The state terminated Quest health insurance coverage for 11,600 Hawaii residents in April because they failed to return renewal forms as part of a new policy.

Quest, the state’s version of Medicaid, is mailing renewal notices to roughly 200,000 members, including 110,000 children, who are required to return the forms or lose coverage in the government health insurance program for low-income residents.

The first forms were mailed in March to roughly 33,000 Quest members, but about one-third of those did not respond and their coverage was canceled in April. The state will continue mailing forms to about 33,000 members each month until all 200,000 have received forms. Based on the return rate in March, about 69,600 people could lose coverage this year.

Community health providers who care for the bulk of the Medicaid population — many of whom are homeless — are worried that the process will result in a major health care disaster for thousands of people.

"If people don’t hear about it, they’re not going to know until it’s too late," said David Derauf, executive director of Kokua Kalihi Valley Comprehensive Family Services, a federally qualified health center that serves the uninsured and Medicaid patients. "There are people who are on medicines that are keeping them alive. If you’re confronted with chronic illness or suffering from ​a life-threatening illness, that link to care through medical insurance can be a link to your life. This is life or death to you."

Some Quest members have found out their coverage was terminated at their doctor’s office, Derauf said. Some of those said they did not receive the forms, and some were disenrolled from the program even though they completed and sent in the forms, he said.

"It doesn’t serve anyone’s purpose that I can see to have people fall off Medicaid," Derauf said. "It’s very shortsighted if someone is thinking maybe we can save money this way. At the end of the day, it all gets paid for whether in higher insurance costs for all of us or adverse outcomes or more infectious diseases spreading in the community."

The state spends on average about $3,000 per year for each Quest member. The Quest program costs taxpayers roughly $2 billion annually.

The state Department of Human Services, which administers the Quest program, said it has been proactive in notifying beneficiaries affected by the renewal process change and has asked providers and health plans to also spread the word to patients. The department said it ran radio announcements in March and posted the information on its website to alert Quest members.

"In addition, beneficiaries are being sent three separate notices reminding them to respond," said DHS spokes­woman Kayla Rosenfeld. "The first notice is effectively a heads-up letter to look for the eligibility renewal package that will follow two weeks later. The second mailing is the eligibility renewal package. If the eligibility renewal form is not returned, a termination notice is sent."

But providers say those efforts may not be enough because many Quest recipients are either homeless or hidden homeless who use the address of social service agencies or friends and don’t pick up their mail regularly.

"The entire system seems to be contingent on people receiving these forms," Derauf said. "The reality is that there are many cases where they probably haven’t had a chance to update recipient addresses. It’s built on a system that wasn’t particularly accurate."

The mailing of renewal notices in Hawaii was prompted by the federal Affordable Care Act, which requires Medicaid programs in all states to collect additional information on income and tax status, the DHS said.

Quest members previously were "passively renewed," or automatically re-enrolled in the program even if they didn’t return renewal forms each year. That left the possibility that the state was paying for health insurance for people who no longer lived in Hawaii, were no longer qualified based on income or had obtained insurance from another source.

The state will require renewal forms be sent in only this year and then will return to passive renewals.

Meanwhile the DHS termination notices are directing people to the Hawaii Health Connector, the online health insurance exchange created by the ACA.

After reviewing the situation, Connector officials said the exchange will allow individuals and families who lose their coverage because they no longer qualify for Medicaid to purchase insurance through the online marketplace even though open enrollment ended April 30.

"It’s not going to help," Derauf said. "The group we’re talking about are people who can’t afford even the lowest price on the Connector. At the end of the day, it’s much harder to take care of people without insurance. Despite our best efforts we can’t provide the quality of care people deserve for (those) who don’t have insurance."

Sheila Beckham, chief executive officer at Wai­kiki Health, said she is "terribly concerned" because many people still don’t know about the new renewal policy and will likely lose coverage.

"People may choose not to come in if they have to pay out of pocket," she said. "If they have to delay things, it could actually be more expensive in the end because they may have to go to the emergency room or be admitted to the hospital. It puts unnecessary stress on people, especially homeless folks that are already experiencing so many challenges. It’s going to hit these patients quite hard."