17-1719.1

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HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1719.1
STATE FUNDED AGED, BLIND, AND DISABLED PROGRAM
Subchapter 1 	General Provisions
§17-1719.1-1 	Purpose
§17-1719.1-2 	General requirements
§§17-1719.1-3 to 17-1719.1-7 	(Reserved)
Subchapter 2 	Eligibility Requirements
§17-1719.1-8 	Purpose
§17-1719.1-9 	Basic requirements
§17-1719.1-10 	Categorical requirements for an
aged, blind, or disabled
individual
§17-1719.1-11 	Income requirements
§17-1719.1-12 	Asset requirements
§17-1719.1-13 	Application periods
§17-1719.1-14 	Eligibility review requirements
§§17-1719.1-15 to 17-1719.1-19 	(Reserved)
Subchapter 3 	Freedom of Choice, Enrollment,
Benefits and Disenrollment
§17-1719.1-20 	Purpose
§17-1719.1-21 	Freedom of choice
§17-1719.1-22 	Enrollment into a participating
health plan
§17-1719.1-23 	Benefits
§17-1719.1-24 	Disenrollment from a health plan
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§§17-1719.1-25 to 17-1719.1-29 	(Reserved)
SUBCHAPTER 1
GENERAL PROVISIONS
§17-1719.1-1 	Purpose. 	This chapter establishes
the State Funded Aged, Blind, and Disabled Program for
certain lawfully present non-pregnant adult non-
citizens who are aged, blind, or disabled and
ineligible under chapter 17-1719 solely due to
citizenship or non-citizen status. 	[Eff 	02/27/15 	]
(Auth: 	HRS §346-14) (Imp: 	HRS §346-14)
§17-1719.1-2 	General requirements. 	(a) 	The
confidentiality, administrative appeal, fraud, medical
assistance recovery, application processing,
eligibility review, and adverse action provisions
described in subtitle 12 shall apply to an individual
who applies or is determined eligible under this
chapter. 	For purposes of this chapter, references to
the terms “Medicaid” or “federal medical assistance” in
the provisions listed above shall be replaced with
“state medical assistance under chapter 17-1719.1”,
when applicable.
(b) 	Processing of applications shall be:
(1) 	In accordance with chapter 17-1711.1;
however, subsections 17-1711.1-32(b)-(e)
shall not apply; and
(2) 	Subject to section 17-1719.1-13.
[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14,
346-44) (Imp: 	HRS §§346-14, 346-44)
§§17-1719.1-3 to 17-1719.1-7 	(Reserved).
SUBCHAPTER 2
ELIGIBILITY REQUIREMENTS
§17-1719.1-8 	Purpose. 	This subchapter describes
the basic, categorical, and financial eligibility
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requirements for participation under this chapter.
[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14) (Imp: 	HRS
§346-14)
§17-1719.1-9 	Basic requirements. 	To be eligible
under this chapter, an individual shall:
(1) 	Meet the basic eligibility requirements
described in chapter 17-1714.1, with the
exception of citizenship or non-citizen
status;
(2) 	Be a lawfully present non-citizen;
(3) 	Not be a beneficiary of Executive Actions
including but not limited to, Deferred Action
for Childhood Arrivals (DACA), or Deferred
Action for Parental Accountability (DAPA);
and
(4) 	Be ineligible for Medicaid, with the
exception of emergency medical assistance.
[Eff 	02/27/15 	] 	(Auth: 	8 U.S.C. §1622;
HRS §346-14) (Imp: 	HRS §346-14)
§17-1719.1-10 	Categorical requirements for an
aged, blind, or disabled individual. 	To be eligible
under this chapter, an aged, blind, or disabled
individual shall meet the categorical requirements for
being aged, blind, or disabled, respectively, as
described in chapter 17-1719. 	[Eff 	02/27/15 	]
(Auth: 	HRS §§346-14, 346-29) (Imp: 	HRS §§346-14, 346-
29)
§17-1719.1-11 	Income requirements. 	(a) 	The
applicable standards of assistance for participation
under this chapter are set forth under chapter 17-1719.
(b) 	An individual who meets the requirements of
more than one standard of assistance shall have
eligibility determined based on the standard of
assistance that would be most beneficial to the
individual.
(c) 	Countable income, as set forth in chapter 17-
1724.1, after allowable disregards and exemptions,
shall be compared to the standards of assistance set
forth under chapter 17-1719.
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(d) 	An individual applying for medical assistance
under this chapter shall not be required to apply for
or receive SSI.
(e) 	If an individual’s income exceeds the
applicable standards of assistance set forth under
chapter 17-1719, the provisions relating to an
individual with excess income described in chapter
1730.1 shall apply.
(f) 	An individual who is requesting or receiving
coverage of long-term care services shall be subject to
chapter 17-1724.1, subchapter 8.
