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

Childhood Cancer Lantern
Search Saved

Hawaii program

Coverage after large medical bills (Med-QUEST spend-down)

A way to qualify for Med-QUEST when medical bills use up income above a low monthly standard.

What it is

A way to qualify for Med-QUEST when medical bills use up income above a low monthly standard.

High medical bills can open a different Med-QUEST route even when ordinary income limits do not fit. The branch compares income and bills month by month. It also checks savings and the rules for your child’s category.

Eligibility rules
  • Children under 19 and people who are aged, blind or disabled can be considered.
  • The monthly standard is $469 for one person, $632 for two, $795 for three and $958 for four. Bills you owe above that figure open the coverage.
  • The child and pregnancy route also has a 300% entry ceiling: $9,488 monthly for four on the 2026 chart. The disabled route has no such ceiling.
  • Resource limits are $2,000 for one person, $3,000 for two, plus $250 for each additional person.
What you get
  • Med-QUEST coverage from the date your monthly spend-down is met.
  • A separate disability route without the child-route income entry ceiling.
What the help covers
  • Med-QUEST subtracts qualifying bills from income above the kept standard. Meeting that amount establishes the coverage start date for that month.
  • Qualifying expenses can include insurance premiums, cost sharing and certain necessary medical or remedial bills still owed from before the application. A bill cannot be counted twice. Insurance-payable costs, employer-paid premiums and voluntary payments by someone else do not count the same way; Med-QUEST lists the accepted expenses.
  • An old paid receipt does not automatically qualify as an unpaid earlier bill. Premiums covering a longer period are allocated by month. Bills used to meet the spend-down may remain your responsibility rather than becoming reimbursable Med-QUEST bills.
If you decide to apply
  1. Ask the Med-QUEST branch for a spend-down assessment through KOLEA or by phone.
  2. Bring income records, savings information and dated medical bills. Ask the hospital financial counselor to total the charges.

Med-QUEST: 1-800-316-8005; KOLEA application. · Official page ↗

What happens next
  • The branch works out the monthly figure. A written breakdown helps you see which bills it accepted and the date coverage begins.
Good to know

This route checks savings, and coverage starts when the monthly spend-down is met. Bills used to meet it can remain yours.

Other details
  • A new month needs its own assessment. This is different from the ordinary child income screen.

Federal background: Medically needy coverage and spend-down.

Official sources
Ask your social worker

“Could our medical bills open Med-QUEST through spend-down? How much would we still owe, and could you help us request a monthly assessment?”

Why I’m asking: I want to know whether the bills themselves create a route to coverage.

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

Give the branch the month’s bills and ask for a spend-down assessment in writing.

Your social worker

The hospital financial counsellor totals the month’s charges and sends them with the request.

The care team

Records and letters when the application asks for them.

Who decides
The Med-QUEST branch works out the monthly figure.
Ask the agency
“We are over the income line but this month’s hospital bills are large. Please work out our spend-down for this month and tell me which unpaid earlier bills count.”

How to apply

First step: Call Med-QUEST on 1-800-316-8005 and ask for a spend-down assessment for the month with the biggest bills.

  1. Ask Med-QUEST in writing to assess spend-down for the month with the big bills.
  2. Keep every unpaid bill: earlier unpaid bills not used before can count.

Official application / program page ↗

Where it starts: Use the ordinary KOLEA application or call 1-800-316-8005 and ask for a spend-down assessment. No dedicated form was published.

What to gather

  • This month’s hospital and pharmacy bills
  • Earlier unpaid bills
  • Bank balances on the first of the month

How long: The branch works it out monthly; no published turnaround was found.

What a yes looks like

A notice giving Med-QUEST from the day the spend-down was met, with the amount the family must carry.

What a no looks like, and the next move

Ask which figure was used as the kept standard and whether the resource count was right, and appeal by the date on the notice.

Watch out

  • The kept standard is frozen at half of the 2006 poverty guideline, so it does not rise with the current chart.
  • Child spend-down has a 300 per cent entry ceiling; the disabled route has none.
  • Savings count here even though they do not count for food help.

The numbers and the rules

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

What it is worth

Med-QUEST for the month once bills bring income down to the kept standard: $958 a month for four, $795 for three.

  • $958/month — Kept monthly standard, household of 4
  • $795/month — Kept monthly standard, household of 3
  • $9,488/month — Child and pregnancy spend-down entry ceiling, household of 4 (300%)

Covers: Full Med-QUEST coverage for the month the spend-down is met

Legal protection: Qualifying unpaid bills from earlier months, not used before, can count

What it costs the family: The family carries the bills above the kept standard.

The eligibility facts, as published

Who
children under 19 and aged, blind or disabled people
Income
income above the kept standard is spent down on medical bills; child and pregnancy spend-down also has a 300 per cent entry ceiling, the disabled route has none
Resources
$2,000 for one person, $3,000 for two, $250 for each additional person
Assessment
monthly
Coverage start
the date the spend-down is met
Statute
HAR 17-1730.1 (2013 text, still listed)

The trap: The kept standard is not an entry limit. Child and pregnancy spend-down also has a separate 300 per cent entry ceiling, $9,488 a month for four; the disabled route has none. The standard itself is frozen at half of the 2006 poverty guideline, so it does not rise with the current table.

Where I read this

← Back to your options