Hawaii medicaid request 2026

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4.8 out of 5

44 votes

The document outlines the application process for providers seeking to enroll in Hawaii's Med-QUEST Division Medicaid program, detailing the requirements set by the Affordable Care Act. It specifies a $500 application fee for most providers, exceptions for certain healthcare professionals, and waivers for managed care health plans. The document includes sections for provider information, licensing, and compliance with federal regulations, emphasizing the importance of accurate disclosure of ownership and criminal history. Additionally, it highlights the need for adherence to non-discrimination laws and confidentiality provisions.

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Click ‘Get Form’ to open the Hawaii Medicaid Request in our editor.
Begin with Section I. Enter your National Provider Identifier (NPI) number if applicable, followed by your name and registered business name. Ensure all fields are filled accurately.
In Section II, provide your service address and correspondence details. Make sure to include a valid email address for communication.
Proceed to Section III for licensing information. Attach any required documents such as licenses or certifications as specified.
Complete the additional information sections, ensuring that all signatures are original where required. Review the entire form for completeness before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I contact Hawaii Medicaid?

Call 1-800-316-8005 to tell us which language you speak. (TTY: 711).

How do I email the Hawaii Department of health?

Questions? Please call SHPDA at (808) 587-0788 or email SHPDA at SHPDA@doh.hawaii.gov.

What is the income limit for Medicaid in Hawaii 2025?

You may be eligible for QUEST (Medicaid) if: Youre 19 or older with a total household income at or below 138% of the federal poverty level (for example, $24,826 for a single person or $51,032 for a family of 4 in 2025)

How do I email Hawaii Medicaid provider enrollment?

Our telephone number is: (833) 909-3630. You can also email your questions to: HCSBInquiries@dhs.hawaii.gov.

How do I contact Medicare in Hawaii?

1-800-MEDICARE (1-800-633-4227) Get this form in Spanish.

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Who is eligible for Medicaid in Hawaii?

Apply for Medicaid in Hawaii Eligibility: Children with family income levels up to 308% of FPL. Pregnant women with family income up to 191% of FPL. Adults with family income up to 138% of FPL.

What does documentation require for Medicaid in Hawaii?

We need a social security number and citizenship information for each person who wants medical assistance. We do not need a social security number and citizenship information if a person does not want medical assistance (non-applicant).

What is the highest income that qualifies for Medicaid?

For most states, the Medicaid income limit is $2,901 per month for a single applicant and $5,802 per month for married applicants, typically set at 300% of the Federal Benefit Rate (FBR).