From 2004 to 2024, the Health Resources and Services Administration (HRSA) funded the National Coordinating Center for the Regional Genetics Networks (NCC). NCC developed and maintained the Genetics Policy Hub.

With the conclusion of NCC funding, the Genetics Policy Hub (GPH) will no longer be updated or maintained. Information on GPH should be used for historical reference only.

Hawaii

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Updated on October 13, 2023

This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.

Medicaid Coverage Information Published

Yes

State Contact Information

Judy Mohr Peterson
Med-QUEST Division Administrator
Hawaii Department of Human Services
601 Kamokila Blvd, Room 518, PO Box 700190
Kapolei, HI 96709-0190
Phone: (808) 692-8050

https://medicaiddirectors.org/wp-content/uploads/2023/06/Public_DirectorsList_June2023-1.pdf

General Genetic Testing Criteria

Genetic Testing Not Covered

State Specific Definition

A genetic test is the analysis of human DNA, RNA, chromosomes, proteins, or certain metabolites in order to detect alterations related to a heritable disorder. This can be accomplished by directly examining the DNA or RNA that makes up a gene (direct testing), looking at markers co-inherited with a disease-causing gene (linkage testing), assaying certain metabolites (biochemical testing), or examining the chromosomes (cytogenetic testing).

Genetic Services for Children

Genetic Counseling Requirement

Metabolic Formula Coverage Legislation

Hawaii HRS §346-67

Metabolic Formula Coverage & Criteria

Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) Public assistance recipients in this State who receive medical assistance pursuant to this chapter shall be allowed coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism; provided that the medical food or low-protein modified food product is:

Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and
Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453.
The department shall adopt rules pursuant to chapter 91 to effectuate this subsection.
1. All health maintenance organizations and prepaid health plans with which the department executes risk contracts for the provision of medical care to eligible public assistance recipients shall provide notice to their members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members and shall be transmitted to members within calendar year 2000 when annual information is made available to members, or in any other mailing to members, but in no case later than December 31, 2000.
2. For the purposes of this section:
  “Inborn error of metabolism” means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.
  “Low-protein modified food product” means a food product that:
  1. Is specially formulated to have less than one gram of protein per serving;
  2. Is prescribed or ordered by a physician or osteopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and
  3. Does not include a food that is naturally low in protein.
    “Medical food” means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.

Prior Authorization Requirements

Prior Authorization Forms

https://medquest.hawaii.gov/content/medquest/en/archive/PDFs/Frequently%20Used%20Forms%20for%20Providers/DHS1144BForm.pdf

Fee Schedule

https://medquest.hawaii.gov/content/dam/formsanddocuments/plans-and-providers/HI_Fee_Schedule_as_of_20210911_FINAL_20220412.pdf