'Ohana Leaves Hawaii Medicaid Dec. 31. Its Claims Window Runs to Dec. 31, 2027
About 24,000 QUEST members move to new plans January 1. Enrollment choice closed October 20, so what's left for providers is contracts, transition-of-care files and a run-out clock.
Centene's 'Ohana Health Plan will exit Hawaii's QUEST Medicaid program on December 31, 2026. About 24,000 members will be enrolled in other plans on January 1, 2027. The special enrollment period, October 1 to 20, has already closed.
That is the part members saw. The 'Ohana provider FAQ is where a practice finds what it has to do.
The turn: your obligations to 'Ohana outlast the plan
'Ohana tells providers to keep treating its QUEST members, and keep billing it, for services through December 31. Claims are due 365 days from the date of service, so for December 31, 2026 dates of service the final deadline is December 31, 2027. 'Ohana's customer service line stays open until then for claims status.
What the plan's own notice says
- Member choice: members who didn't pick a plan by October 20 will be assigned one by the Med-QUEST Division (MQD).
- Transition files: from mid-November through December 31, MQD moves enrollment and transition-of-care (TOC) files to each member's new plan.
- Authorizations: existing QUEST TOC policies apply to this one-time transition. Members getting medically necessary covered services “may continue receiving those services through their new health plan without prior authorization and regardless of provider network status.” The FAQ doesn't say for how long, and doesn't say that a new plan will honor an 'Ohana authorization unit for unit.
- Contracting: the FAQ says contracting and credentialing “vary by health plan” and that providers should review which plans they participate in.
The Honolulu Star-Advertiser lists the other QUEST plans as HMSA, AlohaCare, Kaiser Permanente and UnitedHealthcare. Centene gave rising costs, rates that “have not kept pace,” and federal funding changes as its reasons. It also didn't bid on the behavioral health Community Care Services contract.
The limits
Neither document says 'Ohana's QUEST members include ABA clients, or how many. The FAQ promises further notices on run-out procedures. We could not open MQD's own pages, which blocked our requests, so the plan-assignment details come from 'Ohana and the Star-Advertiser.
What you must know or do
- Owners, this week: run your active-client list by payer and flag every child on 'Ohana QUEST. If you have none, you can stop.
- Before mid-November: for each flagged child, find out which plan they chose or will be assigned, and whether you hold a contract with it. A TOC period protects the child's care for a while. It doesn't pay you out of network after it ends.
- Authorization staff: export every open 'Ohana authorization, with units used and units left, before January 1. You may need them to support a transition request.
- Billing: put December 31, 2027 on the calendar as the last day to bill 'Ohana for 2026 services. Submit December claims early rather than at the end of the run-out.