QUEST Integration Program

Published on
July 19, 2023
Last updated
February 29, 2024
Written by
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Katie Wilkinson
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Learn about the Hawaii QUEST Integration Program, a Medicaid-managed care initiative that ensures residents of all ages receive essential medical care, behavioral health services, and long-term services and supports.
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The Hawaii QUEST Integration Program, or the QI Program, is a Medicaid-managed care program that extends medical and behavioral health services to residents of all ages. However, its significance goes beyond standard care, as it also addresses the needs of those at risk of institutionalization. By providing long-term services and support (LTSS), the program enables individuals to receive assistance in their homes and communities, reducing the necessity for nursing home admission.

While nursing facility care is available under the program, it also prioritizes home and community-based services (HCBS) to prevent and delay the need for institutionalization. These HCBS offerings encompass a wide range of essential caregiving support, such as adult day care, home-delivered meals, personal emergency response systems, respite care, and in-home personal care assistance.

Overview of Hawaii's QUEST Integration Program

The program's primary purpose is to ensure that Medicaid beneficiaries receive the essential medical and behavioral health services they require while also providing the necessary support to prevent unnecessary institutionalization, particularly nursing home admission. To achieve this, the QI Program offers a range of home and community-based services (HCBS), which enable recipients to receive care and assistance within the comfort of their homes and communities.

The QI Program primarily targets individuals who are eligible for Medicaid and require various levels of healthcare support, particularly those at risk of institutionalization due to their health conditions or disabilities. By providing a comprehensive array of services, the program aims to improve its participants' overall health and well-being while promoting cost-effective care delivery and reducing the strain on institutional facilities.

The specific goals and objectives of the Hawaii QUEST Integration Program are:

  1. Comprehensive Healthcare: To ensure that all eligible participants receive complete medical services, behavioral health treatments, and long-term support tailored to their needs.
  2. Home and Community-Based Care: To prioritize HCBS offerings over institutionalization, allowing individuals to receive appropriate care and support in their homes and communities, thereby enhancing their overall quality of life.
  3. Preventing Institutionalization: To proactively identify and address the needs of individuals at risk of institutionalization, thereby reducing the need for costly nursing home care and fostering a more person-centered approach to healthcare.
  4. Empowering Family Caregivers: To recognize the essential role of family caregivers in the healthcare system and provide them with the necessary resources, training, and support they need to effectively care for their loved ones.
  5. Cost-Effectiveness: To promote cost-effective care delivery by focusing on preventive and community-based services, leading to better health outcomes and reduced healthcare spending.

The Hawaii QUEST Integration Program strives to create a more inclusive and person-centered healthcare system through its multifaceted approach.

Eligibility Requirements for Hawaii's QUEST Integration Program

The eligibility criteria for the Hawaii QUEST Integration Program are essential to determine whether an individual qualifies for the comprehensive Medicaid managed care initiative. The program incorporates financial and medical criteria to ensure those in need receive the necessary healthcare and support. Here are the key requirements for eligibility:

  • Income: Applicants must meet the income limit equivalent to 100% of Hawaii's Federal Poverty Level (FPL). The specific income limits vary annually, with individual applicants allowed a monthly income of up to $1,398 as of March 1, 2023. For married couples applying together, each spouse is considered individually, and both can have a monthly income of up to $1,398.
  • Assets: The program has asset limits based on marital status. For single applicants, the asset limit is $2,000 in 2023. For married couples applying together, the asset limit is $3,000. If only one spouse applies for the program, the assets of both spouses are still considered jointly owned. The applicant spouse can retain up to $2,000 in assets, while the non-applicant spouse can keep up to $148,620, known as the Community Spouse Resource Allowance (CSRA). Certain assets, such as the applicant's primary home, household furnishings, personal effects, and a vehicle, are not counted toward the asset limit.
  • Home Ownership: The home is considered exempt (non-countable) for eligibility purposes in specific circumstances:
    > The applicant lives in the home or has an Intent to Return, and the home equity interest is no greater than $1,033,000 in 2023. Equity interest refers to the portion of the home's equity value the applicant owns.
    > The applicant's spouse, a minor child, or a permanently disabled or blind adult child lives in the home.
  • Medical Criteria: An applicant must require a Nursing Facility Level of Care (NFLOC) or be "at risk" of requiring this level of care. A level of care (LOC) assessment determines if an individual meets these criteria. The evaluation considers the need for assistance with Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and cognitive deficits.
Note: A diagnosis of dementia, such as Alzheimer's disease, does not automatically guarantee meeting the level of care needed.

Qualifying for Hawaii's QUEST Integration Program is still possible even if an applicant's income and/or assets exceed Medicaid's limits. Several planning strategies exist to help individuals become eligible for Med-QUEST. Those with income over the limit but substantial medical bills can leverage the Medically Needy Spenddown program, allowing them to use "excess" income for medical expenses to meet the income limit. Spending down assets or implementing various planning strategies can be effective for individuals with assets exceeding the limit. However, engaging professional Medicaid Planners to navigate the complexities and safeguard assets while fulfilling Medicaid's financial eligibility requirements is crucial to avoid the risk of denial or delayed Medicaid benefits.


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Services and Supports

The Hawaii QUEST Integration Program offers a comprehensive range of services and supports to eligible individuals, ensuring their healthcare needs are met effectively. In addition to standard medical services like inpatient and outpatient hospital care, physician services, prescription drugs, and diagnostic services, the program extends various essential offerings, including behavioral health services, vision and hearing services, and durable medical equipment.

One of the program's significant features is providing long-term home and community-based services (HCBS). These services are crucial in supporting individuals who require a Nursing Facility Level of Care (NFLOC) or are "at risk" of needing such care. While individuals at risk of NFLOC have access to slightly reduced benefits, those requiring NFLOC receive comprehensive support.

The services and supports available under the Hawaii QUEST Integration Program include:

  • Adult Day Care / Adult Day Health Care
  • Assisted Living Services
  • Chore Services
  • Counseling / Training
  • Home-Delivered Meals
  • Home Maintenance
  • Home Modifications (for safety and accessibility)
  • Moving Assistance
  • Personal Care Services (includes companion services and homemaker services)
  • Personal Emergency Response Systems
  • Private Duty Nursing / Skilled Nursing
  • Residential Care Services (Community Care Foster Family Home (CCFFH) / Expanded Adult Residential Care Home (E-ARCH))
  • Respite Care
  • Specialized Case Management
  • Specialized Medical Equipment / Supplies
  • Transportation Assistance (non-medical)

While services and supports can be provided in assisted living residences, expanded adult residential care homes, and community care foster family homes, the cost of room and board is not covered by the QUEST Integration Program.


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Does Quest Integration Offer Compensation to Family Caregivers?

The Hawaii QUEST Integration Program does not provide direct financial compensation to family caregivers. However, other avenues of financial assistance might be indirectly available to family caregivers through certain services and supports offered by the program.

For instance, the program may cover the costs of certain services that help alleviate the financial burden on family caregivers. These services could include respite care, where temporary care is provided to the recipient, allowing the family caregiver some time off. Additionally, the program may cover expenses related to specialized medical equipment and supplies, transportation assistance, and counseling/training for caregivers to enhance their caregiving abilities and reduce out-of-pocket costs.

While the program may not offer direct payment for caregiving services, accessing these covered services can help ease some of the financial strains associated with caregiving and support family caregivers in caring for their loved ones.

A Note from Givers

While this program does not directly compensate caregivers, it is still essential to advocate for their recognition and support. If you are a family caregiver in Hawaii, find out if you are eligible for compensation through other available programs by filling out this form.

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