People enrolled in ‘Ohana Health Plan have until Tuesday to select a different Med-QUEST plan. The enrollment window opened in October; members who do not choose a plan will be assigned one, the Honolulu Star-Advertiser reports. Enrollment packets were expected to be mailed in mid-September.
About 24,000 members are affected. ‘Ohana is to cover them through Dec. 31, and their replacement plans are scheduled to begin Jan. 1. Med-QUEST administrator Meredith Nichols said members can remain covered by Medicaid while they continue to meet eligibility requirements, according to the Star-Advertiser. Members who want to keep seeing their current doctors should check whether those providers participate in the plan they choose.
Plan choices and member assistance
Med-QUEST’s five managed-care organizations are AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan and UnitedHealthcare, according to the Hawaii Med-QUEST program. The Star-Advertiser reports that the program serves about 400,000 people statewide, or roughly one in three Hawaii residents.
‘Ohana Medicaid members can call 888-846-4262 for assistance Monday through Friday, 7:45 a.m. to 4:30 p.m., according to the plan’s contact information.
Centene’s Hawaii exit
Centene will end its Med-QUEST contract Dec. 31 and did not seek the state’s Community Care Services contract for behavioral health plans, the Star-Advertiser reports. The company has offered ‘Ohana in Hawaii for nearly 20 years, providing medical, behavioral health and long-term services to low-income people enrolled in Med-QUEST, the state’s Medicaid and Children’s Health Insurance programs.
In explaining its decision to the Star-Advertiser, Centene pointed to higher medical expenses, reimbursement it said was inadequate for the care members need, and changes in federal funding. The company said it is preparing for the changeover involving members, providers, employees and community partners. Centene also says it will continue offering a Medicare Advantage Dual Eligible Special Needs Plan and a standalone prescription drug plan in Hawaii, according to its state information page.
A separate eligibility change is also scheduled
Starting Jan. 1, 2027, most adults ages 19 to 64 who are not blind, disabled or pregnant will need to document at least 80 hours of work or volunteering per month, or be enrolled at least half-time in an educational program, to keep Med-QUEST coverage. The Star-Advertiser reports that the change follows H.R.1’s passage by Congress.
Centene is also leaving Arkansas’ Medicaid expansion program, Arkansas Health and Opportunity for Me, or ARHOME. The program covers about 77,000 members, and Centene’s departure will leave Arkansas Blue Cross and Blue Shield as its only participant, according to Healthcare Dive.
