We want eligible people to continue their public health insurance benefits and you can help by keeping Med-QUEST’s records up-to-date! Review the questions on "Med-QUEST Change Report Form for Community Organizations" with your customer and if there are changes please mail, fax, or bring the form to a local Med-QUEST office listed on page 4. You can download a copy of the form by clicking here: Change Report Form "Enrolling Children and Youth in QUEST and Medicaid” Questions and Answers from Statewide Community Training Workshops This updated version was published on 17 March 2008. If you want a hard copy, click here to download the PDF file: Med-QUEST Information from Workshops. We will write updates on this page when they are available. * If a nonpregnant adult in the household wants health insurance, use form 1100. * The adult listed in Question 1 must also be listed in Question 3A. * A complete mailing address is required. * Answer ALL questions. Do not write N/A--check YES or NO and write information if the answer is YES. * Print clearly. * Use full legal names. * Mail or fax the application pages only. Do not send pages with this footnote: “You May Tear Off and Keep.” The applicant should keep these pages. * Please remind every customer that she/he must report ALL household changes to Med-QUEST, including a new address and telephone number. * Do NOT send a duplicate application unless a Med-QUEST eligibility worker or supervisor requests it. Notes * 1108 refers to the application “For Children and Pregnant Women Only” and 1100 refers to the regular application. * Med-QUEST accepts self-declaration for social security number, birth date, income, and assets. Documents will only be requested if the application has questionable information. * “Five-days retroactive” means QUEST health insurance starts the date Med-QUEST receives the application for eligible household members and payment will be considered for appropriate emergency room or hospital expenses that occurred within the previous five calendar days. 1. Public Health Insurance Programs What is the difference between QUEST and Medicaid? Medicaid Fee-for-Service (Medicaid) is generally for people who are certified blind or disabled and/or over sixty-five years old. Health care providers are paid directly for their services. QUEST is for those under sixty-five years old, not certified blind or disabled, and not in a public institution. It uses managed care plans--currently AlohaCare, HMSA, Kaiser, and Summerlin. 2. Faxed Applications a. If an application is faxed, should an original application be mailed to Med-QUEST? No. Do not mail the original application. A faxed application with a signature is a formal application and Med-QUEST does not require the original signed application. b. How do I know that Med-QUEST received my faxed application? Your fax machine’s receipt with the date and number of pages is your proof. Helpful hints for faxing applications: * Fax only 1 copy. Faxing forms more than once costs money for ink and paper, extra staff time, and is confusing. * Use normal quality. Fine quality causes backups and jamming at the Med-QUEST office. * Put an identifier on each page to avoid loss or misdirection. Each page must be connected to the application and person for proper routing and correct eligibility determination. * Do not fax pages with this footnote: “You May Tear Off and Keep.” The applicant should keep these pages. * Do not send a cover sheet. 3. Residency a. How long must a person live in Hawaii to be eligible? Residency is defined as living in Hawaii with the intent to stay indefinitely. There is no specified time. b. How long can a person be out-of-state and continue receiving health insurance benefits? Within ninety days of the date of departure, Med-QUEST will re-evaluate the individual’s intent to return to Hawaii. Med-QUEST must be informed of any out-of-state visit prior to the date of departure, date she/he intends to return to Hawaii, and if the return date is extended beyond the date initially reported. Questions for the customer: Did you inform Med-QUEST about the temporary absence (e.g., visiting hospitalized or dying relative, attending graduation, going on vacation, etc.) and the dates? Are there extenuating circumstances to extend the absence (e.g., relative's hospitalization continued, couldn’t return due to airline scheduling, etc.)? c. If a student returns to Hawaii during school breaks, is she/he eligible for QUEST or Medicaid? If the student is a Hawaii resident with the intent to remain indefinitely, she/he may be eligible. However, if the student plans to return to another state or country after the break, she/he would not meet the residency requirement. Note: If the student is under 21 years old, it is important to find out if she/he is claimed as a tax dependent because the parents’ or legal guardians’ income may be used to determine eligibility. 