Written by a parent, not a doctor. Nothing here is medical advice.

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Hawaii program

Health insurance for your child (Med-QUEST)

Hawaii’s Medicaid health insurance for children under 19. Your child can have it alongside work insurance.

What it is

Hawaii’s Medicaid health insurance for children under 19. Your child can have it alongside work insurance.

Med-QUEST can cover treatment even when you already have insurance through work. It checks current monthly income, so a loss of pay can change the answer. The state decides who belongs in your child’s household and which income counts.

Eligibility rules
  • Your child must be under 19 and live in Hawaii. A yearly income figure divided by 12 is only an estimate.
  • The chart effective January 13, 2026 has different base limits by age. For four people: under 1, $6,041 monthly; ages 1–5, $4,396; ages 6–18, $4,207.
  • For four people the line is $6,041 a month for a baby, $4,396 for ages 1 to 5 and $4,365 for ages 6 to 18 (from January 2026).
  • Your child must live in Hawaii and meet a citizenship or eligible immigration rule; qualifying lawfully present children have a route, and a parent’s status does not decide the child’s case. Med-QUEST works out the child’s household from tax and family relationships and counts income by source, not simply every person or every dollar at home. SSI and ordinary gifts are not MAGI income. Ordinary child coverage has no savings test.
What you get
  • No premium or child copays for covered hospital care, cancer treatment and medicines.
  • Home nursing and travel to treatment when your child meets the separate care and travel rules.
  • Continuous coverage protections for children, with Med-QUEST confirming the renewal date.
What the help covers
  • Ordinary child coverage can sit behind private insurance. The higher S-CHIP band has a separate uninsured-child requirement.
  • Your work plan is billed first. For covered care, the clinic cannot bill you the deductible or copay the work plan left, even when Med-QUEST pays nothing extra. If a bill arrives anyway, ask billing to check it before paying.
  • Worked example: the work plan leaves $3,400 of a $5,000 bill to you. Med-QUEST pays nothing extra because the work plan already paid more than Med-QUEST's rate, and you still owe $0.
If you decide to apply
  1. Ask the hospital financial counselor to help with KOLEA, or use the Med-QUEST phone application.
  2. Have recent income records, insurance cards and earlier hospital bills ready. Explain any change in pay.
  3. Ask which QUEST plans include your child’s oncology team and whether temporary hospital coverage is available.

Med-QUEST: 1-800-316-8005. KOLEA is the online application. · Official page ↗

What happens next
  • Hawaii’s ordinary coverage can reach back 10 days before the application. A long-term-care request has a separate three-month rule.
  • Once approved, your child keeps coverage for at least 12 months; the approval letter gives the renewal date.
  • The published decision standards are 45 days ordinarily and 90 days for disability-based applications.
  • A participating hospital can start temporary child coverage on the day of its presumptive-eligibility decision. A full application received by the last day of the following month keeps temporary coverage in place until the full decision. Without it, temporary coverage ends at that month’s end. A September 17 decision therefore has an October 31 full-application deadline. The hospital confirms whether it participates.
Good to know

Your work insurer pays first. For covered care, Med-QUEST billing protections can apply even when it pays nothing extra.

Other details
  • Keeping both plans means paying any work-plan premium and coordinating the treatment team. Before changing coverage, the financial counselor can compare access to the oncology team, hospital, pharmacy and planned care.
  • Before a coverage change, the employer can explain the premium savings and when your child could rejoin.
  • A QUEST appeal generally has a 60-calendar-day filing window. Decisions take up to 30 calendar days, or 72 hours for an expedited appeal. A qualifying extension can add up to 14 days.
  • A state hearing generally can be requested within 120 calendar days after receipt of the plan’s appeal-resolution notice. Keeping qualifying services through the hearing needs the hearing and continuation requests within 10 days. The notice and plan confirm the applicable conditions; repayment may be required if the final adverse decision stands.

Federal background: Medicaid · Medicaid as a second insurer.

Official sources
Ask your social worker

“Could Med-QUEST reduce our treatment bills alongside our insurance? What would the tradeoffs be, and would you help us apply if it fits?”

Why I’m asking: I want to understand the cost and treatment access before changing my child’s insurance.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File on KOLEA today with this month’s income and any insurance cards, and name the bills already sitting with the hospital.

Your social worker

The oncology social worker or financial counsellor helps you file, asks the hospital about temporary coverage, and chases the decision.

The care team

Nothing for ordinary child coverage. Medical records matter only for a disability category.

