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About This Handbook - page 46 / 81

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Once you qualify for Medicaid, you must renew your Medicaid eligibility every year.  If you do not renew your Medicaid, or your Medicaid lapses, you will lose your services.  DHS will mail a reminder to renew your Medicaid to the address you give them.  It is very important to inform DHS when you move so they can mail the form to the right place.

Application

You can access the Medical Assistance application online, or you can contact the DHS Eligibility Office near you.  Refer to the Resources, Sample Forms section for a sample Application for Medical Assistance.

To download the application, go to:

http://www.med-quest.us/forms/eligibility/index.html

(Medical Application Form DHS 1100)

To contact a Med-QUEST Division Eligibility Office near you:

Big Island (Hawai`i) – East Hawai`i Telephone: (808) 933-0339

Big Island (Hawai`i) – West Hawai`iTelephone: (808) 327-4970

Kaua`iTelephone: (808) 241-3575

Lana`iTelephone: (808) 565-7102

MauiTelephone: (808) 243-5780

Moloka`iTelephone: (808) 553-1758

O`ahuTelephone: (808) 587-3521

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