4. Foreign Students, Asylees, Immigrants, and Undocumented Aliens a. Are students with F1 or F2 visas and their children eligible? No. A parent who enters the United States temporarily to attend school as a student with no intention of abandoning residence in a foreign country is excluded from receiving health insurance. Residency for the newborn is correctly questioned. Med-QUEST assumes she/he is a United States citizen because the birth occurred in the United States. As an individual who is incapable of indicating intent, the residency of her/his parent would be considered that of the child. Therefore, if the parent has no intent of abandoning residence in a foreign country, the child would not meet the residency requirement although she/he may meet the citizenship requirement. b. Are asylees or immigrants with V, K, or J visas eligible? The person must be a lawful permanent resident (have a “green card”). c. What immigration documents should be attached to the application? For each household member who is requesting health insurance, a copy of her/his permanent resident card (INS Form I-551/Green Card) should be attached. Recent arrivals should attach a copy of the temporary I-551 stamp in a foreign passport or on Form I-94. d. Is an undocumented alien required to apply for a social security number? No. If she/he is applying for emergency medical services as an illegal alien, she/he is not required to apply for a social security number. e. When can undocumented aliens qualify for health insurance? The Med-QUEST application must be submitted AFTER the health care services have been completed and the residency requirement must be met. Services can include labor and delivery for pregnant women, medical emergencies, and hospitalization as determined by Med-QUEST’s physicians. As much documentation as possible--admission and discharge summary, physician’s progress notes, etc.--should be provided to determine the customer’s emergent condition. f. If an undocumented alien applies for QUEST or Medicaid for a child, will she/he be deported? No. There is no system link or automatic dialogue between Med-QUEST and the U. S. Citizenship and Immigration Services. Their computers do not communicate with each other. 5. Income a. Whose income is counted for a pregnant teen who is under nineteen years old? If the teen is living with the parents and/or is their tax dependent, the parents’ income is counted to determine a pregnant teen’s eligibility. If the teen is living outside her parents’ home and not declared as a tax dependent, the teen’s income is counted. b. When a pregnant teen gives birth and applies for her newborn, what income is counted to determine the child’s eligibility? The teen mother’s income is counted. The baby’s father’s income is also counted if he is living in the same household as the baby. Note: Since grandparents are not legally responsible for their grandchildren, Med-QUEST does not count the teenager’s parents’ income to determine the baby’s eligibility. c. If a grandparent applies for a grandchild living in her/his home, what income should be listed on the application? Only list the child’s income. If the child has no income, check Question 4A and explain the child is living with the grandparent. Note: This answer also pertains to other adult relatives (e.g., auntie, uncle, cousin, etc.) or adults with a hänai child. d. A 16-year-old teen applied for QUEST benefits under her name only for her baby. They are both living with the 16-year-old’s mother. Since the 16-year-old's mother provides shelter and food for them, she wants to claim the 16-year-old as a dependent on her income tax forms. Will this affect the baby's eligibility due to income? No. The 16-year-old's mother is not legally responsible for the baby. If she claims the 16 year old as a dependent, it will not affect the baby's eligibility. e. If a child is living with her/his mother or father and stepparent and they only want health insurance for the child, whose income is counted? The income of parents--natural, legal, and adoptive--is considered available to their children in families that include children under nineteen years old. Generally, if the child resides with the mother/father and is not adopted by the stepparent, only the mother's/father’s income is counted. f. A fourteen-year-old is living with his eighteen-year-old sister. The parents are deceased and the eighteen-year-old has legal guardianship of her sibling. What income is counted? The eighteen-year old should sign the application, however Med-QUEST will not count her income for the fourteen-year-old unless he is adopted. Therefore only the fourteen-year-old’s income, such as social security income, will count. g. If Question 4A on an application is completed in detail and information is provided on how the household members pay for food, rent, clothes, and other living costs, must a “Statement of Support by Recipient” form also be completed? No. h. If a person works for cash, is an oral statement on gross monthly amount okay? Yes. i. If a person works for cash, can the boss sign a proof of income statement that she/he pays this person? Med-QUEST accepts self-declaration of income. However, if the customer wants to include documentation, the note can be informal but must identify that it is the boss. j. If a person works odd jobs for cash and/or gets money from family members, where should the information be written? The person should list this information in 4B under “Other Income.” Write the name of the person receiving the income and gross monthly amount. k. If there is involuntary separation of a household member (e.g., military, college, temporary job transfer, etc.), will Med-QUEST count her/his income? The customer should contact the Med-QUEST eligibility worker to explain details about the household member’s absence to determine if information about the separated household member should be included. l. Does Med-QUEST accept a person’s IRS Form W-2 (Wage and Tax Statement) to determine income eligibility? No. However, Med-QUEST can average income for the previous three months. 