Medical Financial Assistance Program for Hawaii
- What's new? »
- Who is eligible? »
- What does the program cover? »
- How do I apply? »
- Appeal process »
- Other programs and resources »
- Need help? »
- Leer esto en español »
Having trouble paying for your Kaiser Permanente medical and pharmacy expenses?
Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, collectively referred to as Kaiser Permanente, are committed to providing programs that facilitate access to care for vulnerable populations. This commitment includes providing financial assistance to qualified patients who are uninsured or underinsured and have low incomes, when the ability to pay for services is a barrier to accessing emergency and medically necessary care. Patients must meet the eligibility requirements explained below to qualify.
What's new?
As of August 1, 2022, when applying for medical financial assistance, award amounts will be based on your gross household income (before taxes) as a percentage of the federal poverty guidelines. If your household has a higher income, you may qualify for an award equal to a maximum of 50% of your share of eligible medical expenses. Households with lower incomes can qualify for an award covering up to 100% of their share of eligible medical costs.
As of October 1, 2022, patients with Medicare Part D who are approved for a partial MFA award, will be expected to pay the remaining pharmacy balance at the point of sale or when ordering by mail.
Award amounts are based on your household income as a percentage of the 2023 federal poverty guidelines:
- 100% of your share of eligible costs for households with incomes at or below 200% of the federal poverty guidelines
- 50% of your share of eligible costs for households with incomes between 201% and 300% of the federal poverty guidelines
If your household or family size is: |
2023 federal poverty guidelines (FPG) | |
|---|---|---|
100% award for gross monthly household income at or below 200% of FPG |
50% award for gross monthly household income between 201% and 300% of FPG | |
| 1 | Up to $2,795 | $2,796 a $4,193 |
| 2 | Up to $3,780 | $3,781 a $5,670 |
| 3 | Up to $4,765 | $4,766 a $7,148 |
| 4 | Up to $5,750 | $5,751 a $8,625 |
| 5 | Up to $6,735 | $6,736 a $10,103 |
| 6 | Up to $7,720 | $7,721 a $11,580 |
Visit aspe.hhs.gov/poverty to find the guidelines for larger households.
Disclaimer
Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. The MFA award is not a covered benefit and will not impact your existing plan coverage.
Who is eligible for Financial Assistance and what are the requirements?
The Medical Financial Assistance (MFA) program helps low-income, uninsured, or underinsured patients who need help paying for all or part of their medical care received from Kaiser Permanente. Patients are eligible for financial assistance when their family income is at or below 300% of the Federal Poverty Guidelines (FPG). Patients should consult with a counselor to determine eligibility and for assistance applying. Patients who have experienced unusually high medical expenses may be eligible for the program, regardless of household income. Refer to the MFA Policy for a complete description of the program eligibility requirements.
What does the program cover?
The MFA program covers emergency and medically necessary health care services, pharmacy services and products, and medical supplies provided at Kaiser Permanente facilities (such as hospitals, medical centers, and medical office buildings), at Kaiser Permanente outpatient pharmacies, or by Kaiser Permanente providers. Services that are not considered emergent or medically necessary as determined by a Kaiser Permanente provider include, but are not limited to, cosmetic surgery or services, infertility treatments, retail medical supplies, surrogacy services, and services related to third-party liability, or workers’ compensation cases. Refer to MFA Policy for a complete list of eligible and ineligible services.
Which providers are and are not covered under the program?
The list of providers in Kaiser Foundation Hospitals that are and are not covered under the MFA policy can be found in our Kaiser Permanente provider list for Hawaii.
How can I get program information?
Copies of the MFA policy, application forms, instructions, and plain language summaries (such as policy summaries or program brochures) are available to the general public, without charge, from Kaiser Permanente’s website, by email, in person, by telephone, or by U.S. postal mail.
Download program information:
| Medical Financial Assistance Policy (English) | Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese |
| Program Summary (English) | Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese |
| Program Application (English) | Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese |
Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-808-432-7940 or 1-800-598-5928 to request electronic copies. Please be prepared to provide an email address that the information can be sent to when calling.
