Hawaii
What Is Hawaii Medicaid Long-Term Care (Med-QUEST)?
Hawaii’s Medicaid program, called Med-QUEST, offers health insurance coverage for low-income residents of all ages. This section focuses on benefits available to seniors aged 65 and over. Med-QUEST provides support not only in nursing homes and assisted living facilities, but also in community care foster family homes and personal residences. Services include both medical and non-medical care aimed at helping seniors remain at home.
1. Who Qualifies for Institutional / Nursing Home Medicaid?
This entitlement program ensures services for any applicant who meets the eligibility requirements. Benefits are only available in licensed nursing facilities.
2. What Are Hawaii’s Home and Community Based Services (HCBS)?
Through a managed care approach, Hawaii coordinates services like adult day care, in-home support, and assisted living through one administering agency. Note that while Expanded Adult Residential Care Homes have state-set reimbursement rates, they do not accept Medicaid beneficiaries. These services may have enrollment limits, which can result in waitlists.
3. What Does Regular Medicaid for the Aged, Blind, and Disabled Provide?
This is an entitlement program that provides personal care services, help with daily activities, and adult day care for eligible seniors.
What Are the Financial Eligibility Guidelines?
Income and asset requirements vary by Medicaid program, marital status, and location. Hawaii also offers multiple eligibility pathways, and the limits are adjusted annually.
Simplified Example (2025)
To qualify for Nursing Home Medicaid, a single senior must:
- Require a Nursing Home Level of Care
- Have countable assets under $2,000
- Contribute most of their monthly income towards care
How Is Income Treated?
What Counts as Income?
Most income sources, including wages, pensions, Social Security, and IRA withdrawals, are countable. Exclusions include Holocaust restitution and VA Aid & Attendance benefits.
How Is Income Evaluated for Couples?
For institutional and HCBS Medicaid, only the applying spouse’s income counts. The non-applicant spouse may receive a Monthly Maintenance Needs Allowance (MMNA) of up to $3,948/month in 2025. For Regular Medicaid, both spouses’ incomes are considered, and no spousal income allowance is granted.
What Assets Count for Medicaid?
Countable vs. Non-Countable Assets
Countable assets include bank accounts, stocks, bonds, and investment properties. Exempt items include household goods, one car, and the primary home (if occupied by the applicant or spouse).
Asset Rules for Married Couples
Assets are considered jointly owned. The non-applicant spouse of a Nursing Home or HCBS applicant can retain up to $157,920 in assets (2025). This does not apply to Regular Medicaid.
What Is the Look-Back Period?
Hawaii enforces a 5-year (60-month) look-back for asset transfers. Transfers for less than fair market value can lead to a penalty. The federal gift tax exclusion of $19,000 (2025) does not apply to Medicaid eligibility.
How Is the Home Treated by Medicaid?
If the applicant or their spouse lives in the home, it is usually exempt. If neither lives there, intent to return is required. For 2025, the home equity interest limit is $1,097,000. The home may be subject to estate recovery after the Medicaid recipient’s death if no proper planning is done.
What Are the Medical Requirements?
Applicants must demonstrate functional need. Nursing Home and HCBS applicants must require a Nursing Home Level of Care (NHLOC). Regular Medicaid requires assistance with Activities of Daily Living (ADLs), though not necessarily NHLOC.
What If a Senior Exceeds the Limits?
1. Medically Needy Option (Spend-Down)
Applicants with high medical costs may qualify by “spending down” income. In 2025, the medically needy income limits are $469/month for individuals and $632/month for couples. Once medical expenses reduce income below these limits, Medicaid benefits may begin for that month.
2. Spending Down Assets
Seniors can convert countable assets into exempt ones by paying off debt, prepaying funeral expenses, or modifying the home. All transactions must be documented to avoid look-back penalties.
3. Medicaid Planning Assistance
Many seniors who exceed financial limits still can’t afford care. Medicaid planning professionals can help implement legal strategies to qualify for Medicaid and protect family assets like the home.
What Specific Medicaid Programs Are Available in Hawaii?
QUEST Integration (QI) Program
This managed care plan provides medical and long-term support services. It includes benefits like home modifications, personal emergency response systems, adult day care, and homemaker services.
Money Follows the Person
This federal program assists Medicaid beneficiaries in moving out of institutional settings and back into the community.
How Do You Apply for Hawaii Medicaid?
Applications can be submitted online via the My Medical Benefits portal, by calling 1-800-316-8005, or by visiting a local Med-QUEST office.
Applicants should confirm that all financial and medical requirements are met before applying. Those who are over income or asset limits are encouraged to work with a Medicaid planner to avoid delays or denials.
