Proposed changes to the state Department of Human Services Med-QUEST program will be valuable for people living with serious medical conditions, particularly those with HIV/AIDS, said Winic Pierce, benefits case manager for the Hawaii Island HIV/AIDS Foundation. Proposed changes to
Proposed changes to the state Department of Human Services Med-QUEST program will be valuable for people living with serious medical conditions, particularly those with HIV/AIDS, said Winic Pierce, benefits case manager for the Hawaii Island HIV/AIDS Foundation.
His clients typically face barriers to finding and keeping qualified providers to care for their needs, as well as paying for the very expensive medications, costing roughly $7,000 for three months. Too often, they also have to make difficult decisions regarding when to see a doctor or specialist because of a specific number of outpatient visits, which is sometimes restricting and can be “catastrophic” to their health, Pierce said.
He called it “significant” upon finding out Wednesday that unlimited prescription drug coverage includes HIV/AIDS medications and outpatient visits are unlimited for his clients with the new QUEST-Adult benefit package. Both helps make testing and treatment easier, he said.
Pierce was among the eight people who attended the informational briefing on the proposed changes to state’s Med-QUEST eligibility rules and benefits, expected to begin in July. No one spoke in opposition to the changes.
Med-QUEST Administrator Kenneth Fink gave a brief overview of the changes, explained the effects, and answered questions Wednesday at the West Hawaii Civic Center.
The changes, still awaiting federal approval, are intended to fill a $75 million budget hold and deal with the rising costs of providing government-funded health services. The state has estimated its spending for Medicaid benefits to increase to $787 million in fiscal year 2013, up from $549 million fiscal year 2011. Fink said Human Services has requested adjustments for the state’s fiscal biennium beginning July 1, 2011, and ending June 30, 2013, via House Bill 2012. The department wants a supplemental $8.1 million in health care payments to cover basic Medicaid services for beneficiaries.
A major proposed change is QUEST, QUEST-ACE and QUEST-Net programs will become one program — QUEST-Adult. Human Services is seeking federal approval to increase the health care benefits for those in QUEST-ACE and QUEST-Net to match those covered in QUEST, providing increased benefits to about 12,000 under-insured adults. 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, Fink 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, Fink said.
Angela Malagonz, of the West Hawaii Community Health Center, called the increase in benefits for people with QUEST-ACE and QUEST-Net “really great.” She said the proposed changes allow for better continuity of care. Malagonz claimed the cost of treatment, visits and medications often prevents her clients from moving forward in treatment or doing preventive care. She thinks the changes may lead to her clients being more responsive when it comes to their health.
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. This eligibility criteria could leave roughly 3,500 healthy adults statewide without health insurance. However, the asset eligibility for adults in QUEST-ACE will increase from $2,000 to $5,000, already the limit in QUEST-Net, Fink said.
“The changes will ultimately focus Medicaid on the state’s neediest, increase the program’s integrity and improve its efficiency,” he said. “The increased benefit coverage of unlimited outpatient visits for the remaining 12,000 in QUEST-ACE and QUEST-Net compared to loss of 12 covered visits for the 3,500 adults who will be disenrolled is expected to result in a net increase in covered utilization. The new benefit levels will also meet the needs of 98 or 99 percent of the people served by the state.”
Medicaid services for the disabled, children and pregnant women will be maintained at the current levels. Children enrolled in QUEST, as well as children and adults enrolled in QUEST Expanded Access, will not experience any changes, he added.
Human Services will provide information to those individuals who may lose their benefits about the availability of privately purchased individual health insurance plans and the availability to pay on a sliding scale for services at a federally qualified health center, such as Kohala Family Health Center in Kapaau, West Hawaii Community Health Center in Kailua-Kona, Keiki Health Center in Kealakekua, Hamakua Health Center in Honokaa, and Ka’u Family Health Center in Naalehu. Affected individuals will receive three notices and the mailings start next month. If people’s circumstances — such as becoming pregnant or having a decrease in household income — have changed, they should contact an eligibility office to review their eligibility, Fink said.
For more information, call the Hawaii Primary Care Association at 791-7822 or visit Human Services’ website at hawaii.gov/dhs.
