From: Legal Aid Society of HI
Basic Health Hawaii will start effective July 1, 2010. This is the health insurance for COFA (Micornesians, Palauans, etc.) and other ineligible legal permanent residents as they will no longer qualify for QUEST. Here are some things of note:
I. Basic Eligibility (current COFA recipients)
Deeming/eligibility: COFA individuals who have received some form of state medical assistance through June 30, 2010 will be automatically deemed into BHH from July 1, 2010. On September 30, 2010, BHH enrollees will be subject to an eligibility review.
Important: Non-pregnant COFA adult age 19 or older shall be ineligible for BHH if the eligibility determination is made on or after June 1, 2010. (Example – A person applies for medical insurance on April 5, 2010. The determination is not made until July 1, 2010. The person is not eligible for BHH.) If enrollment falls below 6,500, individuals can apply during an open enrollment period.
Long term care: A COFA recipient who is receiving LTC services on May 31, 2010 shall continue to receive LTC services. They will continue to be on the QExA plan.
SHOTT: Individuals who are in the SHOTT program (State of Hawaii Organ and Tissue Transplant) program will continue in the SHOTT program if they received transplants by May 31, 2010. If the transplant is after May 31, 2010, they will be enrolled in BHH.
II. Basic Eligibility (current other legal permanent residents)
Deeming: Non-pregnant legal permanent residents who (1) have not resided in the US for more than 5 years, (2) received financial assistance, and (3) maintained eligibility through June 30, 2010 shall be deemed into BHH as long as their income and assets do not exceed BHH limits. They will also be subject to an eligibility review on September 30, 2010.
Long term care and SHOTT: same as above
III. Basic Eligibility (non-medical)
COFA or legal permanent resident
19 years of age or older
Limited assets: $2000 for household of one, $3000 for household of two, $250 for each additional member
Limited income: below 100% of the federal poverty line
Not enrolled in another health plan, except for individuals on state financial or participating in DHS subsidized employment
10 days of inpatient hospital
12 outpatient visits
6 mental health visits
3 medically necessary procedures
4 prescriptions per month
Note: No exception for cancer treatment (i.e. it will count towards the 10 inpatient, etc.) See below for dialysis.
Dialysis will be covered under Medicaid. This means that COFA individuals with diabetes need not worry that BHH is not covering dialysis. Medicaid will cover it. Any drugs used during the dialysis will be covered. However, prescribed medication used outside of the actual dialysis sessions will count towards the 4 prescription medications per month.