When the COVID-19 pandemic swept across the globe in 2020, Hawaii’s enrollment in Medicaid, the public safety-net health insurance program, jumped significantly, spurred by widespread unemployment. In March 2020, the federal Families First Coronavirus Response Act protected this access to health care, essentially pausing requirements for reenrollment verification and paperwork.

As the feds declare an end to the pandemic emergency, loosened rules for establishing Medicaid eligibility will also come to an end. Those insured with Medicaid — known in Hawaii as Med-QUEST — will need to adjust.

Beginning April 1, the state will start to phase in reenrollments — and disenrollments.

Hawaii’s Department of Human Services (DHS), which administers Med-QUEST, now must do its part to keep recipients informed. This is an urgent effort that can also be aided by community organizations and health-care providers who serve Med-QUEST patients.

Access to health care is crucial for every person in the islands. Hawaii recognized this as one of the first round of states to take advantage of a 2014 expansion of the Affordable Care Act (ACA), aka “Obamacare.” This made a wide swath of Hawaii residents with limited incomes, including adults, eligible for Medicaid.

Med-QUEST insurance covers about 33% of the state’s residents — more than 465,000 people, including more than half of the state’s children. Of those, 138,000 have joined Med-QUEST since March 2020.

The worry now is that recipients who grew used to automatic renewal during the pandemic will not pick up on the new rules in time to avoid lost coverage.

DHS’ Med-QUEST Division has already begun putting the word out to recipients, asking that they update their contact information and be alert for renewal paperwork, which will come by mail in a high-visibility pink envelope, starting next month.

Under federal rules, Hawaii must seek to automatically qualify recipients based on information from state payroll data, unemployment records and other programs such as food stamps. If it can be verified that a Med-QUEST client is eligible, they will be automatically reenrolled.

In that case, the pink notice will inform the Med-QUEST client of renewed coverage. Otherwise, the recipient will be asked for more information.

The renewal notices will be spread out evenly across 12 months for Hawaii Med-QUEST recipients, between April and March 2024. The notices will give recipients 30 days to provide additional information.

Extra efforts should be made to establish contact with those who have changed addresses, those with limited English proficiency or disabilities — the groups at greatest risk of falling off the rolls.

Organizations that provide community services, along with caregivers and health-care providers, can help. AARP Hawaii, for example, has already begun working with members and fellow service groups to build awareness among seniors.

For Med-QUEST recipients, the important thing is to be in contact with the program — to update contact information and respond to any communications from Med-QUEST/Medicaid in a timely manner. (See medical.mybenefits.hawaii.gov or call the number on the Med-QUEST card to update contacts.)

DHS must also adhere to high standards of verification and reporting, to avoid excess costs and remain in good standing with federal administrators. Federal rules are stringent, but agencies that bring their records up to date in an accurate and timely manner also qualify for the highest payment rates from Medicaid.

Some people will appropriately fall off the Med-QUEST rolls, including those who have added to their incomes or found new jobs with employer-provided health care. Others may have left the state, or had other changed circumstances.

Estimates of how much Med-QUEST enrollment may change vary. But the highest priority should be placed on continuing coverage for those who qualify.