The state Department of Human Services has opened up competition among health plans interested in Medicaid Quest contracts.

Quest is a subsidized health insurance plan offered to 165,000 Hawai'i residents who cannot afford their own medical coverage.

Currently only three health plans — AlohaCare, Kaiser Permanente and the Hawai'i Medical Service Association — offer Quest coverage, down from five in 2002.

The state wants to raise the number of options to four. "When plans compete, they typically offer extra services that result in better health outcomes for our clients," DHS director Lillian Koller said in a press release. "Greater competition also tends to produce lower bid prices, so we can stretch our budget and help more people."

If more contracts are awarded, Quest members will be able to choose from an expanded list of health plans when the state begins its "positive enrollment" process.

Starting this year, Quest members will have to re-enroll in a health plan or select another, unless they want the state to reassign them.

Since current Quest clients do not have to do anything to remain with the same provider, the changes raised concerns during the past legislative session.

However, Koller said that after listening to a wide range of viewpoints, DHS modified the request for proposals.

"If a client does not choose a plan and is automatically assigned one, for instance, he or she can easily change plans at any time if their primary care physician is not on the new plan," Koller said.