UnitedHealthcare Community Plan
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Frequently Asked Questions

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UnitedHealthcare Community Plan - QUEST Integration Program (January 1, 2015)

What is Medicaid?
Medicaid is a program for people with low income who meet certain eligibility requirements and programs can vary from state-to-state.
Who is eligible for Hawaii Medicaid?

To qualify for Medicaid, potential members or their children must:

  • Be a Hawaii resident
  • Be a U.S. citizen or a legal resident
  • Meet certain resource and income limits
  • Fit into one of these groups:
    • Parent and caretaker relatives
    • Children
    • Pregnant women
    • New adult group
    • Non-U.S. citizen needing emergency medical services
    • Children or pregnant women who are medically needy due to high medical bills
How do I find out what drugs are on the formulary?

You or the member may call Customer Service toll-free at 1-888-980-8728 (TTY/TDD: 711) to request a printed copy of the formulary, or you may visit this link:  Search for drugs covered by UnitedHealthcare QUEST Integration Program     

What documents will members need when they apply for Medicaid?

When applying for services, potential members will need to take or mail (if available) the following documents:

  • Pay stubs or other papers to show all family members' monthly income.
  • Social Security numbers for all individuals who want Medicaid (not required for children less than 6 months of age).
  • Papers that show family resources for all individuals who want Medicaid (for example: bank records, make, model, and year of your vehicles). This is not needed if they are applying because someone is pregnant or if they are applying only for children (age 18 or younger).
  • Legal resident papers if the potential member is not a U.S. citizen and he/she wants Medicaid for them self.
  • Proof of residence (for example: gas, electric, or water bill, letter from his/her landlord). This is not needed if applying only for children (age 18 and younger).
  • NOTE: Potential members may ask a friend or other person you choose to be their "authorized representative" to apply for him/her. He/she may also ask for a language or a sign interpreter to help him/her apply. Ask for an interpreter when calling to set up an appointment.
What should a member do if he/she has a medical emergency?

If a member has a medical emergency:

  • They need to get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. Members don’t need to get approval or a referral first from his/her primary care provider or other plan provider. 
  • Make sure that the member’s primary care provider knows about the member’s emergency, because the primary care provider needs to be involved in following up on the member’s emergency care. The member or someone else should call to tell his/her primary care provider about the emergency care as soon as possible, usually within 48 hours
How to get urgently needed care?
If, while temporarily outside the Plan’s service area, and the member requires urgently needed care, then the member may get this care from any provider. The plan is obligated to cover all urgently needed care at the cost-sharing levels that apply to care received within the Plan network.
What is a referral?

A referral is from your PCP for you to see a specialist to get services. A referral is not needed when you see any specialist that is in our network that your PCP referred you to. You do not need a referral for the following services:
• Emergency Services
• Women’s health care services, including yearly exams, pap smears, breast exams and birth control
• Behavioral health services, such as counseling or treatment for alcohol and drug use
• Covered family planning services

What is a prior authorization?

You may need approval or permission to get some services under our plans. This is called a prior authorization. Your PCP will work with us to get prior authorization if needed.

You do not need a prior authorization for emergencies.

You do not need it to see a women’s health provider for women’s health or if you are pregnant.

Some services that need a referral will also need a prior authorization.