QUEST re-enrollment under way
Health-care activists worry that patients will forget or not be notified of the rule
The state's 165,000 QUEST members are required to re-enroll in their health plan by May 31 under a new policy that community health centers and others tried to stop when it was proposed last year.
Quest patients, pick a plan
These are the health plans available on each island:
Oahu: AlohaCare, HMSA, Kaiser and Summerlin
Big Island: AlohaCare, HMSA and Summerlin
Kauai: AlohaCare, HMSA and Summerlin
Maui: AlohaCare, Kaiser and Summerlin
Lanai and Molokai: AlohaCare
For more information, call 524-3370 or, toll-free from the neighbor islands, (800) 316-8005.
QUEST members who do not re-enroll in their existing plan by the deadline may be reassigned to another health plan and a new doctor. In the past, those who did not re-enroll in their existing plan were automatically reassigned to it.
The state Department of Human Services adopted a mandatory re-enrollment policy last year to try to increase competition among QUEST service providers and provide more services. QUEST offers health coverage through managed care plans for eligible lower-income residents.
The goals were achieved with a new plan entering the market and the plans offering additional services and disease-management tracks, said Patty Johnson, administrator, Adult and Community Care Services Branch, Social Services Division.
Nevada-based Summerlin Life & Health Insurance Co. has joined three previous QUEST providers: AlohaCare, a community-based health plan for QUEST beneficiaries, the Hawaii Medical Service Association and Kaiser Permanente.
Members will be assigned to their health plans by July 1.
"The thing we are most concerned about is the additional chaos and confusion having to (re-enroll) creates," said Beth Giesting, Hawaii Primary Care Association executive director.
The Department of Human Services "has spent a fair amount of resources to make this work," she said. "Our question is, Was this really necessary? Notwithstanding their efforts, there will be a lot of people who won't know what to do with the information or may not get it. ...
"All providers will have to deal with the effects of people coming in and not being in the plan they think they will be, and unsnarling all of that."
Johnson said the department was "very, very successful in getting plans to offer different types of services that are more than the standard QUEST package."
Each plan will offer asthma, diabetes and two other disease-management programs with special services to help improve outcomes for clients, she said.
"It is really a more specialized kind of intensive management and monitoring of the disease in cooperation with the client, physicians and any other providers involved," Johnson said.
She said the Department of Human Services has conducted an extensive program with TV and radio ads and bus posters to inform clients about the plans and benefits. Fourteen client focus groups helped to develop newsletters for clients, and booklets were sent with more details about the plans, she said. Posters also were sent to 400 churches, which were asked to help clients make a choice, she said.
The Legislature was drawn into the controversy last year as community health centers, many doctors and advocates opposed the "positive enrollment" policy when it was introduced.
Opponents argued that many QUEST members are homeless and will not respond to mailings. They said many have a close relationship with their doctor but might not know what their health plan is.
The department made some changes to address concerns and added safety features Director Lillian Koller said were designed to make sure services would not be delayed or denied if a client goes to the wrong place or is auto-enrolled in a different plan.
Notices and letters listing new health plan choices have been mailed to QUEST members. They must fill out a form and mail it back to the Department of Human Services or face automatic assignment.
The department also put a cap on the number of members allowed for each plan on each island, so members could be assigned to another plan if the one they want has reached the limit.
Contracts were awarded based on competitive bidding, and no plan has protested the awards, Johnson noted.
There have been some changes: Kaiser is not participating on Kauai, and HMSA is not participating on Maui, Lanai or Molokai.