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Medicaid, SCHIP, & Federal Authority

  • Section 1115 Waiver – Hawaii’s QUEST Expanded (Quality care, ensuring Universal access, encouraging Efficient utilization, Stabilizing costs, and Transforming the way health care is provided to public clients) demonstration was originally approved by the Centers for Medicare & Medicaid Services (CMS) in 1993. Since that time, Hawaii has continued to enhance this coverage initiative to include additional populations and benefits. Under this section 1115 waiver program, the state uses a managed care delivery system to create efficiencies in the Medicaid program while extending coverage to individuals who would not otherwise be covered. Since 1994, the QUEST program has expanded coverage to pregnant women with incomes up to 185 percent of the federal poverty level (FPL); all children ages 0-19 with incomes up to 300 percent of the FPL; and adults with incomes at or below 100 percent of the FPL. This demonstration program works in partnership with the Hawaii Prepaid Health Care Act program (see below) in an unprecedented State public/private partnership that directly impacts the rate of uninsurance in the State.

    Under the QUEST Expanded demonstration, Hawaii has implemented three programs: QUEST, QUEST-Net and QUEST Adult Coverage Expansion (QUEST-ACE). QUEST is primarily for pregnant women, children with family incomes under 200 percent of the FPL, and adults under 100 percent of the FPL. QUEST-Net covers children and qualified adults up to 300 percent of the FPL. And, QUEST-ACE provides benefits for childless adults up to 100 percent of the FPL who are otherwise not eligible for coverage. Under the Quest Expanded section 1115 program, Hawaii provides a full Medicaid benefit for all QUEST enrollees and children with family incomes less than 300 percent of the FPL. Adults in QUEST-Net and QUEST ACE receive a more limited benefit package.

State Specific Strategies

  • Hawaii's Prepaid Health Care Act (PHCA) - Hawaii's Prepaid Health Care Act of 1974requires nearly all employers to provide health insurance to their employees who worked 20 hours or more a week for four consecutive weeks. Employees must maintain the minimum of at least 20 hours a week to remain eligible.   Hawaii was the first state to implement an employer mandate and has one of highest rates of individuals covered under employer-sponsored insurance.   Starting in 2004, the Hawaii Department of Labor and Industrial Relations has conducted random audits of employers to assure compliance with PHCA.