Hawaii

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Managed LTSS Program

In June 2012, CMS approved the state’s QUEST Expanded (QEx) program, a statewide §1115 demonstration waiver. The four programs included in QEx (QUEST; QUEST-Net; QUEST-ACE; and QExA) use capitated managed care as a delivery system unless otherwise noted. The demonstration enables the state to operate QUEST, which provides Medicaid coverage for medical, dental, and behavioral health services through competitive managed care delivery systems. The QUEST Expanded Access (QExA) component provides acute and primary care using managed care, as well as institutional and home and community-based long-term-care services through comprehensive and specialized managed care plans to individuals eligible as ABD under the Medicaid State Plan. Enrollment is mandatory regardless of need for LTSS. (Source: Medicaid.gov)
Approval Document (6/14/2012)
Fact Sheet

In May 2012, the state requested a three-year extension of the QEx §1115 demonstration program, set to expire on June 30, 2013. The state would submit a separate proposal to amend the demonstration to reflect new Affordable Care Act requirements. (Source: Hawaii State Med-QUEST Division)

In July 2012, the governor signed H.B. 2275 into law, establishing a hospital sustainability fee and hospital sustainability program fund to receive Medicaid matching funds under the QEx §1115 demonstration. The legislation required the state to charge and collect a provider fee on health care items or services provided by private hospitals. (Source:Press Release link no longer available)

In August 2013, Hawaii submitted an RFA for its QUEST Integration (QI) program, which will consolidate the Medicaid Managed Care programs Hawaii operates independently under the QUEST Medicaid umbrella into a single Medicaid managed care program serving all of Hawaii’s Medicaid population under §1115 Waiver authority. Hawaii’s current separate Medicaid managed care programs – QUEST and QExA – are served by five managed care plans. These programs include several smaller Medicaid and non-Medicaid state-funded programs. The beneficiaries of all programs will be mandatorily enrolled in the plans awarded QI contracts under this RFP. The QI program will cover all Medicaid and state-funded non-Medicaid individuals under a unified contract with the awarded health plans. The only individuals excluded from the QI program are those who are Medicare Special Savings Program Members; enrolled in the State of Hawaii Organ and Transplant Program (SHOTT); retroactively eligible only; and those eligible under non-ABD medically needy spend down. The state anticipates finalized capitation rates to be released in December 2013 and contract awards following in January 6, 2014. (Source: HMA Weekly Roundup, 8/14/2013)
Request for Proposals
QUEST Integration Procurement Information (2013)

In January 2014, the state announced awards in its RFP to integrate the QUEST and QUEST Expanded Access (QExA) Medicaid managed care programs. The state awarded contracts to the five incumbent health plans currently serving QUEST and QExA. According to the award announcement, all 5 health plans will provide QI services statewide except for the Kaiser Foundation Health Plan, which will focus on the islands of Oahu and Maui. The QI program will launch enrollment on January 1, 2015, and the health plans will start provision of services to QI members on January 1, 2015. (Source: HMA Weekly Roundup, 1/8/2014)

On July 25, 2014, Hawaii announced it is on track to implement its QUEST Integration health plan on January 1, 2015; QI will create a single managed care program for the state. (Source: State Human Services News website)
Press Release, 7/25/2014

On September 14, 2018 Hawaii submitted its revised “Quest Integration” § 1115 Waiver Extension Application. Hawaii is seeking a five-year extension of this waiver. The QUEST Integration demonstration began in October 2013 and is currently effective through December 2018. The demonstration consolidates QUEST, QUEST-Net, QUEST-ACE, and QExA into a single QUEST Integration program and also integrates the demonstration’s eligibility groups and benefits within the context of the Affordable Care Act. Hawaii’s waiver extension application includes a summary of the comments received from stakeholders during the comment period. Several comments expressed support for this demonstration as an important effort to improve care coordination. Other comments specifically supported this demonstration due to its community based health reform initiatives and value-based purchasing model. Additionally, multiple stakeholders pointed out the importance of addressing the needs of high cost/high need utilizers of care and also emphasized the need for improved real-time availability and transparency of data, especially on the part of Medicaid MCOs. (Sources: State of Reform, 10-03-2018, and Hawaii QUEST Integration §1115 Waiver Extension Application, 09-14-2018)

On October 2, 2018, AlohaCare and ‘Ohana Health Plan announced that they will cover basic adult dental care for Medicaid members in Hawaii. The two managed care providers will include this coverage beginning January 1, 2019. LIBERTY Dental Plan will manage the dental network for both health plans, and coverage will include an annual exam, fluoride treatment, a cleaning every six months, one set of bitewing x-rays per year, and either a non-emergent tooth extraction or filling. Members with dual coverage (Medicaid and Medicare) will not qualify. Hawaii has not had basic dental coverage for adult enrollees in Medicaid since 2009. (Sources: AlohaCare and ‘Ohana Health Plan Joint Press Release, 10-02-2018, and American Dental Association, 10-05-2018)

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

The state’s proposed QExA Integrated with Medicare (QExA-IM) Program was based upon leveraging the existing QExA program model to deliver integrated care to dual eligibles. The target population would have included the dual eligible portion of the existing QExA population, including children and adults with disabilities, adults with SMI, and the elderly. Individuals receiving HCBS under the state’s approved §1115 demonstration waiver would also have been included. Persons enrolled in the I/DD §1915(c) HCBS waiver program would be excluded, and specialized behavioral health services would be carved out. The state proposed a January 2014 implementation date, but later decided to withdraw its demonstration proposal and reevaluate its options. (Source: Demonstration Proposal; NSCLC Dual Eligibles website)