Our goal is make sure you get answers to all your questions about QExA, your health plan choices, and more. Start by taking a look at these QExA Questions & Answers.
Remember, you can find out more by calling us. Help is available in many languages at no charge. We’re waiting for your call.
QExA Helpline Toll-Free : 1-866-928-1959
Open 8 a.m to 5 p.m. Monday – Friday
TTY Line Toll-free for hearing impaired users: 1-866-928-1958
What is QUEST Expanded Access (QExA)?
QExA is the Medicaid program for seniors, 65 and older, and people of all ages with disabilities. Everyone in QExA will get their Medicaid healthcare services through a health plan. QExA clients choose the health plan they want to use
Who is eligible for QExA?
Most Medicaid clients who are seniors, 65 and older, and people of all ages with disabilities are in the QExA program. To find out more, call the toll-free Helpline at 1-866-928-1959.
What is QExA managed care?
QExA managed care gives clients improved access to quality healthcare. Clients choose the health plan they want to use. They get their healthcare services through their health plan.
Health plan members use the doctors, hospitals, clinics and pharmacies that are in their health plan. QExA managed care covers all regular Medicaid services plus some additional services including:
- A primary care provider (PCP) they choose who is responsible for their care.
- Long Term Care (LTC) Services.
- Regular check-ups and health assessments to keep members well.
- When QExA members need to see a medical specialist, their PCP helps and sends them to another provider in their health plan.
- Access to healthcare 24 hours a day, 7 days a week through their health plan.
- A Service Coordinator to work with members to make sure their health needs are met.
Where can I find out more about QExA?
It’s easy to learn about QExA and the participating health plans. To find out more you can:
- Call us toll-free at 1-866-928-1959 and talk with an Enrollment Counselor. We are here to answer your questions and help you choose a health plan.
- Meet face-to-face with an Enrollment Counselor. To schedule an appointment call us, toll-free at 1-866-928-1959
There is no charge to call the Helpline Toll-Free, 1-866-928-1959, or meet with an Enrollment Counselor. If you do not speak English, you can still call this number. We have interpreters for you. If you are deaf, call the toll-free TTY Line Toll-Free, 1-866-928-1958.
Do I have to choose a QExA health plan?
Yes. Medicaid clients who are seniors, 65 and older, and people of all ages with disabilities need to
choose a health plan for their healthcare services. QExA managed care is designed
to bring you:
- Improved access to care
- Coordination of your healthcare services
- Enhanced quality of care
- Outreach and education
How do I sign-up with the health plan I choose?
There are three ways to sign-up with your health plan. You can:
- Call the Helpline Toll-Free at 1-866-928-1959 and talk with an Enrollment Counselor. We are ready for your call and want to help you choose the best health plan for your needs.
- Send in the QExA CHOICE Form (Click here to download a copy of the CHOICE form: QExA CHOICE form) Fill it out and send it to us at: PO Box 135038, Honolulu, HI 96801. Or fax it toll-free to 1-866-928-7620.
- Meet with an Enrollment Counselor to choose your health plan. Call us toll-free at 1-866-928-1959 to schedule an appointment.
Can I still see my doctor?
Yes. If your doctor works with the QExA health plan you choose, you can stay with that doctor. All you have to do is choose that health plan.
Ask your doctor and other providers which health plans they work with
If your doctor does NOT work with a QExA health plan that is available in your area, you can ask your doctor to sign up with your QExA health plan. If not, you will need to choose a new doctor.
How do I find out which health plan my doctor is in?
You can call your doctor.
You can use a computer. Both health plans have a Web site. It has a list of doctors for each QExA health plan.
What healthcare services are covered under QExA?
You receive your Medicaid healthcare services through your QExA health plan. A list of QExA covered services is provided below:
- Hospital services: emergency, inpatient and outpatient
- Visits to your doctor who is also called a PCP (Primary Care Provider), medical specialists and other providers
- Lab tests and X-rays
- Prescription drugs
- Durable medical equipment and medical supplies
- Home health services
- Hospice services
- Vision services
- Preventive care services
- Maternity and family planning services
- Rehabilitation services
- Transportation services
- Urgent care services
- Service Coordinator through your health plan
- Personal Assistance Services – Level I
Behavioral Health Services, including:
- Acute care for psychiatric illnesses
- Crisis services – 24 hours a day, 7 days a week
- Substance abuse treatment
- Psychiatric or psychological evaluation
Long-Term Care Services, including:
- Home and Community-Based Services (HCBS), such as adult day care, personal care attendants, residential care
- Institutional Services, such as a nursing home
These covered services are coordinated by your health plan:
- Dental services
- School health services
- Zero to Three program from Department of Health
- DD (Developmentally Disabled) waiver clients use their QExA health plan for acute and primary care services ONLY. They receive Medicaid waiver services (case management, etc.) as they do now.