6. Pregnant Women a. Does a pregnant woman qualify at a higher income limit? Yes. She can qualify at 185% FPL if pregnancy is self-declared on the application. However, if she applies the day after giving birth, she must qualify as a nonpregnant adult. b. How long does it take for a pregnant woman’s application to be approved or denied? Med-QUEST processes a complete pregnant woman application within five business days. The five-day clock starts the date Med-QUEST receives the complete application via facsimile, mail, or electronic upload regardless of the time it arrived. The five-day clock stops the date a determination is made (approval or denial) and a Med-QUEST eligibility worker enters the information in the Hawai‘i Automated Welfare Information (HAWI) computer system. If information on the application is incomplete or questionable, it can take longer for Med-QUEST to approve or deny it. Med-QUEST will mail a ten-day pending notice requesting information and the five-day clock will start when it receives the essential facts. If Med-QUEST does not get the requested information within thirty days from the date it received the application, it will be denied. Note: If a pregnant woman visits a Med-QUEST office, eligibility determination may be made the same day. c. Which application form should be completed if a woman who gave birth would like QUEST or Medicaid to cover her labor and delivery expenses? If Med-QUEST receives the application or the outstationed eligibility worker’s interview date is on the same date the woman gives birth, use 1108. Income eligibility will be 185% and asset information is not required. However, if the application or interview date is after the baby’s birth date, use 1100 because assets are counted and the income limit will be for a nonpregnant adult. d. Are all pregnant immigrants who have been in the United States less than five years eligible? No. The woman must be a lawful permanent resident (have a “green card”). e. If a pregnant ineligible alien is admitted to a hospital but doesn't want to sign papers, must she submit a Med-QUEST application? Yes. She must send a completed application along with the hospital summary to find out if Med-QUEST can assist her. The Med-QUEST office can’t help her without an application. f. When should a pregnant teen covered by her parent’s health insurance apply for health insurance for her baby? When the baby is born. Make sure she applies within five calendar days of delivery (“five-days retroactive”) so the baby can be covered from the birth date. g. Should a pregnant woman complete form 1149 (Request for Emergency Processing of a Medical Application)? Only if there is a medical emergency. h. Is a pregnant woman required to report the child’s father if he lives in the home? No. However, it could be advantageous to the applicant if the child’s father is listed on the application depending on household size and income. Note: Information on a child’s father living in the home is needed after the baby is born if the woman and/or child want health insurance. i. If a pregnant teenager is listed on her mother’s case, what form should an outstationed eligibility worker complete to enroll the baby? If the baby’s father is not living in the home, the outstationed eligibility worker should send an add-on form--along with a picture or 8000K--for the baby. 7. Newborns a. If a mother is enrolled in a private plan, is the newborn temporarily covered by her plan? Yes. During the first thirty days of the baby’s life, she/he is covered by the mother’s private health insurance plan. However, after the baby is discharged from a hospital, the mother’s private plan only covers well-child checkups during this period, not emergency or other health care services. b. Can a customer call her/his worker with notification of the baby’s birth? A newborn whose mother is a QUEST or Medicaid recipient at the time of birth does not need an application. The facility or customer can call the mother's eligibility worker to add the baby. Another option is to fax a copy of the hospital record or add-on form—with a photo or 8000K attached—along with details of the mother's social security number and birth date or Medicaid ID number. The newborn will be covered either by Medicaid until enrolled in a health plan or enrolled in the mother's health plan effective the date of birth regardless of when it is reported. A copy of the birth certificate is required as soon as it is available. Note: An application is required for the baby if the newborn's mother is not a QUEST or Medicaid recipient at the time of birth. c. What happens if an application is submitted for an uninsured newborn after “five-days retroactive?” Generally, if Med-QUEST receives an application within five calendar days, the baby’s expenses could be covered if childbirth took place in an emergency room or hospital. However, if an initial application is received more than five days after delivery, birth expenses will not be covered. Note: The exception is a child who is blind and/or disabled and eligible for Medicaid. In this situation, the retroactive period is three months. d. What is required if a social security number has not been assigned? When someone applies for a social security number, the Social Security Administration issues a letter stating the applicant will receive a card within two weeks of the letter’s date. A copy of this document should be attached to the application or sent to the Med-QUEST eligibility worker. 