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Medicaid Program

Title XIX of the Social Security Act is a program that provides medical assistance for certain individuals and families with low income and resources. The program, known as Medicaid, became law in 1965 as a jointly funded cooperative venture between the Federal and State governments to assist States in the provision of adequate medical care to eligible needy persons. Medicaid is the largest program providing medical and health-related services to America's poorest people.

Med-QUEST Division (MQD)

The Med-QUEST Division (MQD) within the Department of Human Services is responsible for the overall administration of the Medicaid Program in the State of Hawaii. Specific responsibilities include the following:

  • Policies and Procedures - Establish and implement Medicaid Program policies and
    regulations to ensure compliance with State and Federal requirements.
  • Provider Approval/Termination – Maintain control of provider enrollment processes such as approve providers for participation in the Medicaid Program, maintain provider information,investigate reported violations of Medicaid policies, recommend or initiate appropriate action against offenders, and notify providers of denied applications for and participation in the Medicaid Program.
  • Recipient Eligibility – Determine eligibility policy, determines recipient eligibility, answer inquiries regarding eligibility status, and identify third party liabilities.

Medicaid Program in Hawaii

The Medicaid Program in Hawaii is separated into two different methods of providing services to qualified beneficiaries. One method of providing services is through the fee-for-service (FFS) program. Under this program, providers bill Medicaid directly to be reimbursed for services provided to Medicaid-eligible beneficiaries. The other method of providing services is through managed care health plans that are contracted by MQD. MQD has two managed care program: QUEST and QUEST Expanded Access (QExA). Information about these programs may be found on the home page on the left side of the webpage.

More detailed information can be found in the provider manual.

   
© Hawaii State Med-QUEST Division 2003-2007