- Behavioral health services for enrollees with serious mental illness (SMI) or children with serious emotional disturbances (SED)
Participants in the State of Hawaii Organ and Tissue Transplant Program (SHOTT) are NOT eligible for QExA and will not enroll in a health plan..
For more information about QExA covered services, call us toll-free at 1-866-928-1959.
Can I get home care services?
Yes. Most QExA clients will receive home care services through their health plan.
If you are in the DD waiver, then you receive your waiver services through the Department of Health. Call the toll-free Helpline at 1-866-928-1959 to find out more.
If you are in one of the other waiver programs*, then special rules apply. Call the toll-free Helpline at 1-866-928-1959 to find out more.
* Waiver programs include: NHWW, RACCP, MFCCP and HCCP
Which health plans are in QExA?
There are two health plans in QExA: United Healthcare Community and ‘Ohana Health Plan. Most members in QExA can choose either plan. The plans you can choose depends on where you live, see the chart below:
|ISLAND||Hawaii (Big Island)||Kauai||Lanai||Maui||Molokai||Oahu
|United Healthcare Community||x||x|| ||x|| ||x
|‘Ohana Health Plan||x||x||x||x||x||x
Does each health plan offer the same services?
QExA health plans must provide all of the Medicaid covered healthcare services. The providers that work with each health plan may be different. Plus, each health plan may offer some extra benefits. Call the Helpline Toll-Free at 1-866-928-1959 to find out more.
Can I change health plans?
You can change health plans if you make the change within the first 90 days of your enrollment in the health plan. After the 90-day period ends you can only change health plans:
- if you have good cause as determined by the Department of Human Services
- during QExA’s annual open enrollment period
What is a PCP?
Your regular doctor is also called a PCP (Primary Care Provider). Your PCP takes care of your healthcare needs. You need to choose a PCP who works with your health plan. When you need to see a specialist or use other medical service, your PCP helps you get that care.
Your current doctor may be able to be your PCP. Call an Enrollment Counselor at the Helpline Toll-Free at 1-866-928-1959 to find out more.
I don’t have a doctor to be my PCP. How do I choose one?
Your health plan will help you find a PCP. Once you are a health plan member, you have 15 days to choose a PCP. Call your health plan as soon as you get your health plan confirmation notice from the Department of Human Services.
Can I change my PCP?
You can choose a new PCP anytime. Call your health plan; they will help you find a new PCP.
If I have an emergency, can I still go to the emergency room?
Yes. If you have an emergency go to the nearest emergency room (ER) or call 911.
You should only go to the ER if you are having an emergency. If you are sick and need to see a doctor, your new health plan can help you. You do not have to go to the ER. You can call your new plan to get this help.
What is Open Enrollment?
Once a year during Open Enrollment everyone in QExA can review their health plan options. If they want to choose a new QExA health plan, they can choose one at that time. We will send you information about your choices and what to do before the Open Enrollment period.
What is a Service Coordinator?
Everyone in QExA has a Service Coordinator through their health plan. Your Service Coordinator helps you:
- Get better access to healthcare services and providers
- Take a more active role in your care
- Understand and use your QExA benefits
Once a year your Service Coordinator will do a Health and Functional Assessment for you. If you want a different Service Coordinator, call your health plan.
I have Medicare coverage. Do I have to choose a health plan?
Yes. Your QExA health plan may provide some services that Medicare does not, such as prescription drugs and an annual physical exam. Your Medicare benefits do not change.
What happens if I don’t choose a health plan?
If you do not choose a health plan, the Department of Human Services will choose one for you. Don’t wait; call the toll-free Helpline at 1-866-928-1959 to find out more about your choices. An Enrollment Counselor is ready to answer your questions and help you choose your health plan over the phone.
What can I do if I have a problem with my PCP or my health plan?
Call your health plan for assistance. Each health plan must follow an approved complaint process. This process is described in your health plan’s Member Handbook which will be sent to you following your enrollment in the health plan. If your health plan cannot assist you with your problem, you can receive assistance from the QExA Ombudsman.