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Hawaii Medicaid and the new work rules
Med-QUEST, Adults group — Hawaii's name for the ACA expansion group, covering people 19 through 64 is run by State of Hawaiʻi Department of Human Services (DHS), Med-QUEST Division (MQD) — the single state agency for Medicaid under Title XIX. The division is led by the Med-QUEST Division Administrator, which is also Hawaii's title for the State Medicaid Director. Hawaii expanded Medicaid on January 1, 2014, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.
From January 1, 2027, most adults have to show 80 hours a month
The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 130,404 people in Hawaii. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.
Hawaii checks first and asks second. Its member notice is explicit: "You do not need to do anything at this time. We will reach out if we need proof." The federal rule requires a state to use the records it already holds — payroll data, its own eligibility system, SNAP and TANF participation, the past twelve months of Medicaid claims and encounter data, and federal data sources — before asking you for anything. So for most people in the group the first they will know of it is either nothing at all or a letter asking for one month's worth of proof. Which makes the address in your KOLEA account the thing that actually decides this.
If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.
That is the range the state itself published.
Hawaii's own figure, and Hawaii's own hedging. Med-QUEST told its advisory committee on August 20, 2025 that "per national guesstimates, if implementation followed other states' implementation: 20 to 40% or 27,000 to 54,000 of current Med-QUEST members could lose coverage" — and said in the same breath that its goal is not to have that level of drop-off, because the federal rules are substantively different from the handful of states that ran work requirements of their own. So this is a worst-case borrowed from elsewhere rather than a forecast. The same presentation records that 61.5% of working-age adults on Med-QUEST are already employed — 36% full-time and 25.5% part-time. Hawaii's legislature has separately estimated that the federal changes together with the expiry of the enhanced marketplace subsidies will leave six to seven percent of Hawaii's population uninsured, but that figure bundles several changes and is not a work-requirement number.
Most of that is expected to be paperwork rather than people becoming ineligible. Which is the whole reason to sort out your address and your proof now rather than at the last minute.
You do not have to prove anything if any of these describe you
Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.
What you can earn and still qualify
Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.
Adults 19 to 64133% of the poverty line
- 1 person
- $2,035
- 2 people
- $2,759
- 3 people
- $3,483
- 4 people
- $4,207
- 5 people
- $4,930
- 6 people
- $5,654
- 7 people
- $6,378
- 8 people
- $7,102
Parents and caretakers100% of the poverty line
- 1 person
- $1,530
- 2 people
- $2,075
- 3 people
- $2,619
- 4 people
- $3,163
- 5 people
- $3,707
- 6 people
- $4,251
- 7 people
- $4,795
- 8 people
- $5,340
Pregnant191% of the poverty line
- 1 person
- $2,923
- 2 people
- $3,962
- 3 people
- $5,002
- 4 people
- $6,041
- 5 people
- $7,080
- 6 people
- $8,120
- 7 people
- $9,159
- 8 people
- $10,198
Source: Hawaii DHS Med-QUEST Division, Policy and Program Development Office, "2026 MAGI and MAGI-Excepted Income Standards Chart," effective January 13, 2026, read alongside Table 2 to Table 4 of the CMS-approved QUEST Integration Special Terms and Conditions of January 8, 2025 and the 2026 HHS poverty guidelines at 91 Fed. Reg. 1797. A note on precision: Three things are worth knowing about these numbers. We publish the state figure.
Two other changes land on the same day
Renewals get more frequent, and back-dated coverage gets shorter.
P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.
Do this now
Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.
About the phone numbers: Expect to wait, and plan around it. CMS's own performance data for Hawaii in June 2026 records an average call center wait of 159 minutes and an abandonment rate of 36% across 27,179 calls — more than a third of callers hung up before anyone answered. Almost everything the phone line does, KOLEA does too, so use medical.mybenefits.hawaii.gov for address changes, document uploads and checking an application, and save the call for something that genuinely needs a person. Two other things catch people out. Med-QUEST no longer publishes separate phone numbers for each island: all nine service centers share 1-800-316-8005, and the old per-island direct numbers still circulating online come from documents dating back to 2014 and 2017. And 1-800-316-8005 is toll free from the neighbor islands and the mainland, while 808-524-3370 is the Oahu local line for the same service.
Deaf, hard of hearing or speech-impaired: 711.
Free interpreter line: 1-800-316-8005.
