QUEST is a program the Department of Human Services (DHS) developed for Medicaid clients who are under the age of 65 years and without a disabling diagnosis. The State of Hawaii implemented QUEST on August 1, 1994. QUEST is a statewide section 1115 demonstration project that provides medical and behavioral health service through managed care delivery systems. The QUEST program was designed to increase access to health care and control the rate of annual increases in health care expenditures. The State combined its Medicaid program with its then General Medical Assistance Program and its State Children’s Health Insurance Program and offered benefits to citizens having incomes below 300 percent of the Federal Poverty Level (FPL). Low-income women, children, and adults who had been covered by the two “state-only” programs were enrolled into fully capitated managed care plans throughout the State. This program contributed substantially to closing the coverage gap in the State for low-income individuals. QUEST includes three primary programs: QUEST, QUEST-Net, and QUEST-ACE.
The goals of the QUEST, QUEST-Net, and QUEST-ACE programs are to:
- Improve the health care status of the member population;
- Establish a “provider home” for members through the use of assigned primary care providers (PCPs);
- Establish contractual accountability among the state health plans and health care providers;
- Continue the predictable and slower rate of expenditure growth associated with managed care; and
- Expand and strengthen a sense of member responsibility that leads to more appropriate utilization of the health care system.