8. Children a. A pregnant teen is living with her parents and currently covered by their health insurance. After she gives birth, who should apply to enroll her baby in QUEST or Medicaid? The teen is legally responsible for her child, therefore she should apply for the baby and be listed in Questions 1 and 3A. The household members listed in Question 3 are the teen and baby (and the baby's father if he is living in the home). However, if the teen is unfit to care for her baby, an adult who becomes responsible for the child should apply. b. If a single mother is applying for health insurance only for her children, are asset verifications required? No. Asset information is not required for children. Use 1108 that does not include the question on assets. c. Can a child apply for herself/himself if homeless, living alone, or living with friends? If a child is not living with her/his parents or under the care of a specified relative, the child may apply for herself/himself. Note: Med-QUEST does not require a legal emancipation document. d. What happens if a child is placed in a treatment facility and her/his QUEST health insurance is currently through the parents? The QUEST health plan should be notified about the child’s placement. The child’s new situation should also be reported to the Med-QUEST eligibility worker because it may affect the child’s eligibility. e. What happens if a child currently receiving health insurance under her/his parents is placed in Hawaii Youth Correctional Facility (HYCF)? If the child is placed in HYCF due to a statutory offense (e.g., curfew violation, skipping school, etc.), the child is not considered an inmate of a public institution and is under the jurisdiction of her/his parents. Therefore, she/he would continue receiving health insurance under the parents’ plan. If the child is placed in HYCF due to a criminal offense (e.g., robbery, theft, etc.), the child is considered an inmate of a public institution under court jurisdiction and the institution must apply for the child. f. Is the Hawaii State Department of Health (DOH) required to complete an application if a child is receiving mental health services under DOH? A child’s parent must apply for health insurance for the child if the child is residing with her/him. g. If a child has medical insurance but not dental or vision coverage, can Med-QUEST help? If household income is at the regular Medicaid level (not the expansion level), the child might qualify with third party liability coverage. It is recommended the parent or guardian complete an application and send it to Med-QUEST to determine this eligibility. h. A father is required to provide health insurance for his child but does not. If the child is living with the mother only (father is not in the home), can the mother apply for QUEST or Medicaid benefits for the child? Yes. i. What happens when a child turns nineteen years old? There is an alert in the Hawai‘i Automated Welfare Information (HAWI) computer system and the eligibility worker sends an adult application (1100) for the customer to complete. A separate case will be opened for the nineteen-year-old person who must now qualify at a new income level and her/his assets will be counted. j. A mother is pregnant and has a two-year-old child. She is only applying for health insurance for her two-year-old. Is the unborn child counted in the household size? No. The unborn child is only counted in household size if the pregnant woman wants health insurance. k. A child lives with a parent and adult guardian (e.g., grandparent, adult family member, friend, etc.). The parent is involved with drug abuse, wandering about, and not responsibly caring for the child, therefore the guardian takes care of the child. Can the guardian apply for the child? If the child’s parent is living in the home with the child and the guardian hasn't formally adopted the child, the parent is still responsible for the child and must apply on his/her behalf. Med-QUEST would count the parent's income to determine eligibility. If the parent doesn't actually live with the child (e.g., drops in now and then) and the guardian is responsible for the child, the guardian can apply on behalf of the child. If the parent stays overnight at the residence only periodically during each month, the guardian should apply for the child using form 1108. The guardian must list her/himself in Questions 1 and 3A and explain the relationship under “Other” (e.g., grandparent, aunt, uncle, friend, etc.). Write the child's information in 3B. Write the parent's information in Question 3C, but indicate she/he does not want medical assistance. The parent's income will be used to determine the child's eligibility, therefore if the parent is employed explain the details in Question 4B. Otherwise check the box for Question 4A and explain how basic living costs are provided (e.g., child and child's parent live with the guardian who provides basic needs). It is helpful for Med-QUEST to explain the family situation by writing information at the top of page 2. For example: Grandparent is the child's guardian because the parent does not have a residence and is seldom at this home, therefore the grandparent is applying for the child. If the parent only drops by the residence from time to time but does not stay overnight, the guardian should apply for the child using form 1108. The guardian should list her/himself in Questions 1 and 3A. Write the child's information in 3B. Only the child's income will be used to determine her/his eligibility, so if the child has no income check the box for Question 4A and write: Child living with guardian and child has no income. 