Initial Medicaid Implementation: Hawaii implemented Medicaid in January 1966 which was the first opportunity that states had to implement the program and less than six months after the program was passed in Congress.
Key Medicaid Political Issues: Hawaii faces a unique challenge to its Medicaid program because of the law that requires the state provide Medicaid services to people living in territories and the island’s unique location near territories. In addition, the island’s geography makes its medical system more dependent on air transportation which drives up costs in the system. In 1974 Hawaii became the first state to implement an employer mandate which requires employers to offer health coverage plans to all employees working over 20 hours per a week. This lower requirement on number of hours worked has an impact on the state’s Medicaid expansion population with many Medicaid eligible individuals having the choice between employer plans and the state’s Medicaid program. Hawaii implemented one of the country’s first Medicaid 1115 waivers in 1994 to expand coverage for its State Health Insurance Program (SHIP) which covers uninsured residents. The state has a large portion of managed care participants.
Medicaid Expansion Implementation: Hawaii expanded Medicaid with coverage beginning in January of 2014. The state has begun making some changes to its Medicaid expansion program to expand service for people lacking sustainable housing. The supportive housing plan would provide wrap around services to homeless residents and would focus on behavioral health and services for substance abuse and mental health. The state has limited availability of dentists that serve expansion enrollees. This means that low-income adult residents in the state have harder times seeing dentists and potentially worse health outcomes.
General facts about Hawaii Medicaid:
Medicaid program name: Med-QUEST, QUEST (MMCO) and Medicaid (FFS)
CHIP Program name: QUEST
Separate or combined CHIP: Medicaid Expansion
Medicaid Enrollment: 348,400 (March 2017 estimate)
Total Medicaid Spending: $2.2 billion
Share of total population covered by Medicaid: 18%
Share of Children covered by Medicaid: 33% (estimate)
Share of Medicaid that is Children and Adults: 83%
Share of Spending on Elderly and people with disabilities: 52%
Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)
Expansion state: Yes
Number of people in expansion: 110,000 (2016 estimate)
Work Requirement: No