Obtain program information in person: Program information is available at Admitting and Emergency Room Departments in Kaiser Foundation Hospitals. Financial Counselors are also available at Kaiser Permanente medical centers and medical office buildings to provide program information and to quickly determine MFA eligibility. Financial Counselors are available Monday through Friday, 8:30 a.m. to 5 p.m. at the Business Services Office in each of the following Kaiser Permanente facilities:
Moanalua Medical Center
3288 Moanalua Road
Honolulu, HI 96819
Honolulu Medical Office Building
1010 Pensacola Street
Honolulu, HI 96813
Waipio Medical Office Building
94-1480 Moaniani Street
Waipahu, HI 96797
Mapunapuna Medical Office Building
2828 Pa’a Street
Honolulu, HI 96819
Request program information by telephone: Financial counselors are available by telephone to provide information, determine MFA eligibility, and assist a patient to apply for MFA. Financial counselors can be reached Monday through Friday, 8:30 a.m. to 5 p.m. Hawaii time, at 1-808-432-7940 or 1-800-598-5928.
Request program information by mail: A patient can request program information by mail. Information requests can be mailed to:
Kaiser Permanente
Attention: MFA Program – Business Services
3288 Moanalua Road
Honolulu, HI 96819
How do I apply?
You can apply for medical financial assistance through Kaiser Permanente during or following a course of care or treatment received from Kaiser Permanente. To be eligible for the program, you must demonstrate an immediate need caused by a bill for an outstanding balance for Kaiser Permanente services, a scheduled appointment with Kaiser Permanente, or a pharmacy prescription ordered by a Kaiser Permanente provider for eligible services and meet income qualifications.
When you apply, you will be asked to list your household size and total gross household income, which will be validated by an external data source. Applying online is the quickest and easiest way to apply. If your income recently changed or you prefer to submit current financial documentation, you can fax or mail your MFA program application, along with your supporting financial documentation, as specified below.
Household income source |
Financial documentation to submit |
|---|---|
| Employment income wages | Current pay stub with pay period and year-to-date gross wages |
| Business income/rental property | Most recent tax return and all schedules |
| Unemployment benefits/disability income | Unemployment Benefit Payment Summary showing your gross weekly benefits |
| Alimony/child support | Court Divorce Decree/amount awarded |
| Pension or retirement/annuities | Monthly gross benefit letter or most recent tax return and all schedules filed |
| Social Security/Supplemental Security Income/veterans benefits | Social Security and/or monthly veterans benefit letter showing the gross benefit |
Important: Any missing or unclear information may delay the application process or result in a denial.
What should I expect after I apply?
After we review your completed application, we’ll send you a decision within 30 days of receipt. If it is not approved, we will provide a reason for the denial and instructions on how to appeal the decision if you disagree.
Apply online
- Before starting the online application process, be prepared to provide all the information listed on the MFA application.
- To begin your application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to complete your application.
Mail it
- Complete the MFA application on the following page.
- Mail your completed application to:
- Kaiser Permanente
Attention: MFA Program — Business Services
3288 Moanalua Road
Honolulu, HI 96819
Drop it off
- Complete the MFA application.
- Drop off your completed application at any Kaiser Permanente facility.
Meet with a financial counselor
Meet with a financial counselor at one of our designated facilities, Monday through Friday, 8:30 a.m. to 5 p.m. Hawaii time.
- Moanalua Medical Center
- Waipio Medical Office Building
- Honolulu Medical Office Building
- Mapunapuna Medical Office Building
Be prepared to provide all the information listed on the MFA application.
Kaiser Permanente will review submitted applications when they are complete and will determine whether you are eligible according to the Kaiser Permanente Medical Financial Assistance Policy. Incomplete applications may result in a delay in processing or denial of your MFA application, but Kaiser Permanente will notify applicants and provide an opportunity to send in the missing documentation or information, by the required deadline.
Appeal process
Amounts Generally Billed
Amounts Generally Billed is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service and Medicaid fee-for-service (and co-pays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2021, to September 30, 2022, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2023 AGB reduction to gross charges is 61% for hospital charges.
Is there language assistance?
Interpreters are available to you at no cost. The medical financial assistance application, policy, and policy summary may be available in your language. For more information, call 1-808-432-5955.
Other beneficial programs and extra resources:
If you don’t have health care coverage and would like more information, call us at 1-800-479-5764 (TTY 711) Monday through Friday between 9 a.m. and 5 p.m. to learn more about your coverage options.
We’re here to support you however we can. If you need help with essentials like food or housing, or need assistance paying bills, start your search at kp.org/communityresources or call 1-800-443-6328 (TTY 711), Monday through Friday between 8 a.m. and 5 p.m.
Need help?
For help or questions about the Medical Financial Assistance application process or other questions, please call 1-808-432-7940 or 1-800-598-5928, or speak to a financial counselor within the Business Services Department at the Kaiser Permanente hospital.