Auto Assignment Algorithm for QUEST Integration (QI) Members
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Defines how QI members will be auto-assigned to health plans statewide for March 1, 2026 through December 31, 2028, including quality-measure weighting, ranking, and allocation percentages; affects QUEST Integration health plans and MQD auto-assignment configuration.
No material clinical or coverage changes in this revision.
Auto-assignment Allocation and Ranking Rules
Auto-assignment allocation criteria
How auto-assignment percentages are computed and applied based on plan ranking and number of participating health plans.
ALL of the following
If four health plans operate
- Rank 1 (highest) = 40.0% of the quality portion
- Rank 2 = 30.0% of the quality portion
- Rank 3 = 20.0% of the quality portion
- Rank 4 (lowest) = 10.0% of the quality portion
If three health plans operate
- Rank 1 (highest) = 50.0% of the quality portion
- Rank 2 = 30.0% of the quality portion
- Rank 3 (lowest) = 20.0% of the quality portion
Key Terms and Values
Notifications and Operational Contacts
Notify QI health plans and provide MQD contact for questions
Notify QUEST Integration (QI) health plans that MQD is changing the auto-assignment algorithm and that the number of plans available for auto-assignment has decreased in certain counties due to OHP non-renewal; direct any questions to MQD staff as indicated in the memorandum.
- Inform QI health plans that available plans decreased from five to four in Honolulu and Maui counties and from four to three in Hawaiʻi and Kauaʻi counties, effective immediately.
- Advise plans that changes are due to ʻOhana Health Plan not renewing its QI contract beginning January 1, 2027 and MQD/OHP agreement not to increase OHP QI membership for remainder of CY2026.
- Provide MQD contact/notification channel for questions (as directed in the MQD memorandum).
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