Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Hawaii (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes		Specified services and procedures		All-inclusive rate per episode of care using Medicare groupings for most procedures	CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			24 one-hour individual or group psych therapy visits/year plus 6 more if combination of therapy, limits on session duration	Fee for service	CN & MN
Federally Qualified Health Center Services
Yes				Prospective cost based payment	CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes			Psych services limited to 30 days/year, LOS limited by state's Utilization Review authority, tissue and organ transplants limited to Medicare-certified transplant facilities	Prospective cost based payment	CN & MN
Outpatient Hospital Services
Yes				All-inclusive rate per episode of care using Medicare groupings for most surgical procedures or fee for service with limits	CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
Yes		Yes		Fee for service or prospective payment system rate	CN & MN
Rural Health Clinic Services
Yes				Cost based payment	CN & MN
Practitioner Services
Certified Registered Nurse Anesthetist Services
No
Chiropractor Services
No
Dental Services
Yes			Preventive and restorative services up to $500/year	Fee for service	CN & MN
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			Limited to trauma care and emergency treatment for relief of pain and infection	Fee for service	CN & MN
Nurse Midwife Services
Yes				Fee for service	CN & MN
Nurse Practitioner Services
Yes				Fee for service	CN & MN
Optometrist Services
Yes			1 refractive exam/2 years	Fee for service	CN & MN
Physician Services
Yes				Fee for service	CN & MN
Podiatrist Services
Yes		Inpatient hospital services and appliances costing more than $100	Routine foot care and other specified services not covered	Fee for service	CN & MN
Psychologist Services
Yes		Psychological testing	4 hours psychological testing/year with 2 additional hours for comprehensive testing	Fee for service	CN & MN
Prescription Drugs
Prescription Drugs
Yes		Specified drugs		AWP-10.5%, plus $4.67 dispensing fee	CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
Yes		Yes	Two weeks of treatment	Fee for service	CN & MN
Physical Therapy Services
Yes		Yes	Two weeks of treatment	Fee for service	CN & MN
Services for Speech, Hearing and Language Disorders
Yes		Yes		Fee for service	CN & MN
Products and Devices
Dentures
Yes			1 full or partial denture up to $1,000/year	Fee for service	CN & MN
Eyeglasses
Yes		Contact lenses, visual aids costing more than $50	1 pair eyeglasses/2 years unless vision change exceeding specified diopter criteria is met, special lenses limited by age and medical condition	Fee for service	CN & MN
Hearing Aids
Yes		Yes	Hearing aid rented for 30 day trial period before state authorizes purchase, 1 evaluation/year, 1 hearing aid/2 years	Fee for service	CN & MN
Medical Equipment and Supplies
Yes		Specified items		Fee for service	CN & MN
Prosthetic and Orthotic Devices
Yes		Services or items costing more than $50		Fee for service	CN & MN
Transportation Services
Ambulance Services
Yes				Fee for service	CN & MN
Non-Emergency Medical Transportation Services
Yes		Yes		See service-specific FN	CN & MN
Other Services
Diagnostic, Screening and Preventive Services
Yes		Specified services		Fee for service	CN & MN
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes		Specified procedures		Fee for service	CN & MN
Targeted Case Management
Yes				Negotiated rate	CN & MN

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 2, 4, 5, 6 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes	Specified serviceds		Fee for service	CN & MN
Hospice Care
Yes	Yes	Two 90-day periods plus one 60-day period	Prospective payment based on Medicare methodology and rates	CN & MN
Personal Care Services
No
Private Duty Nursing Services
No
Program of All-Inclusive Care for the Elderly
Yes			Capitated payment	CN & MN
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
No
Inpatient Psychiatric Services, under age 21
Yes		Coverage limited to 40 days/year	Prospective cost based per diem	CN & MN
Intermediate Care Facility Services for the Mentally Retarded
Yes	Yes	12 hosp or therapeutic leave days/year with up to 3 consecutive days	Prospective cost based per diem with limits	CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		12 hosp or therapeutic leave days/year, up to 3 consecutive days	Prospective cost based per diem	CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has an approved Section 1115 Waiver from CMS, funded by both Title XIX and Title XXI, under which it extended Medicaid eligibility to a number of previously uninsured individuals and through which care is delivered by managed care organizations. The waiver program, initially called QUEST was renewed in early 2006 and is now known as QUEST Expanded, or QEx. The waiver has multiple components, for different groups at different income levels, with premium requirements for individuals not otherwise eligible for Medicaid, including children. Note that the federal poverty level for Hawaii is 15 percent higher than in the 48 contiguous states and the District of Columbia. Copayments are not required from any beneficiaries. The QUEST-Net and QUEST Adult-Coverage Expansion components of the waiver offer more restrictive benefit packages, which are not reflected on the tables. Services covered under these two components include limited days and visits in the hospital setting, with no coverage for maternity, nursery, rehabilitation or skilled nursing; emergency medical and dental care; limited visits for mental health and substance abuse treatment; and prescription drug coverage based on a strict formulary. Generally, aged, blind and disabled Medicaid beneficiaries receive their health care on a fee for service basis in the same scope as the QUEST group.