[Eff 	02/27/15 	] 	(Auth: 	HRS §§346-14, 346-53)
(Imp: 	HRS §346-53)
§17-1719.1-12 	Asset requirements. 	(a) 	The
personal reserve standards are the maximum amount of
countable assets, as set forth in chapter 17-1719, that
may be held by the household while establishing or
maintaining eligibility for medical assistance under
this chapter and are equal to the resource limits
employed by the SSI program.
(b) 	An individual or household whose equity in
non-exempt assets as determined in chapter 17-1725.1
exceeds the personal reserve standard for medical
assistance for a household of applicable size shall be
ineligible for medical assistance under this chapter.
(c) 	An individual who is requesting or receiving
coverage of long-term care services shall be subject to
the requirements of chapter 17-1725.1, subchapter 7.
[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14) (Imp: 	HRS
§346-14)
§17-1719.1-13 	Application periods. 	(a) 	The
department shall begin receiving applications for state
medical assistance under this chapter starting on the
effective date of this chapter, and may stop accepting
applications pursuant to subsection (d).
(b) 	After the initial application period under
subsection (a) is closed, the department shall accept
applications under this chapter only during an
announced open application period.
(c) 	Prior to the start of an open application
period, the department shall issue a public notice at
least once statewide announcing the start of an open
application period.
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(d) 	The department may close the initial
application period, or any subsequent open application
period, by issuing a public notice once statewide at
least thirty days prior to the date the application
period will be closed. 	Applications received by the
department after the open application period has ended
shall be denied.
(e) 	The restriction on submission of an
application under subsection (b) shall not apply to an
individual who loses eligibility under the Children
Group as a result of reaching age nineteen years or
under the Pregnant Women Group as a result of reaching
the end of the post-partum period, and who is eligible
under this chapter.
(f) 	Upon adoption of this chapter, an individual
receiving state medical assistance as an aged, blind or
disabled individual shall be deemed eligible under this
chapter. 	[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14)
(Imp: 	HRS §346-14)
§17-1719.1-14 	Eligibility review requirements.
(a) 	An eligible individual shall receive an
eligibility review every twelve months.
(b) 	Eligibility shall be redetermined in
accordance with chapter 17-1712.1 and chapter 17-
1714.1, subchapter 5. 	[Eff 	02/27/15 	] 	(Auth: 	HRS
§346-14) (Imp: 	HRS §346-14)
§§17-1719.1-15 to 17-1719.1-19 	(Reserved).
SUBCHAPTER 3
FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND
DISENROLLMENT
§17-1719.1-20 	Purpose. 	This subchapter addresses
freedom of choice, enrollment, benefits and
disenrollment for an individual who is eligible under
this chapter. 	[Eff 	02/27/15 	] 	(Auth: 	HRS §§346-
14, 346-29) (Imp: 	HRS §346-29)
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§17-1719.1-21 	Freedom of choice. 	(a) 	An
individual eligible under this chapter, with the
exception of an individual identified in section 17-
1735.1-2(a), shall be provided a choice of a health
plan and a provider as described in chapter 17-1720.1.
(b) 	An individual eligible under this chapter
identified in section 17-1735.1-2(a) shall choose a
department approved provider as described in section
17-1736-3. 	[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14)
(Imp: 	HRS §346-14)
§17-1719.1-22 	Enrollment into a participating
health plan. 	(a) 	An individual eligible under this
chapter, with the exception of an individual identified
in section 17-1735.1-2(a), shall be enrolled in a
health plan as described in chapter 17-1720.1,
subchapter 2.
(b) 	An individual eligible under this chapter
identified in section 17-1735.1-2(a) shall not be
enrolled into a plan, and services shall be provided on
a fee-for-service basis. 	[Eff 	02/27/15 	] 	(Auth:
HRS §§346-14, 346-29) (Imp: 	HRS §346-29)
§17-1719.1-23 	Benefits. 	(a) 	An individual
eligible under this chapter shall be provided a
standard benefits package by a participating health
plan and other services when appropriate as described
in chapter 17-1720.
(b) 	An aged, blind or disabled individual
identified in section 17-1735.1-2(a) shall be provided
coverage under the fee-for-service provisions described
in chapter 17-1737. 	[Eff 	02/27/15 	] 	(Auth: 	HRS
§§346-14, 346-29) (Imp: 	HRS §346-29)
§17-1719.1-24 	Disenrollment from a health plan.
An enrollee shall be disenrolled from a health plan
under the provisions described in chapter 17-1720.1.
[Eff 	02/27/15 	] 	(Auth: 	HRS §346-14) (Imp: 	HRS
§346-14)
§§17-1719.1-25 to 17-1719.1-29 	(Reserved).
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