9. Application Signature and Applicant Representative a. Who should sign the application? An applicant who is capable of acting on her or his own behalf must sign the application for it to be a complete application. This ensures the applicant is assigning her or his rights to third party payments, the information provided is true under penalty of perjury, and the applicant understands her or his rights and responsibilities. If the applicant is incapable of acting on her or his own behalf or is deceased, someone else can submit an application. In this situation, documentation such as a statement from the applicant's physician explaining the applicant's inability to act on her or his own behalf or power of attorney must be attached. A written statement from a hospital, nursing home, or mortuary can be used to verify an applicant's death. b. Who should sign “Certification by Person Assisting the Applicant in Completing This Application” on the last page? The person who signs will be recorded by Med-QUEST as the customer’s authorized representative (AR). The AR can receive or give information on eligibility. c. When is it necessary to complete form 1123 (Authorization to Disclose Confidential Information by Med-QUEST Division)? If the customer completes 1123, it authorizes another person to receive information about eligibility as well as HIPAA-protected information (e.g., health plan, health matters, etc.). This person will be listed as the Medical Representative (Med Rep) in Med-QUEST’s computer system (HAWI). d. Who should we contact if there is a question about a customer’s health plan? Call Med-QUEST’s Customer Service Section at 524-3370 on Oahu or 1-800-316-8005 from the Neighbor Islands. Health care providers, including community health centers and hospitals, who are “covered entities” (e.g., submit reimbursement claims or process billing for patients), must give a provider identification number to discuss the customer's case. Other people or organizations must be listed as the customer’s Medical Representative (Med Rep) in Med-QUEST’s computer system (HAWI) to discuss these details. 10. Emergency Medical Services a. What is considered a medical emergency? The condition places the person’s health in jeopardy and could result in serious impairment to body functions or serious dysfunction of any body organ or part. b. If there is an emergency, whom do we call to track down a submitted form 1149 (Request for Emergency Processing of a Medical Application)? Call the supervisor first. If there is no action, call the eligibility branch administrator. c. Will all medical expenses be paid if form 1149 and a Med-QUEST application are completed? Form 1149 expedites the application process due to a medical emergency. It does not guarantee payment for services. d. If a physician signs form 1149 and the Med-QUEST application is approved, how can the customer's prescription be filled? After a Med-QUEST application is approved, it takes approximately three days for pharmacy computer systems to have the updated information. In the meantime, a customer can call the Med-QUEST eligibility worker and request a coupon. The customer (or authorized representative if form 1123 is completed) can pick it up at the Med-QUEST office. Alternatively, the eligibility worker can fax the coupon to a pharmacy and then mail it to them. If the pharmacy will accept faxed coupons, write the pharmacy's name, pharmacy’s fax number, and date the prescription will be filled on form 1149. e. Are coupons used for regular emergencies? No. Generally, Med-QUEST only uses coupons for pharmacy emergencies when information is not in the pharmacist’s computer system for several days and for payment of emergency services for undocumented aliens. Coupons are no longer a guarantee of payment and bills will not be paid if information is not in Med-QUEST’s computer system (HAWI). If a coupon is required and the eligibility worker does not provide one, contact the Med-QUEST supervisor or if she/he is unavailable contact the eligibility branch administrator. 11. Household Relationships a. What if a boyfriend and his girlfriend apply together? If there is a common child requesting health insurance, Med-QUEST processes the case as a family. If only adults want health insurance, they can be one case or two separate cases depending what is more advantageous to them. b. For common-law relationships, how long must the couple be together? Hawaii does not recognize common-law marriages. However, if the couple presents themselves in the community as husband and wife or if they have a common child, Med-QUEST considers them a common-law couple. c. If grandparents are applying for grandchildren, is legal guardianship required? No. 12. Renewal a. If a customer already reported a change, is she/he required to write it on the renewal form (e.g., income, address, telephone number, addition or removal from the household, etc.)? Yes. If the reported change does not appear on the prepopulated form, the customer must write it. b. Is there a time limit for completing and returning a renewal form? There is a due date, however the last business day of the month the form is due is the last day the form can be submitted. c. Are there exceptions for a late renewal (e.g., not receiving mail)? Does Med-QUEST call customers to follow-up on renewals? It is the customer’s responsibility to complete the renewal form. Timely and adequate notice is sent the month before health insurance is stopped, so she/he is informed the case will close. It is also the customer’s responsibility to report address changes. Currently, there are no follow-up telephone calls to the customer for non-receipt of the renewal form. However, the eligibility worker may contact the customer regarding questions or clarification on the completed renewal form. 13. Language Access If a customer doesn’t speak English, will an interpreter be provided? Yes. The applicant can request an interpreter on the “Bilingual and Sign Interpreter Services” page. It is also helpful to write the applicant’s best language in Question 1 to facilitate communication. If a non-English speaking person visits a Med-QUEST office or calls on the telephone, Med-QUEST has procedures to use a Med-QUEST bilingual employee, Hawaii State Department of Human Services volunteer interpreter, or Tele-Interpreters. 