Overview
Medicaid Eligibility

Hawai'i Medicaid
 

Overview

Under the Social Security Act, Medicaid is defined as a jointly funded federal and state program that pays for the medical assistance of individuals and families with low income and resources. Medicaid covers approximately 36 million individuals nationally, including children, the aged, the blind and/or disabled, and individuals eligible for Social Security Income (SSI). Medicaid can also help pay for Medicare deductibles and other out-of-pocket costs.

Medicaid is one of two government assistance programs that provide health care benefits. The other program, Medicare, has some distinct differences from Medicaid. Refer to the Guide to Medicare to learn the differences.

Back to Top

Medicaid Eligibility

States are given broad guidelines by the Federal government concerning which groups their Medicaid programs will cover. However, there are certain groups states are required to provide Medicaid coverage for, including:

• Children under six years of age whose family income is at or below 133% of the Federal poverty level (FPL).
• Expectant mothers whose family income is below 133% of the Federal poverty level. Services to these women are limited to those related to pregnancy.
• Supplemental Security Income (SSI) recipients in most states.
• Those who receive adoption or foster care assistance under Title IV of the Social Security Act (allows temporary assistance for needy families).
• Specially protected groups (i.e., individuals who lose their cash assistance due to earnings from work or from increased Social Security benefits, but who may keep Medicaid for a period of time).
• All children born after September 30, 1983, under the age of 19, and whose family income is at or below the Federal poverty level.
• Certain Medicare beneficiaries.

Centers for Medicare and Medicaid Services (CMS), Medicaid General Information
In the publication called "Medicaid General Information" the Centers for Medicare & Medicaid Services has compiled a comprehensive overview of Medicaid. It includes its history, the scope of Medicaid services, and its relationship to Medicare.

Centers for Medicare & Medicaid Services (CMS), Medicaid Eligibility Policy
In this section of its website, CMS posts eligibility requirements by year and by state to help individuals determine if they qualify for Medicaid benefits.

Social Security Online, Supplemental Social Security Income (SSI)
Social Security Online hosts a comprehensive section on Supplemental Social Security Income (SSI). From this website, you can determine your eligibility, learn about the law, and read a more comprehensive handbook published by the Social Security Administration.

U.S. Department of Health and Human Services, Understanding Medicaid Home and Community Services
This primer, published and hosted by the U.S. Department of Health and Human Services provides a comprehensive overview of Medicaid coverage for Home and Community Services.

Medicaid Waivers
Waivers are tools used by states to obtain federal funding to provide long-term care to patients in settings other than institutions. On this site, you will find information about managed care waivers, home and community-based service waivers, and combination waivers.

Elder Law Answers
The Elder Law Answers website contains information written specifically for seniors. Visit this page for informative articles on Medicaid and Social Security benefits. Search in attorney news for all articles and resources on the site for your State.

Back to Top

Hawai'i's Medicaid Program

In 1994, Hawai'i's Medicaid program was divided into services for two separate groups. The first group consists of individuals 65 and older and the certified-blind or disabled. This group is under the Hawai'i fee-for-service Medicaid Program, where providers are paid directly for their services. Qualifying service coverage for individuals and families in this group, include:

• Inpatient and outpatient hospital and clinical services (including X-ray and laboratory examinations).
• Physician services (including osteopathic).
• Nursing facility and home health services.
• Drugs, and biological and medical supplies (including medical equipment and appliances).
• Podiatry (foot care).
• Whole blood.
• Eye examinations, refraction, and eyeglasses.
• Dental services (only emergency services are covered for individual age twenty-one and over).
• Family planning services.
• Psychiatric/psychological services.
• Diagnostic screening, and preventive and rehabilitative services.
• Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services.
• Prosthetic devices (including hearing aids).
• Transportation to, from, and between medical facilities (including inter-island or out-of-state air transportation, food, and lodging as necessary).
• Respiratory care services.
• Hospice care services.

Hawai'i's Medicaid Office
The website of the Centers for Medicare & Medicaid Services (CMS) includes a Hawai'i Medicaid Office section that lists local resources and programs.

MedQuest
The second group covered in the Hawai'i Medicaid Program consists of individuals who are considered low-income and eligible for Medicaid services. They are under the Hawai'i QUEST program, financed through the State. Visit this site for more information on the Hawai`i QUEST program.

Department of Health Hawai'i: Developmental Disabilities Division
The Department of Health Hawai'i, Developmental Disabilities Division has information on the application process for a Medicare waiver at this section of its website.

Hawai'i Executive Office on Aging: Sage PLUS
Hawai`i's State Health Insurance Counseling Program (Sage PLUS) provides information and counseling to people sixty years or older concerning their health insurance needs. This website includes contact information for the Sage PLUS program and links to Medicare and Medicaid benefits.