Who decides
The Med-QUEST Division checks the income. The QUEST Integration health plan you choose then runs the coverage.
Ask your social worker
“Can you help me file on KOLEA today and ask whether this hospital can open temporary Med-QUEST while we wait? Which QUEST plans does the oncology team take?”

How to apply

First step: Apply at medical.mybenefits.hawaii.gov (KOLEA, the state application) or call 1-800-316-8005 this week.

  1. Apply on KOLEA this week and give this month’s income, not last year’s.
  2. List the bills from the last ten days so the look-back covers the admission.
  3. Pick a QUEST plan the oncology team and Kapiolani take before you choose.

Official application / program page ↗

Where it starts: Apply on KOLEA at medical.mybenefits.hawaii.gov, or call 1-800-316-8005. Ask the hospital financial counsellor the same day whether the hospital can open temporary coverage.

What to gather

  • Child’s birth certificate or ID and Social Security number
  • Hawaii address
  • This month’s income for each adult in the tax household
  • Insurance cards, if any
  • Hospital bills from the last ten days

How long: Full-application standards are 45 calendar days ordinarily and 90 days for disability decisions. Children have at least 12 months of continuity; Med-QUEST confirms whether the approved longer periods are operational for the child.

What a yes looks like

A notice with coverage dates and a choice of QUEST Integration health plan. Check that Kapiolani and the oncology group are in that plan before you choose.

What a no looks like, and the next move

Read whether the answer turned on income, a missing document or the category. If it was income, ask in the same application about the S-CHIP band and the spend-down, and appeal by the date on the notice.

Watch out

  • The five-point column is not a second band: it is added only when it changes the answer.
  • Your child can keep private insurance and have Med-QUEST too. Do not cancel the work plan to apply.
  • Ordinary coverage reaches back only ten days, so file the week the child is admitted.

Dates that change this

2026-01-13: The income limits come from the state chart effective January 13, 2026. Hawaii has no fixed annual adoption day: the last three charts started on March 1, January 1 and January 13.

2027-01-01: From January 1, 2027 Hawaii is changing adult Med-QUEST, including six-month renewals and work or activity rules. Children are not named in that announcement; ask Med-QUEST how it reaches your household. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Full QUEST Integration coverage with no premium. For four people the limits are $6,041 under age 1, $4,396 at ages 1 to 5 and $4,207 at ages 6 to 18, and the chart prints a five-point column above each.

  • $6,041/month — Under age 1, family of 4, published base line (191%)
  • $4,396/month — Ages 1 to 5, family of 4, published base line (139%)
  • $4,207/month — Ages 6 to 18, family of 4, published base line (133%)
  • $4,365/month — Ages 6 to 18, family of 4, published five-point column (138%)
  • $3,483/month — Ages 6 to 18, family of 3, published base line (133%)
  • $2,035/month — Ages 6 to 18, family of 1, published base line (133%)

Covers: Hospital and clinic care · Chemotherapy and prescriptions · Anything medically necessary for a child under 21 under the child health benefit · Nursing and personal care at home when the plan approves it · Rides to appointments, and inter-island or mainland travel the plan arranges · Dental and vision

Legal protection: At least 12 months of child continuous eligibility, with limited exceptions. The approved 2025 waiver also authorizes through-sixth-birthday coverage and 24 months for ages 6–18; Med-QUEST confirms operational start and renewal dates.

What it costs the family: No premium and no copays for a child.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
MAGI budget group; base lines 191 / 139 / 133 per cent of the Hawaii poverty guideline, with a published five-point column added only when it changes the answer
Insurance status condition
none on the lower child bands; the upper S-CHIP band carries an uninsured requirement
Residency
Hawaii
Continuous eligibility
At least 12 months under SPA 23-10, effective July 1, 2023; the 2025–2029 QUEST waiver authorizes longer child periods, with operational start and individual renewal confirmed by Med-QUEST.
Retroactive days
10 days before the application; three months for a long-term-care request
Processing standard
45 days ordinary, 90 days when the claim is based on disability (2013 rule, still listed; actual turnaround NOT FOUND)

Decisions this site cannot make: Med-QUEST eligibility decision on the KOLEA application · Hospital presumptive eligibility can include children at participating hospitals; current Kapiolani participation is confirmed by the hospital.

Expect friction on: Choosing a QUEST Integration health plan the oncology team takes · Neighbour-island families should check the plan before travelling to Oahu

The trap: The five-point column is not a second band. The chart says the disregard is added only to the highest standard the child reaches, and only when it makes the difference. Do not drop private insurance to apply.

Where I read this

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