Hawaii Medicaid Definition
In Hawaii, the Medicaid program is also called MedQuest, and the agency that administers it is the Hawaii Department of Human Services.
Medicaid is a wide-ranging health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides health coverage for various groups of Hawaii residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. However, this page is focused strictly on Medicaid eligibility for Hawaii elders, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, in a community care foster family home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Hawaii seniors may be eligible. These programs have slightly different financial and medical (functional) eligibility requirements, as well as varying benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that Hawaii offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program for assistance only in nursing home facilities. Anyone who meets the eligibility requirements will receive benefits via this program.
2) Home and Community Based Services (HCBS) – Hawaii used to offer HCBS Medicaid waivers, but no longer offers them for the elderly. Instead, long-term care services are provided at home, adult day care, community care foster family homes, or in assisted living residences via a managed care system. This allows program participants to receive all needed services via one administering agency. Unlike with waivers, the managed care program does not have enrollment caps, which means there are no waiting lists for home and community based services.
3) Regular Medicaid / Aged and Disabled – this is an entitlement program for assistance at home or adult day care. Anyone who meets the eligibility requirements will receive services via this program.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an Hawaii Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2019 Hawaii Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||No hard income limit. One’s entire income except for $50 / month must go towards cost of care.||$2,000||Nursing Home||No hard income limit. Each spouse’s entire income except for $50 / month must go towards cost of care.||$4,000 (Each spouse can have up to $2,000)||Nursing Home||No hard income limit. One’s entire income except for $50 / month must go towards cost of care.||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||If one lives at home $1,198 / month. For income guidelines for adult foster care, see below.||$2,000||Nursing Home||Each spouse is considered separately. If they are living at home, each spouse can have up to $1,198 / month. Income guidelines for adult foster care are below.||$4,000 (Each spouse is allowed up to $2,000)||Nursing Home||If one lives at home $1,198 / month. For income guidelines for adult foster care, see below.||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,198 / month||$2,000||None||$1,622 / month||$3,000||None||$1,198 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse does not affect the eligibility of the applicant spouse regardless of how much income the non-applicant spouse receives each month. For additional information on how Medicaid calculates income, click here.
For married couples, with non-applicant spouses’ with insufficient income in which to live, there is a Minimum Monthly Maintenance Needs Allowance (MMMNA). The MMMNA is intended to ensure non-applicant spouses have sufficient income from which to live. Basically, if the non-applicant spouse, also called the community spouse or well spouse, has income under $2,366.25 / month, as of 7/1/18 (this figure changes each year in July), he or she is entitled to a portion of the applicant spouse’s income (to bring the non-applicant spouse’s income to $2,366.25 / month). Based on one’s shelter and utility costs, an applicant spouse may be entitled to an even greater amount, up to $3,160.50 / month. (This figure changes January 1st of each year.)
As mentioned above, the income limit to receive home and community based services differ based on the location in which the senior lives. Also, as indicated previously, the income limit for a senior seeking long-term care services at home is $1,198 / month. Any income that exceeds that amount must go towards the cost of one’s care. (This is sometime referred to as a share of cost) For a senior who receives SSI and is seeking HCBS in an adult foster care home, the entire SSI amount ($771 / month), with the exception of $50 / month, must go towards their cost of care. If a senior has income that exceeds the SSI amount, $418 / month must be paid towards the cost of room and board and the remaining funds must be paid to the foster home caregiver. In this case, the senior is also able to retain $50 / month for a personal needs allowance.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are not counted. In other words, they are exempt from the asset limit. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, and irrevocable funeral trusts. One’s primary home, given the Medicaid applicant or their spouse lives in it and the equity value is under $878,000 (in 2019) is also exempt.
For married couples, as of 2019, the community spouse can retain up to a maximum of $126,420 of the couple’s joint assets, as shown in the chart above. This is referred to as the Community Spouse Resource Allowance (CSRA) and is intended to prevent the non-applicant spouse from becoming impoverished.
Please note, it is vital that one does not give away assets or sell them for less than fair market value in an attempt to meet Medicaid’s asset limit. This is because Hawaii has a Medicaid Look-Back Period, which is a period of 60 months (5 years) that dates back from one’s Medicaid application date. During this time frame, Medicaid checks all past asset transfers to ensure no assets were sold or given away for less than they are worth. This includes asset transfers made by one’s non-applicant spouse. If it is determined one is in violation of the look-back period, one will be penalized with a period of Medicaid ineligibility.
Qualifying When Over the Limits
For elderly residents (65 and over) in Hawaii who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In Hawaii, the Medically Needy Pathway allows seniors who are categorically aged or disabled who would otherwise be over the income limit to qualify for Medicaid if they have high medical expenses. In simple terms, one may still qualify for Medicaid services by “spending down” his or her income to the Medicaid income limit. (The Medically Needy Program is sometimes called a Spend-Down Program). One can “spend down” their excess income by paying for medical services / goods. This may include paying unpaid medical bills, prescription drugs, private health insurance, and medical expenses that Medicaid does not cover. Once one has spent their income down to the Medically Needy Income Limit (MNIL), Medicaid will kick in for the remainder of the medically needy period, which is one month in Hawaii. Please note, the aged and disabled MNIL is lower than the income limits mentioned in the chart above. As of 2019, it is $469 for a single senior applicant and $632 for a married elderly couple with both spouses applying for Medicaid.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones. Examples include home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. As mentioned previously, when spending down assets, it’s important that one does not give away assets or sell them for less than their value. Doing so can violate Hawaii’s Medicaid “Look-Back” period and result in penalization in the form of Medicaid ineligibility.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Hawaii Medicaid Programs
Med-QUEST – this is a managed care program, previously known as Expanded Access (QExA), that covers care services in a variety of settings, including one’s home, assisted living residences, and community care foster family homes. Other benefits via this program include adult day care, homemaker services, personal emergency response systems, respite care, and chore services.