At a time when purse strings are tightening around the nation's shrinking store of tax dollars, the prospect of a government program with the potential to use them effectively comes as a rare piece of good news.

Such is the case with the new Quest Expanded Access (QExA), which makes more health services broadly available to the elderly and disabled lower-income people enrolled in the federal Medicaid program.

Essentially, the new program, which goes live Feb. 1, shifts the most vulnerable Medicaid clientele to a managed-care health plan. Currently, the care of this group is covered through a fee-for-service program.

The very term "managed care" has acquired — unfairly — a negative connotation. The emphasis on regular, proactive and preventive care may be especially well suited to this group. Many people can sustain healthier, more independent living with the early medical interventions that managed care encourages.

Among the advantages, clients will have a personal care physician, who will work with a service coordinator to develop a care plan. Long-term care will be more broadly available than it is now, including new coverage for at-home health and support services that will make it easier for people to remain at home.

Moreover, officials of the state Department of Human Services, the agency that administers federal Medicaid funds in Hawai'i, figure that regular preventive care often is cheaper over the long term.

The state's 37,000 QExA clients must select between two providers by the Dec. 1 deadline, or have the health plan chosen for them.

Fortunately, the state has given them ample leeway to change their selection. In addition to the yearly open-enrollment period, each new enrollee can opt for a 90-day trial period in each plan to check out both of them.

But it's critical for clients and their loved ones to get the advice that's offered through outreach programs and through a phone consultation service.

If this program works as anticipated, it should be tracked and adopted by more providers, public and private, as a model of care that's user-friendly, accessible and cost-effective, as well.