Med-QUEST's promise is printed on its home page in seventeen languages and it is a simple one: "Do you need help in another language? We will get you a free interpreter. Call 1-800-316-8005 to tell us which language you speak." The seventeen are English, Spanish, Cantonese, Mandarin, Chuukese, French, German, Hawaiian, Ilocano, Japanese, Korean, Marshallese, Samoan, Tagalog, Tongan, Vietnamese and Visayan. Hawaii's language access plan, effective October 10, 2024, treats Chinese, Ilocano, Korean and Vietnamese as the four languages that get translated documents as a matter of course, and names Chuukese and Marshallese alongside them as the most common languages Med-QUEST's own clients report speaking. Every Department of Human Services office has telephone interpreting in more than a hundred languages, 24 hours a day, so a language that is not on any published list can still be arranged by asking; in-person interpreting needs booking ahead. There is one list that is longer than the home page's, and right now it is the one that matters most: Hawaii's notice about the new work rules exists in eighteen languages, adding Kosraean, Pohnpeian, Thai, Russian and Ukrainian, which the home page does not offer. If a letter about the work rules reaches you in English and you would rather read it in your own language, ask for that version by name. Two numbers to be careful with. The non-discrimination notice on Med-QUEST's own pages tells you to call 1-877-628-5076 for language help, directly above taglines on the same page giving 1-800-316-8005; the 1-877 number belonged to the Hawaii Health Connector, which closed in December 2015, so use 1-800-316-8005. And the apply page prints a TTY number of 1-855-889-4325, which reaches HealthCare.gov rather than Hawaii — for relay use 711, or 1-800-603-1201.
Most people who lose coverage lose it over paperwork, not eligibility
7.5% of the coverage losses recorded in Hawaii were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. From January 1, 2027 that matters more, not less.
NOTICE OF ELIGIBILITY DETERMINATION
Case number: ███████
Date of this notice: 1January 12, 2027
Our records do not show that you met the community engagement requirement for the reporting period.
2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.
3Coverage for other members of your household is not affected by this notice.
What the federal data says about coverage here
Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.
Of people who lost coverage here, this share lost it over paperwork rather than eligibility.
Open every letter. Keep your address current with the agency.
Records here are relatively accurate, so treat a notice as real rather than assuming a mistake.
Quintile 1 of 5.
Provider supply here is around the national middle.
Book an appointment before you need one, not when you do.
Where you live in this state changes what coverage is worth. Nearly four in ten Hawaii Medicaid members live somewhere other than Oahu — 156,076 of the 396,361 in managed care in June 2026, across Hawaii Island, Maui, Kauai, Molokai and Lanai — and almost every specialist is on Oahu. The University of Hawaii's annual report to the 2026 Legislature puts the physician shortage at 43% of need on Hawaii Island, 41% in Maui County and 28% on Kauai, against 15% on Oahu, and 833 full-time physicians statewide. So the most useful benefit you may not know you have is this one: Med-QUEST pays for the flight. Hawaii's Medicaid plan provides that "air transportation is provided when required specialized medical services are not available on the island of beneficiary's residence," and the benefit covers the airfare, a round-trip fare for an attendant when your doctor says you need one, and meals, lodging and ground transport if you have to stay overnight — at no cost to you. Ask your QUEST Integration health plan to arrange it at least 48 hours ahead; if you are in fee-for-service rather than a health plan, your doctor has to file form DHS 208 and get it approved before you travel, and travel booked outside Med-QUEST's contracted agent is not reimbursed. One more thing worth knowing before 2027: having to travel off your island for care for a serious or complex condition that is not available where you live is one of the hardship exceptions Hawaii has adopted from the new work rules. Hawaiʻi Medicaid State Plan, Attachment 3.1-D; Med-QUEST, "Non-Emergency Medical Transportation"; Med-QUEST Provider Manual chapter 16, section 16.3, "Inter-Island Travel"; "Report to the 2026 Legislature: Annual Report on Findings from the Hawaiʻi Physician Workforce Assessment Project," University of Hawaiʻi John A. Burns School of Medicine, December 2025, Tables 2 and 3; Hawaii Medicaid Enrollment Report, June 2026
The requirement also reaches a separate waiver group here
Hawaii is one of eight states CMS named for an extra 1115 waiver population.
Who that is. Three groups, not one — more than CMS named in any other state. In the words of Hawaii's own waiver, they are parents and caretaker relatives living with an 18-year-old who would still be a dependent child but for turning 18; people aged 19 and 20 who are receiving adoption assistance, foster care maintenance payments or kinship guardianship assistance; and people under 26 who aged out of an adoption assistance or kinship guardianship agreement with any state and were on Medicaid while receiving it.
The new work rules were written for the ACA expansion group, but federal law also reaches adults covered through a section 1115 waiver that provides full coverage and who are not eligible under the ordinary state plan. CMS reviewed every state's waivers and named thirteen such populations across eight states. Hawaii's row names three of the thirteen — the largest share of any state — and this is the part that should stop a Hawaii reader: all three are, as far as Hawaii's own rules and Hawaii's own website are concerned, invisible. Hawaii does not call them demonstration populations anywhere a member would look. Population 1 sits inside the chapter Hawaii calls the Parents and Other Caretaker Relatives Group. Population 4 sits inside the Children Group. Population 5 sits inside the Former Foster Care Children Group. Those three names are not neutral: two of them correspond to federal categories that genuinely are outside the work rules. The federal rule says in terms that state plan parents and caretaker relatives are not applicable individuals, and former foster care children are an explicit exclusion. So a Hawaii member in any of these three groups can read the federal rule carefully, in good faith, and conclude it misses them. It does not. What CMS named is precisely the margin by which Hawaii's version of each group is wider than the federal version — and nothing Hawaii publishes tells a member which side of that margin they are on.
