Evercare QUEST Expanded Access Program (QExA) Hawaii

What is QUEST Expanded Access (QExA)?
QExA is a new Medicaid program for seniors, 65 and older, and people of all ages with disabilities. Starting February 1, 2009, everyone in QExA will get their Medicaid health care services through a health plan. QExA members 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 members improved access to health care. Members choose the health plan they want to use. They get their health care services through their 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 health care 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?

• Call toll-free 1-866-928-1959 and talk with an Enrollment Counselor.
• Attend a QExA meeting in your area. Enrollment Counselors provide information on QExA and your choices. You can get all your questions answered and choose your health plan, too. Call toll-free 1-866-928-1959 to find a meeting near you.
• Meet face-to-face with an Enrollment Counselor. To schedule an appointment call toll-free 1-866-928-1959.

There is no charge to call the Helpline, 1-866-928-1959, or to meet with an Enrollment Counselor. If you do not speak English, you can still call this number. QExA has interpreters for you. If you are deaf, call the toll-free TTY line, 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 health care services.

How do I sign-up with the health plan I choose?

• Call the toll-free Helpline at 1-866-928-1959 and talk with an Enrollment Counselor
• Meet with an Enrollment Counselor to choose your health plan. Call toll-free 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.

It is easy to find out which health plan your doctor works with, you can:

• Ask your doctor and other providers which health plans they work with
• Call the toll-free Helpline at 1-866-928-1959 and ask an Enrollment Counselor

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.

Will my healthcare services stay the same?
Yes. You continue to receive the same Medicaid healthcare services. The only difference is that now you get those services through your 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/MR (Developmentally Disabled/Mentally Retarded) 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) and Maui PACE are NOT eligible for QExA and will not enroll in a health plan.

For more information about QExA-covered services, call toll-free 1-866-928-1959.

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.