Starting Jan. 1, most adults enrolled in the government\u2019s Medicaid program will have to show they work, volunteer or go to school part-time at least 80 hours in a month to qualify for healthcare under Med-QUEST, Hawaii\u2019s Medicaid program.<\/p>\n
If not, they may be dropped.<\/p>\n
The changes are a result of H.R.1, which U.S. Congress passed last year, requiring states with expanded eligibility for Medicaid coverage to impose the work requirements.<\/p>\n
KFF, a health policy think tank, estimates the new requirements will reduce federal spending by $326 billion and increase the number of uninsured people in the U.S. by 5.3 million over 10 years.<\/p>\n
In Hawaii, Medicaid is administered as Med-QUEST <\/a>by the Hawaii Department of Human Services, and provides healthcare coverage for about 383,000 residents with state and federal funds.<\/p>\n \u201cThese new requirements only apply to approximately one-third of Med-QUEST members,\u201d said DHS Med-QUEST Administrator Meredith Nichols in a statement. \u201cSpecifically, 19-64 year olds who are not pregnant, blind, or disabled and do not qualify for any exemptions. This law does not impact our keiki or kupuna.\u201d<\/p>\n Don’t miss out on what’s happening!<\/p>\n Stay in touch with breaking news, as it happens, conveniently in your email inbox. It’s FREE!<\/p>\n She added that of the approximately 124,000 members subject to the new rules, about half already meet the work requirements or qualify for an exemption.<\/p>\n Health providers in Hawaii, however, are bracing for a financial hit as well as drop in patients covered under Med-QUEST due to the new requirements, which will present additional hurdles for a population already challenged on numerous fronts.<\/p>\n Rich Bettini, CEO of the Waianae Coast Comprehensive Health Center, has been bracing for the impacts for at least a year.<\/p>\n The center is one of the largest providers for Medicaid patients in the state, serving about 24,000. Of that total, the center estimates about 1,800 face new work requirements. Starting next year, members also will need to reenroll every six months instead of once a year, meaning more administrative burdens and potentially more losses in coverage.<\/p>\n He estimates about two-thirds of the center\u2019s revenue comes from Medicaid, and has already trimmed back the budget for next year, anticipating the drop.<\/p>\n \u201cWe are not in disagreement that from a health basis, work, vocation and avocation and learning is healthy,\u201d said Bettini. \u201cThere\u2019s not a doubt in my mind that people that have a direction, have a job, a meaningful place to volunteer or education \u2014 they change their attitude.\u201d<\/p>\n WCCHC itself is one of the largest employers in the area, providing about 700 jobs for many that live in the community.<\/p>\n But these new rules are especially challenging for a rural community like Waianae, where jobs and job training opportunities are limited, requiring travel to Kapolei or town to qualify. Due to traffic, he said, getting to even Kapolei from the back of Waianae Valley without a car presents numerous barriers.<\/p>\n These may sound like excuses, he said, but transportation issues are very real.<\/p>\n \u201cWe don\u2019t have the infrastructure yet in our rural community,\u201d he said. \u201cSo many things are concentrated in town, even training programs.\u201d<\/p>\n WCCHC has been working to set up local job training programs and a network of volunteer opportunities. Waianae needs more programs like the paid Emergency Medical Training program with American Medical Response where, instead of going to Diamond Head, emergency medical technicians can train close to home to meet work requirements.<\/p>\n The center\u2019s Food as Medicine programs, which run a farmer\u2019s market and food pantries, could also potentially provide work and volunteer opportunities. Still, Bettini said, more funding is needed to expand it and build a teaching kitchen.<\/p>\n The center has also hired outreach workers and set up kiosks at its clinics and at Tamura\u2019s Market to help people stay enrolled in Med-QUEST.<\/p>\n In a community where many patients are homeless or nomadic, without access to a computer, it\u2019s an uphill challenge.<\/p>\n \u201cEspecially in a high-risk community, you don\u2019t want people to lose their insurance,\u201d he said. \u201cIt\u2019s catastrophic for health plans to lose them until they\u2019re sick or injured.\u201d<\/p>\n Eligibility changes<\/p>\n What are the requirements, exactly, and who will be affected?<\/p>\n In 2027, the U.S. Centers for Medicare and Medicaid Services will require all adults ages 19 to 64 to meet work requirements in order to qualify for coverage.<\/p>\n Med-QUEST will require adults to enroll at least half time in an educational program, or work or volunteer 80 hours in at least one month of the previous six months to reenrollment. The 80 hours can be a combination of the three.<\/p>\n Another option is to show proof of household income of $580 or more in at least one of the previous six months.<\/p>\n Adults who are blind, disabled or pregnant are exempt, as are parents and guardians of a child under 14, and caregivers of a disabled individual. People with serious mental conditions or substance abuse problems are exempt as well, along with those living in a national disaster area.<\/p>\n While Alaska Natives and American Indians are exempt from the work requirements, Native Hawaiians are not<\/a>.<\/p>\n The department recommends that members create an online account and make sure their contact is updated at mybenefits.hawaii.gov.<\/p>\n DHS in July sent notices to impacted adult members explaining the new federal requirements. Nichols said a second notice will be sent four months prior to each member\u2019s renewal, asking for documents and attestations demonstrating how they are exempt or how they have met the new work requirements.<\/p>\n \u201cThe best and easiest way to do this is by uploading information to their online Med-QUEST account,\u201d said Nichols.<\/p>\n DHS will send a third notice a month before renewal dates to know if members have been renewed or need to provide more information.<\/p>\n AlohaCare, one of Hawaii\u2019s top Med-QUEST insurance providers, is also trying to make sure its members stay enrolled.<\/p>\n Besides creating an informational website<\/a> and a social media toolkit, AlohaCare is working with community partners to help members navigate the reenrollment process, particularly those with new work requirements.<\/p>\n \u201cWe\u2019ll be engaging our health coordinators and care navigators,\u201d said Mike Nguyen, senior director of external affairs. \u201cWe will do outbound phone calls and text messages to say, \u2018Hey we\u2019re here to help.\u2019\u201d<\/p>\n He estimates about a third of AlohaCare\u2019s 66,000 members are enrolled in the Affordable Care Act adult expansion pathway and may face these new work requirements.<\/p>\n Fuzzy on details<\/p>\n Despite these efforts, it remains unclear how many Med-QUEST members know about the new work requirements.<\/p>\n Luke Toy, fund development coordinator at Palama Settlement, said older adults seem more aware of the upcoming changes while those in their 20s to 30s do not.<\/p>\n Older adults generally seem less concerned, he said, believing they qualify for exemptions, while younger adults have not given much thought to how they will fulfill work requirements.<\/p>\n With the deadline just a little over a month away, some healthcare providers said they are fuzzy on the details of how reenrollment and verification will work, exactly.<\/p>\n