Take Population 1 first, because it is the sharpest case in the entire eight-state set. The federal rule excludes a parent, guardian, caretaker relative or family caregiver from the work requirement — but it defines a dependent child, for that purpose only, as a child 13 years of age or under. An 18-year-old is not a dependent child. So the one group in Hawaii that exists solely because of parenthood gets no protection whatsoever from the parenthood exclusion. A Hawaii parent whose youngest child at home is 18 is in exactly the same chapter of Hawaii's rules, at exactly the same income limit, as a parent whose youngest is 8 — and the second is excused while the first must demonstrate 80 hours. Nothing in Hawaii's materials explains this. Populations 4 and 5 carry a different version of the same trap. Hawaii's own rule puts them in groups named Children and Former Foster Care Children, and the federal exclusion does cover "the eligibility group serving former foster care children." But that federal group is about having been in foster care and aged out of it. Adoption assistance and kinship guardianship are not foster care, and a 19-year-old still receiving foster care maintenance payments has not aged out of anything. Hawaii folded all of them together under one familiar name years ago; federal law did not.
Two things are not settled. First, nobody can say how many Hawaii residents are in these three groups, including Hawaii. Hawaii's monthly enrollment report breaks members into nine program rows, and Populations 1, 4 and 5 are buried inside two of them — Parents/Caretakers, with 50,390 people in June 2026, and Current and Former Foster Care, with 6,061. The waiver's own reporting categories lump all three under "Adults" alongside the whole expansion group. No published figure separates them. Second, Georgetown CCF reports that since the deck was posted CMS "has been working with at least some of the states with small, targeted Section 1115(a)(2) demonstrations to assess whether some kind of exception might be allowed." No government source confirms that and the rule contains no size-based exception, so treat it as advocacy reporting rather than fact. What is settled is that CMS named three Hawaii populations, that the naming follows logically from the rule's own text, and that Hawaii has published nothing at all acknowledging it.
If you are covered one of these ways rather than through the ordinary expansion group, the rules above still reach you. Don't assume otherwise because your coverage has a different name.
CMS, "Community Engagement Requirement for Certain Individuals — Interim Final Rule with Comment Period (CMS-2454-IFC) Overview Slide Deck," posted to medicaid.gov July 27, 2026, slide 9; CMS interim final rule, 91 Fed. Reg. 33348, with the section 1115(a)(2) waiver population discussion at 33353-33354 and the specified excluded individuals at 42 CFR 435.554, 91 Fed. Reg. 33471-33472 (June 3, 2026); Hawaiʻi QUEST Integration Section 1115(a) Demonstration, project number 11-W-00001/9, approval period January 8, 2025 through December 31, 2029 — expenditure authority 1 and Special Terms and Conditions Table 4; Hawaii Administrative Rules 17-1715 (Children Group), 17-1715.1 (Former Foster Care Children Group) and 17-1717 (Parents and Other Caretaker Relatives Group), compiled November 10, 2016; Med-QUEST, "Medicaid Programs"
Questions people ask about this
Do the new Medicaid work rules apply to me in Hawaii?
How many hours a month do I have to work?
Who is exempt from the work requirement in Hawaii?
When do the Hawaii work rules start?
What is the income limit for Hawaii Medicaid?
How do I apply for Med-QUEST, Adults group — Hawaii's name for the ACA expansion group, covering people 19 through 64?
How often do I have to renew Hawaii Medicaid?
Guides for every other state
Hawaii doesn't share a border with anywhere else, but the rules change completely from state to state. If you're helping family on the mainland, start with their state rather than this one.
Hawaii asks less of you than the headlines suggest: you need to have worked, volunteered, studied or earned $580 in just one of the six months before your renewal — not every month, and the date that decides anything for someone already enrolled is your own 2027 renewal rather than January 1.
Med-QUEST's own notice says you do not need to do anything yet and that it will write to you only if it cannot find proof in records it already holds. Which makes one thing worth doing today: log in to KOLEA at medical.mybenefits.hawaii.gov and check that your address, phone and email are current, because the letter is how you will find out. If you call 1-800-316-8005 instead, be ready to wait — Hawaii's Medicaid call center averaged a 159-minute hold in June 2026 and more than a third of callers gave up.
Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.
Go to KOLEA at medical.mybenefits.hawaii.gov →