14. Foster Care a. Can the plastic Med-QUEST and health plan cards go to the foster family instead of the foster care unit? When a child is removed from her/his home, she/he usually goes to an emergency shelter until a long-term placement is found. The cards will be mailed to the social worker’s unit unless the Med-QUEST eligibility worker is instructed differently. b. What if a child currently receiving health insurance under his/her parents is placed in foster care? Child Welfare Services must apply for the child because the state has custody. c. If a child under 18 years old in foster care is pregnant, who is notified? The Child Welfare Services’ social worker should notify the Med-QUEST eligibility worker. However, if Med-QUEST is notified through another source (customer, health plan, etc.), the eligibility worker will notify the Child Welfare Services’ social worker. 15. Assets a. Does Med-QUEST count the values of a family’s home and car? The applicant’s residence is exempt. Med-QUEST does not count cars owned by the applicants. b. Why are burial plans and burial plots listed as assets? The information is used if there is a request for funeral services. Note: One burial space (e.g., plot, vault, niche, etc.) is exempt per family member if it is intended for the Med-QUEST customer or the applicant’s immediate family member. A limited value of bona fide funeral or burial plans or agreements is also exempt. c. Should information about a customer's motor vehicle insurance be listed on the application? Motor vehicle insurance details are only required if there was an accident involving a motor vehicle. Therefore, motor vehicle insurance or no-fault information should be listed only if a household member who wants health insurance sustained an accident-related injury involving a motor vehicle as indicated in question 8E on 1100 or 5D on 1108: “Does anyone have medical problems due to an accident?” 16. Self-Employed These self-employment forms are available in typable PDF at Library of Forms: * 1273C Report of Self-Employment Earnings * SEBEXP Itemized Record of Self-Employment Business Expenses * SEBINC Itemized Record of Self-Employment Business Income a. Who is considered self-employed? Self-employment is performing services or selling goods by an individual or group who legally decide what must be done and how it is done. The person or group is not subject to the will and control of an employer. b. If people work odd jobs for cash, are they considered self-employed? Yes. However, if the household wants business expenses deducted from gross income, copies of expense receipts and verification of general excise tax (GET) license are required. c. Are all household members required to pay 50% premium share if someone is self-employed? No. Only the self-employed adult and/or spouse must pay 50% of the premium if the household income is at or below 100% of the federal poverty level. Exceptions are pregnant women, families with children in the 1931 eligibility group, and general assistance (GA) financial assistance recipients. Note: more details are in Hawai‘i Administrative Rules section 17-1726. d. How is self-employment income determined when it fluctuates? Med-QUEST uses a three-month average of self-employment income. The applicant should complete a copy of 1273C for each month. Note: If the household wants business expenses deducted from gross income, copies of expense receipts and verification of general excise tax (GET) license are needed. Also, to deduct home business space a copy of the most recent tax return must be attached. e. If a person owns a company that is a corporation, is she/he considered self-employed? No. The person is considered an employee of the corporation. Her/his salary should be listed as income. Also, if the adult wants health insurance, the number of shares owned and current price must be listed as an asset under "Stocks and Bonds." 17. Citizenship, Alien Status, and Photo Identification Requirements a. What documents must be submitted with a Med-QUEST application? The federal government requires one copy of a citizenship or alien status document and one copy of photo identification for each person who wants health insurance. Photo Identification: A copy of ONE ITEM ONLY: * Driver License or Permit with Photo * Employee Photo Identification * School Photo Identification * Bus Pass with Photo * State Identification Card with Photo * Permanent Resident Card * Bank Card with Photo * Store Card with Photo * Other Official Photo Identification * Affidavit (Children Under 16 Years Old Only) United States Citizen: A copy of ONE ITEM ONLY: * Certified U.S. Birth Certificate * Current Hawai‘i State Identification Card * U.S. Passport * Certificate of Naturalization (N-550 or N-570) * Certificate of U.S. Citizenship (N-560 or N-561) * Certificate or Report of Birth Abroad (DS-1350, FS-240, or FS-545) * Northern Mariana Identification Card (I-873) * American Indian KIC Card (I-872) * U.S. Military Record (DD-214) * U.S. Final Adoption Decree * U.S. Civil Service Employment Before June 1, 1976 * U.S. Citizen ID Card (I-179 or I-197) Alien: A copy of ONE ITEM ONLY: * Permanent Resident Card (I-551) * Arrival/Departure Record (I-94) * Recent Arrivals Only: Foreign Passport or I-94 with I-551 Stamp * Employment Authorization Card (I-688B) * Refugee Travel Document (I-571) * U.S. Veteran Discharge Papers (DD-214) * Active Duty Orders b. What if a birth certificate is lost? If someone who needs medical assistance must get a new birth certificate, attach a copy of the birth certificate paper application or electronic confirmation and money order. The Med-QUEST eligibility worker will wait 45 days from the date Med-QUEST received the application to determine eligibility. When the birth certificate arrives in the mail, immediately send a