Medicaid, SCHIP, and Federal Authority²

Section 1115 Waiver - In 1993, Hawaii received approval to expand Medicaid for the QUEST (Q uality care, ensuring U niversal access, encouraging E fficient utilization, S tabilizing costs, and T ransforming the way health care is provided to public clients) demonstration. The implementation of the QUEST section 1115 program allowed the state to use a managed care delivery system to create efficiencies in the Medicaid program to and enable the extension of coverage to individuals who would otherwise be without insurance. Since 1994, the QUEST program has expanded Medicaid to cover p regnant women up to 185 percent FPL; all children age 19 with incomes up to 200 percent FPL; and all adults with incomes at or below 100 percent FPL.

Hawaii also has a program called QUEST-Net, a medical assistance program which was developed mainly for people who no longer qualify or voluntarily requested termination of Hawaii QUEST or Medicaid Fee-For-Service. The program provides a full Medicaid benefit for children with family incomes above 200 percent but less than 300 percent FPL who were previously enrolled in either QUEST or Medicaid fee-for-service and whose income or assets rise above the eligibility limits; and non-categorical individuals with incomes at or below 100 percent of FPL who meet the Medicaid asset limits. QUEST-Net also offers a limited benefit package for adults with incomes at or below 300 percent FPL who have lost Medicaid eligibility.

The extension of Hawaii 's Section 1115 demonstration in January 2006, continues the State's current coverage, while also expanding coverage to children from 200 percent through 300 percent FPL using Title XXI funding. Hawaii will also expand coverage to adults up to 100 percent FPL, who are not otherwise eligible for coverage through the QUEST Adult Coverage Expansion (QUEST-ACE).

Other

Hawaii 's Prepaid Health Care Act (PHCA) - Hawaii 's Prepaid Health Care Act of 1974 requires 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.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

² The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

³ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.