Medicaid eligibility rules 3,500 to be cut from state health care program

Roughly 3,500 healthy adults statewide will be cut from the Department of Human Services Med-QUEST program to fill a $75 million budget hole and deal with rising costs of government-funded health services, said Patricia McManaman, Human Services director.

The cuts will affect adults under age 65 who are able to work, and are not blind, pregnant or disabled, McManaman said.

Human Services could not provide an estimate of how many of the affected are Big Island residents as of press time Tuesday. However, at February’s end, there were about 89,182 QUEST adults, ages 21 to 64, statewide. Of which, 18,983 live on the Big Island, said Kayla Rosenfeld, Human Services spokeswoman.

The income eligibility requirements for the adults in QUEST-ACE and QUEST-Net programs will decrease from 200 percent to 133 percent of the federal poverty level. The annual income limit, which allows people to participate, tightens from $51,420 to $34,194.30 for a family of four and from $25,080 to $16,678.20 for an individual. However, the asset eligibility will increase from $2,000 to $5,000 for an individual, McManaman said.

Another major change is QUEST, QUEST-ACE and QUEST-Net programs will be “aligned across the board” into one program. Members will now have access to the QUEST-Adult benefits package, which has no cost-sharing. The package includes 30 medical inpatient days, 30 behavioral inpatient days, unlimited pregnancy-related services, unlimited surgical center or outpatient hospital procedures, unlimited outpatient visits, unlimited prescription drugs and unlimited emergency room visits, she said.

The new benefits adults currently in QUEST program will notice is a limit on the number of inpatient days and that outpatient rehabilitation, optometry services or prosthetics are not included. Those now in QUEST-ACE or QUEST-Net will receive increases in the number of covered inpatient days and outpatient visits, as well as in prescription drug coverage, which will go beyond limited generic antibiotics and contraceptives, McManaman said.

Changes to the state’s Med-QUEST eligibility rules and benefits begin in July. Human Services will present an overview of the changes from 2 to 4 p.m. March 28 at the West Hawaii Civic Center’s Community Meeting Hale. Med-QUEST Administrator Kenneth Fink will conduct the informational briefing, answer questions and explain how the changes affect beneficiaries.

Human Services is holding meetings on each island because “it’s important to be transparent,” McManaman said. Besides bringing awareness, Human Services hopes those affected will begin looking at their situations, speak to their employers about the possibility of picking up their health care, even if they work less than 20 hours a week, or purchase a national health insurance program with a sliding-scale fee.

“With this knowledge, people will be able to become really self-sufficient to make the choices and decisions best for them,” she said.

Services to the state’s “most vulnerable and neediest populations” — people with disabilities, children, pregnant women, the elderly and adults receiving long-term care services — will not change. However, the benefit package for children will be called QUEST-Keiki. Also, those with a disabling diagnosis and not receiving long-term care services will have a decrease in the maximum weekly chore hours from 20 to 10, she said.

Human Services has seen a enrollment spike in Med-QUEST because of the recession starting in late 2009, which resulted in bankruptcies, layoffs and a high unemployment rate. Enrollment as of last month was 286,612 residents, which represents one in every five people in Hawaii. Of those residents, 50,583 are Big Island adults and children, McManaman said.

Enrollment in 2008 was 212,489 residents statewide, of which 42,409 were Big Island residents. A year later, enrollment statewide was 235,203, of which 47,913 were Big Island residents, she said.

For more information, call the Hawaii Primary Care Association at 791-7822 or visit Human Services’ website at hawaii.gov/dhs.