copy to Med-QUEST or the person will be denied. c. If someone from the Federated States of Micronesia, Marshall Islands, or Republic of Palau loses her or his I-94 record, can her or his current Hawai‘i State Identification Card verify Compact of Free Association (CFA) status? Yes. d. A photo identification affidavit can be used in place of photo identification for children under sixteen years old. Where can I get a copy of it (Form 8000K)? It can be downloaded from the Library of Forms section at www.coveringkids.com. e. Should the photo identification affidavit for children under sixteen years old (Form 8000K) be notarized or have an organization witness it? No. f. What photos are acceptable? Applicants can send a copy of any photo with an organization’s name on it. They can also send a copy of a photo that an organization or health care provider (community health center, school, child care center, WIC, Head Start, pediatrician, nurse, hospital, etc.) confirms by signing and clearly writing the organization’s or health care provider’s name, address, and telephone number. g. If an organization’s representative or health care provider photocopies the photo identification and the photo appears black, fuzzy, or blank, what should she/he do? The organization’s representative or health care provider should write on the photo identification copy, “I viewed original photo.” h. Are household members obligated to be with the applicant for pictures to be confirmed? No. It is NOT necessary for household members to be present to confirm their photos. i. Are expired photo identifications acceptable as photo identifications? Yes. j. Is there a time limit for photos? No. A copy of any photo regardless of age is okay. k. If someone submits U.S. citizenship, alien status, or photo identification documents with conflicting names or other legal details, must she/he also attach proof the information changed? Yes. The person must submit a copy of the marriage certificate, adoption certificate, revised birth certificate, court document, or other proof so Med-QUEST can confirm citizenship. 18. Benefit, Employment, and Support Services Division (BESSD) a. If customers apply for both BESSD programs and health insurance, where are the forms sent? BESSD’s application for financial assistance and food stamps (1240) has a Med-QUEST application (1100) attached to it. * Separate the 1100 Med-QUEST application from the 1240 packet. * If customers are already enrolled in a Med-QUEST program or do not want health insurance: Do NOT complete or send 1100 (or 1108). Complete only 1240 and send it to the local BESSD office. * If customers need health insurance: Complete 1100 (or 1108) and send it to the local Med-QUEST office for processing. Send the completed 1240 to the local BESSD office. b. If a health insurance application is submitted to Med-QUEST and the family later applies at a BESSD office for financial assistance, why is the medical application denied because the family has an application with BESSD? If the financial assistance application is approved and the application date is the same or before the Med-QUEST application, the health insurance application will be denied. Health insurance benefits begin the same date as financial assistance, so there is no need for the application at Med-QUEST. Note: If the application shows medical services within “five-days retroactive,” the health insurance application will be approved for one month then closed. c. If someone is enrolled in a Med-QUEST program but the case belongs to BESSD, whom should we call if there are questions about QUEST or Medicaid? Call the Med-QUEST eligibility worker. 19. Miscellaneous a. Is a form required to report income changes? No. Information can be self-reported. However, for adult-only cases all income must be verified during annual renewals. b. Who should be notified if the person moves to another island? The customer should contact the local Med-QUEST office near the new home. She/he should also contact the health plan if enrolled in QUEST. c. Should original verifications be submitted? No. If a document is requested, only submit copies (e.g., I-94, permanent resident card, pay information, etc.). d. If the case is closed can the customer reapply? How many times? Yes. There is no limit on the number of times a person can apply. e. For health care providers, how long does it take for Med-QUEST’s web site and Automated Voice Response System (AVRS) to list the customer’s application status? When a Med-QUEST eligibility worker approves or denies an application, the information is typed into the HAWI computer system. The HAWI information is loaded into the Hawai‘i Prepaid Medical Management Information System (HPMMIS) nightly and it takes one to two days for it to appear on the web site and in AVRS. f. Do hospitals submit applications for their uninsured patients? Yes. They have staff dedicated to this task. However, it is the customer’s responsibility to ensure the application is completed and she/he should follow up with hospital staff. g. If the hospital initiated the application and Med-QUEST needs additional documents to process it, where should the customer send her/his papers? The documents should be sent to hospital personnel assisting with the application. They will follow-up with Med-QUEST regarding the application and additional documents. h. What happens if a customer dies? It must be reported to the Med-QUEST eligibility worker. If assistance is needed to pay funeral or burial services, the caller should request a Funeral Payments Program brochure and application. i. Why are two forms required to establish a disability? Form 1127 (Medical History and Disability Statement) is completed by the