already have?
Medicaid may be able to help with outstanding medical bills that are up to ten (10) days prior to the date of application, or up to three (3) months for individuals requesting long-term care services.
How is the Affordable Care Act connected to Hawaii's Medicaid programs?
“Affordable Care Act (ACA),” “health care reform,” or even “Obamacare” – they all mean the same thing. “ACA” is a Federal law that was passed by Congress and signed into law by President Barack Obama in March 2010.
The ACA went into full effect on January 1, 2014. Some states like Hawai‘i, had permission to open Medicaid to more people starting October 1, 203. Hawaii has received special permission to apply the Medicaid eligibility laws beginning October 1, 2013.
What is the connection between Medicaid and HealthCare.gov?
Medicaid is a federal and state partnership to provide health coverage to very low-income children and adults. In Hawai‘i, it is administered by the Department of Human Services, Med-QUEST Division and is jointly financed by the State of Hawaii and the Federal Centers for Medicare and Medicaid Services.
Under a partnership between the state of Hawai‘i and the federal government, Hawai‘i residents can apply and enroll in local health plans on HealthCare.gov starting November 1, 2015. The plans must go through a local certification process for approval to be offered at HealthCare.gov. This online marketplace allows people to shop and compare plans online.
I have heard that some people have to reenroll for 2016 benefits through HealthCare.gov. I have Medicaid. Do I have to reenroll?
No. You do not have to reenroll in your Medicaid benefits and you do not need to go to HealthCare.gov. This open enrollment period does not affect you. Medicaid has an annual opportunity for you to change your plan if you choose in October. You will receive a packet in the mail telling you what to do.
Who has to reenroll for 2016 benefits?
It is very important to know that everyone who has coverage through the Connector today will have to reenroll. Hawaii Health Connector cannot transfer its clients’ identifying information to HealthCare.gov because of strict security protocols. When people reenroll, their identifies will be verified and protected. This is a one-time-only process.
Open enrollment starts on November 1, 2105. It closes on January 31, 2016.
Here are the important deadlines for enrollment:
For coverage to start January 1, 2016 enroll by December 15, 2015
For coverage to start February 1, 2016, enroll by January 15, 2016
For coverage to start March 1, 2016, enroll by January 31, 2016
To apply and enroll, people can go directly to HealthCare.gov. For local assistance with the application and enrollment process. If people want local assistance to apply and enroll they start at HawaiiHealthConnector.com so they can get an appointment with a local Kōkua (navigators) and finding a local enrollment event. Go to HawaiiHealthConnector.com to make an appointment.
I am not sure if I qualify Medicaid. Where should I start?
If you aren’t sure, you can start at MyBenefits.Hawaii.gov. If you fill out an application there but don’t qualify for QUEST Integration / Medicaid, the Department of Human Services will send your application to HealthCare.gov. Whey they receive your application, HealthCare.gov will contact you to let you know how to apply for private coverage and receive any tax credits you qualify for.
What is changing for Hawai'i Health Connector?
Hawai‘i Health Connector is in the process of shutting down and transferring its services to the state of Hawai‘i and to HealthCare.gov.
Starting November 1, 2015, people who need new health coverage can go directly to HealthCare.gov or call toll-free 1-800-318-2596 (phone lines open 24 hours a day, 7 days a week). Through January Hawai‘i Health Connector will also be available to support enrollment in HealthCare.gov through local enrollment events and with local Kōkua (navigators). Go to HawaiiHealthConnector.com to learn how to get local assistance.