Negative Impact of "Mandatory Re-Enrollment" Requirement in RFP to

QUEST Beneficiaries and Providers

Situation:

The Department of Human Services (DHS) has changed the current enrollment process for more than 165,000 QUEST Medicaid beneficiaries in the new Med-QUEST RFP to include a mandatory re-enrollment policy effective August 1, 2006. This change would require QUEST health plan members to re-select their current health plan then at a later date, reselect their primary care physician (PCP).

Beneficiaries will be sent new applications by mail, and given a 30-day window of time to respond. Those who fail to respond will be auto-assigned to a State designated health plan. Thereafter, they will need to re-select their PCP or they will be auto-assigned to a new PCP. If they are auto-assigned to a new health plan, they may not be able to re-select their current doctor.

Currently, existing QUEST beneficiaries are allowed to automatically stay with their existing QUEST health plans and PCPs during annual open enrollment periods without taking any action. Filling out a new application is only necessary if the QUEST beneficiary wishes to change their health plan.

However, with the new “Mandatory Re-Enrollment” requirement, many of the existing 165,000 QUEST beneficiaries are likely not to respond, and as a result, may be reassigned, without their knowledge and consent to new QUEST health plans and completely new PCPs and health care providers, causing potential chaos and disruption in their medical care. Community groups and advocates for Hawaii's QUEST populations have pleaded with DHS to amend the RFP. In the last week the following legislative actions have occurred:

April 6, 2006: Senate Resolution

Senate resolutions SCR 81 and SR 52 (Urging DHS to amend the mandatory re-enrollment policy in the new QUEST RFP) was passed by the Senate Human Services Committee. More than 16 community organizations offered testimony in support of this resolution: Hawaii Pacific Health (Kapiolani Medical Center for Women and Children, Straub Clinic and Hospital, Wilcox Hospital, Kapiolani Medical Center for Women at Pali Momi), Hamakua Health Center, AlohaCare, Community Clinic of Maui, Hana Health, Waikiki Health Center, Waimanalo Health Center, The Queen Emma Clinics, Papa Ola Lokahi, Hawaii Primary Care Association, Kalihi Palama Health Center, Keiki Caucus, Hawaii Independent Physician Association, Hale O Lanakila, MothersCare, and Waianae Coast Comprehensive Health Center.

(See attached testimony excerpts)

April 11, 2006: HB 2043 SD3 – Senate Committee

Through a floor amendment, HB 2043 SD 3 was passed in Senate committee to prevent DHS from initiating mandatory re-enrollment unless a QUEST member belongs to a QUEST health plan that is no longer in existence.

April 19: House Resolution

Despite an overwhelming avalanche of testimony from the community, Rep. Alex Sonson (Chair, Human Services Committee) and Rep. Dennis Arakaki (Chair, Health Committee) deferred a decision on the Resolution to April 21, at 8:00 a.m.

April 20: HB 2043 SD3 – House Committee

Unfortunately, Rep. Sonson and Rep. Arakaki had reservations about passing the Bill so deferred a decision on the Bill to April 25, 10:30 a.m., room 229 at the State Capitol. We urgently need the community to voice their concerns and to pressure Rep. Sonson and Rep. Arakaki to pass the HB 2043 SD3.

April 24, 2:00 p.m.: Public Rally, State Capitol Rotunda

QUEST members, social service and community health center representatives, physicians and providers will rally at the State Capitol to bring public attention to the issue and to urge our legislators to take action and pass HB 2043 SD3.

April 25, 10:30 a.m., Rooms 229, State Capitol: Conference Committee Meeting for HB2043 SD3

House and Senate Conference Committees will decide on the passage of HB2043 SD3, a Bill that will prevent mandatory re-enrollment of all QUEST members.