applicant and used by the Aid to Disabled Review Committee to determine the individual’s profile. Form 1128 (Disability Report) is completed by the applicant and physician and used by the health plans or Med-QUEST if they think the customer may meet the definition of a disabled person. j. Who initiates the switch from QUEST to Medicaid? Requests to move someone who is blind or disabled from QUEST to Medicaid generally come from the health plan and/or health care provider. They assist the family in completing the two forms (1127 and 1128) for approval. k. Sometimes an outstationed eligibility worker submits an application and when she/he checks with Med-QUEST there is no record of the application. Why? If the application is adding a person to an existing case, it is not registered as an application and does not show up in Med-QUEST’s system as an application. The application is sent to the eligibility worker who has the existing case. You can call the eligibility worker or if you do not know whom it is, contact the supervisor and she/he can tell you. l. If a health plan or outstationed eligibility worker discovers a customer has moved out-of-state, must a new address be listed on form 1179 (Change Report Form)? No. Write as much information as possible on the form and Med-QUEST will follow-up. m. If an application is denied, can the person reapply? Yes. If it is within 120 days from the date Med-QUEST received the application, she/he can go to the Med-QUEST office and re-sign the original application. If this is not convenient or it is past the time limit, the person can submit a new application. If an outstationed worker (OEW) has the original application (it was faxed to Med-QUEST and she/he kept the original copy), the OEW can help the customer within 120 days of the date Med-QUEST received the application. The OEW should have the customer review the application, date and initial any changed information, re-sign it next to the signature line and write the current date, and send it to Med-QUEST. At the top of the application on page 1, the OEW must write that it is a re-signed application so Med-QUEST knows it is a new application. n. What happens if two applications for the same household are mistakenly sent to Med-QUEST? The application with the earliest registration date will be used and the duplicate application will be matched with the first one. Note: Do NOT send duplicate applications unless a Med-QUEST eligibility worker or supervisor requests a second copy. o. If someone requesting health insurance has an injury requiring medical care, should it be reported on the application? Yes. If the person has a medical problem or needs medical treatment due to an accident or incident, list details in 8E on 1100 or 5D on 1108 and complete forms 1125 (Assignment of Payment, Repayment Agreement, and Authorization and Waiver for Release of Information) and 1125A (Supplement to Assignment of Payment). Note: Medicaid is the payer of last resort, therefore Med-QUEST makes a reasonable effort to exhaust all other insurance sources (e.g., motor vehicle, worker compensation, homeowner, renter, business, etc.) before billing the QUEST or Medicaid programs. It is called third-party liability (TPL). p. If a person recently applied for a social security number, can she/he also send an application to Med-QUEST? Yes. When someone applies for a social security number, the Social Security Administration issues a letter stating the applicant will receive a card within two weeks of the letter’s date. A copy of this document should be attached to the Med-QUEST application or sent to the Med-QUEST eligibility worker. Federal law requires a social security number for someone to receive QUEST or Medicaid benefits (except ineligible aliens who received emergency services), therefore the person must inform Med-QUEST of her/his social security number as soon as it is issued. q. If an outstationed eligibility worker (OEW) submits an incomplete application to Med-QUEST, what will happen? The OEW should make sure the application is signed, lists the applicant’s mailing address in Question 1, and includes pages 1-6 (1100) or pages 1-5 (1108). If an application is missing a signature and/or page, it will be returned to the OEW and the date will not be preserved. Occasionally, an OEW is unable to get the applicant’s mailing address, income, assets, citizenship/alien status papers, photo identification, or other required details within the 15-days allowed by Med-QUEST for OEWS to submit applications. The OEW should note on 1100A what information is missing and dates and times the OEW tried to get the information. In this situation, the Med-QUEST eligibility worker will follow-up directly with the applicant. r. Are employed people eligible for QUEST? If the employed person is eighteen through sixty-four years old and receives or is eligible to receive employer-sponsored health insurance, she/he is generally not eligible for QUEST (see note below). This pertains to the employed person and not her/his dependents. However, it does not apply to these people: * Pregnant; * Eligible for General Assistance (GA) Financial Assistance; * Eligible for Transitional Medical Assistance (TMA); * Covered Under Section 1931 of the Social Security Act; and * Aged, Blind, and/or Disabled and Eligible for Medicaid. s. What if an employer does not offer employer-sponsored health insurance? Hawai‘i employers are required by law to offer employer-sponsored health insurance to anyone who works over twenty hours per week. If you find an employer who is not following the law--or is trying to avoid it by hiring, laying off, and rehiring an employee--please call the Hawaii State Department of Labor at 586-9151.