Hawaii Med-QUEST for a Grandchild: Medicaid Application and Income Rules

Health Coverage for a Child You Are Raising in Hawaii

Getting a grandchild or relative's child onto health insurance is usually one of the first things a new kinship caregiver needs to do. In Hawaii, the Med-QUEST Division administers Medicaid through a managed care system called QUEST Integration. The income limits for children are high enough that most kinship-care children qualify — and if you are not claiming the child on your taxes, your income may not count at all.

MAGI Income Limits for Children

Med-QUEST uses Modified Adjusted Gross Income (MAGI) rules for children. No asset or resource test applies — savings, vehicles, and property are irrelevant. The income thresholds use Hawaii-specific Federal Poverty Level guidelines, which are higher than mainland standards:

• Children (Medicaid): up to 138% FPL for ages 6–18 ($2,112/month for a one-person household), 144% for ages 1–5 ($2,204), and 196% for children under age 1 ($2,999)
• S-CHIP children under 19: up to 313% FPL ($4,789/month for a one-person household)
• Pregnant women: up to 196% FPL
• Caretaker adults: up to 138% FPL

The key rule for kinship caregivers: if you do not claim the child as a tax dependent, your income generally is not included; Medicaid's non-filer rules may still count other family members who live with the child.

If you do claim the child as a dependent, your household income is evaluated, and the applicable age-based limit applies.

How to Apply

Two paths:

Online: Use the KOLEA portal at medical.mybenefits.hawaii.gov. The portal walks you through the application and lets you upload documents electronically.

Paper: Submit Form DHS 1100 (the canary-colored form) to any county processing center. The form requires a signature on page 11. If you are applying on behalf of a minor as an authorized representative, complete Appendix C.

For urgent medical needs, a licensed physician completes Form DHS 1149. If the eligibility worker determines that expedited processing is warranted, DHS must process the application within 48 hours or two working days of receiving the form.

Managed Care Plans and What They Cover

After approval, Med-QUEST assigns the child to one of the QUEST Integration health plans: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, or UnitedHealthcare Community Plan. You receive a mailed packet to choose a plan. If Med-QUEST auto-assigns one, you have 15 days to switch.

Children's coverage under QUEST Integration is comprehensive. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) standard covers well-child visits, immunizations, vision, hearing, dental care through the Community Case Management Corp (CCMC), behavioral health services, and specialized therapies. For children with severe emotional disturbances, care may be coordinated with the Department of Health's Child and Adolescent Mental Health Division.

The Medically Needy Spend-Down

If the child's household income exceeds standard MAGI limits — less common for children but possible when a caregiver claims them as a dependent — Hawaii has a Medically Needy pathway. For pregnant women and children, the 2026 Medically Needy Spenddown chart uses a 300% FPL standard — $4,590 per month for a one-person household. This is a backup for situations where standard MAGI does not work.

Renewals

Med-QUEST coverage is redetermined annually. The Division runs an ex parte review first, cross-checking state databases to auto-renew when possible. If the automated check cannot verify continued eligibility, Med-QUEST mails a pre-populated renewal form. Return it by the deadline to avoid a coverage gap.

If Med-QUEST terminates coverage because you did not submit the renewal form or necessary information, it must reconsider your eligibility if you submit the renewal form within 90 days after termination. You do not need to file a new application.

Report any changes in household composition or income within 10 calendar days.

For the full application walkthrough, document checklist, and managed care plan comparison, see the Hawaii kinship financial help guide.

Frequently Asked Questions

Can I apply for Med-QUEST using a caregiver health affidavit instead of a court order? A notarized caregiver health affidavit under HRS § 577-28 may authorize a caregiver to consent to a minor's medical care, except when the child is in DHS custody under Chapter 587A. Med-QUEST applications use separate authorized-representative provisions for filing on behalf of a minor.

Does QUEST Integration cover dental for children? Yes. Dental care for children is managed through Med-QUEST Dental Care Coordination, covering preventive care, cleanings, restorations, and emergency treatment.

What if we move to another island? Report the move to Med-QUEST within 10 days. Your coverage continues — QUEST Integration operates statewide — but your managed care plan options may change depending on the county.

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