Medicare vs. Medicaid in Hawaii: What Mental Health Professionals Need to Know
Understanding the Difference Between Medicare and Medicaid
Medicaid vs Medicare broken down
I often get asked questions about Medicaid and Medicare- especially questions asking what the difference is between the 2.
As a Hawaii therapist, understanding Medicaid credentialing and Medicare credentialing is essential for staying compliant and serving clients effectively.
So let's walk through these differences one by one (despite the many changes that have happened in our country in 2025, these all seem to remain true at the time of this writing):
What Is Medicaid?
For providers, going through the Medicaid credentialing process (sometimes referred to as “Medicaid credentialing Hawaii”) is required before you can bill for services.
Medicaid is
Issued by each state, but funded by both the state and federal government.
Income based (meaning that you have to be considered low-income in order to qualify.
Not age-based (meaning you can be 1 day old or 101 years old and qualify- as long as you meet the income-related criteria)
Also known as Quest or Med-Quest
Made up of 5 different plans in the state of Hawaii, and those are: HMSA Quest, United HealthCare Quest, Kaiser Quest, AlohaCare Quest, or Ohana Health Plan (meaning that anyone in Hawaii who qualifies for Quest/Medicaid will then be asked to select one of those 5 plans).
A client's primary insurance if that client doesn't have another insurance plan, but is always secondary if the client has some other insurance plan.
Allowing for in-person sessions, telehealth video sessions, and audio-only sessions.
On the other hand…
What Is Medicare?
Clinicians often ask about Medicare credentialing, and whether they need to be credentialed with Medicare to work with certain insurance panels.
Medicare is
Issued and funded by the federal government
Not income based
Always a client's primary insurance if she/he/they have Medicare.
Allowing for in-person sessions, telehealth video sessions, and audio-only sessions. Telehealth and audio-only sessions are still available due to the bipartisan support for telehealth behavioral health coverage for Medicare beneficiaries.
Either age-based or disability-based. Let's unpack this last one a little bit
Someone can become eligible for Medicare when they turn 65 years old.
They can also become eligible for Medicare if the Social Security Administration approves them for disability benefits for either physical health or mental health reasons.
At this time, if they have enough work credits and it is determined that they are no longer able to work, they can pull money from their retirement benefits (i.e. Social Security and Medicare) early.
(Don't worry about determining all of this for a client- have a client apply through the Social Security Administration or ssa.gov to see if they quality for Social Security benefits or Medicare due to a disability).
Can a client qualify for both Medicare and Medicaid?
Yes, absolutely. I have seen many clients qualify for both Medicare and Medicaid- particularly if they have a disability and are also considered low-income.
And in these cases, Medicaid will pay the client's $200/month Medicare premium.
(If someone tells you they have both Medicare and Medicaid but shares that they have a $200/month premium, make sure they call the Social Security office at 1-800-772-1213 to have this premium covered immediately.
How Clients Can Apply for Medicaid and Medicare in Hawaii
A client can apply to Medicaid/Quest by going to mybenefits.hawaii.gov. Your client could also apply via The HealthCare Marketplace either at healthcare.gov, or by calling their 24/7 hotline at 1-800-318-2596.
With this option, even if a client doesn't qualify for Medicaid/Quest, they still may be able to qualify for a stipend for an insurance plan if they don't already have other insurance options.
How can a client apply for Medicare if they're younger than 65 and disabled?
By calling the Social Security office at 1-800-772-1213 to apply for disability benefits, or by applying for disability benefits online at ssa.gov.
How Can Clinicians Get Credentialed with Medicaid and Medicare?
To get credentialed with Medicaid/Quest, you'd have to go through the HOKU database to go through the application process.
If you get stuck during that process, you can contact them at hcsbinquiries@dhs.hawaii.gov, or 1-833-909-3630.
To get credentialed with Medicare, you would begin the credentialing process here.
Medicare Credentialing Support for Hawaii Therapists
Whether you’re just starting with Medicaid credentialing Hawaii, or need Medicare credentialing support, my workshops and resources can help you every step of the way.
If you need help with the Medicare Credentialing process, check out my Medicare Credentialing Workshop. It'll walk you through the steps to get credentialed with Medicare.
Since many insurance plans are either explicitly requiring providers to be credentialed with Medicare, or are refusing to work with providers who aren't credentialed with Medicare, this course offers you a great chance to continue working with the insurance plans you're already working with!
I know there is a lot of information in this email, so feel free to reach out anytime!
Resources for Hawaii Therapists
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About Jessica Wong, LCSW
Jessica Wong is a Licensed Clinical Social Worker and the founder of The Hawaii Therapist Hub, LLC and DaVine Counseling Services, LLC. She provides step-by-step support for Hawaii therapists who want to simplify insurance credentialing, billing compliance, and private practice growth. Jessica’s courses and consultations are designed to cut through the confusion so therapists can run their practices with confidence and clarity.