Hawaii Medicaid Definition
In Hawaii, the Medicaid program is called MedQuest. The agency that administers MedQuest is the Hawaii Department of Human Services.
Medicaid is a health insurance program for low-income individuals of all ages. Jointly funded by the state and federal government, it provides coverage for various groups of Hawaii residents. This includes pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. The focus of this page, however, is strictly on Medicaid eligibility for Hawaii elders, aged 65 and over. Specifically, long term care is covered. In addition to providing care in nursing homes, community care foster family homes, and assisted living residences, MedQuest pays for non-medical services and supports to help frail seniors remain living in their homes.
Income & Asset Limits for Eligibility
There are several Medicaid long-term care programs for which Hawaii seniors may be eligible. These programs have varying financial and medical (functional) eligibility requirements, as well as 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; Anyone who meets the eligibility requirements will receive benefits. Assistance is only provided in nursing home facilities.
2) Home and Community Based Services (HCBS) – Hawaii used to offer HCBS Medicaid Waivers for the elderly, but no longer does. 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 HCBS Waivers, the managed care program does not have enrollment caps. This means there are no waiting lists for home and community based services.
3) Regular Medicaid / Aged, Blind, and Disabled – This is an entitlement program; Anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Hawaii Medicaid / MedQuest program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Hawaii. More.
|March 2022 – February 2023 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*||$2,000||Nursing Home||No hard income limit*||$4,000 ($2,000 per spouse)||Nursing Home||No hard income limit*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Home and Community Based Services||$1,303 / month†||$2,000||Nursing Home||$1,303 / month per spouse if living at home†||$4,000 ($2,000 per spouse)||Nursing Home||$1,303/ month for applicant if living at home†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged, Blind, and Disabled||$1,303 / month||$2,000||Help with ADLs||$1,755 / month||$3,000||Help with ADLs||$1,755 / month||$2,000||Help with ADLs|
†The income limit varies based on the location in which the senior lives. While the income limit for a senior living at home is $1,303 / month, any income that exceeds that amount must go towards one’s care costs. For a senior SSI recipient seeking home and community based services in an adult foster care home / community care foster family home (CCFFH), the entire SSI amount ($1,492.90 / month), with the exception of $50 – $70 / month for a personal needs allowance, must go towards their care costs. To avoid confusion, SSI payments for persons residing in CCFFH’s are higher than for persons residing at home or in assisted living. If a senior has income that exceeds the SSI amount, $419 / month must be paid towards the cost of room and board. The remaining funds, with the exception of a personal needs allowance between $50 and $70 / month, must go to the foster home caregiver.
What Defines “Income”
Any income that a Medicaid applicant receives is counted. 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. Covid-19 stimulus checks and Holocaust restitution payments do not count as income and do not impact Medicaid eligibility.
When only one spouse of a married couple applies for Nursing Home Medicaid or Home and Community Based Services Medicaid, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and has no impact on the applicant spouse’s eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) to prevent spousal impoverishment. In 2022, the MMMNA in HI is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from their applicant spouse, bringing their monthly income up to $3,435. A non-applicant spouse who already has a monthly income of $3,435 or more is not entitled to a MMMNA / spousal income allowance.
Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind, and Disabled; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. For additional information on how Medicaid calculates income, click here.
Please note that many states change their income limits in January, but Hawaii’s income limits increase in March of each year.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, IRAs, promissory notes, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that Medicaid does not count; They are exempt from the asset limit. Exemptions include personal belongings, such as clothing, household furnishings and appliances, an automobile, a burial plot, irrevocable funeral trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in it or have intent to return, and in 2022, their home equity interest must not be greater than $955,000. Equity interest is the amount of the home’s value owned by the applicant. If a spouse lives in the home, it is exempt regardless of where the applicant lives or their home equity interest.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a Nursing Home Medicaid or Home and Community Based Services Medicaid applicant is permitted a Community Spouse Resource Allowance (CSRA). This is a spousal impoverishment provision, and in 2022, allows the community spouse (the non-applicant spouse) to retain up to a maximum of $137,400 of the couple’s assets, as shown in the chart above.
Hawaii has a 60 month (5 year) Medicaid Look-Back Period that immediately precedes the date of one’s long-term care Medicaid application. During this period, Medicaid checks all past asset transfers to ensure no assets were sold or gifted for less than fair market value. This includes asset transfers made by one’s spouse. If these types of transfers has been made, the Medicaid agency assumes it was done to meet Medicaid’s asset limit. A penalty period of Medicaid ineligibility will be calculated for anyone who violates the “look back”.
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 – Hawaii has a Medically Needy Program that allows seniors who are over the income limit to become income eligible if they have high medical expenses. Also called a Spend-Down Program, one’s “excess” income is used to cover medical services / goods. This may include paying for overdue medical bills, prescription drugs, private health insurance, and medical expenses that Medicaid does not cover. In 2022, the medically needy income limit (MNIL) in HI is $469 / month for an individual and $632 / month for a couple. The “spend down” amount, which can be thought as a deductible or a share of cost, is the difference between one’s monthly income and the MNIL. Once the “spend down” has been met for the month, one is eligible for Medicaid benefits for the remainder of the month. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple.
2) Asset Spend Down – Persons who have assets over Medicaid’s limit can “spend down” assets on non-countable ones and become asset eligible. This can be done by making home modifications (i.e., the addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value, as doing so violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program.
Read more or connect with a Medicaid planner.
Specific Hawaii Medicaid Programs
Like all states, Hawaii Medicaid / MedQuest pays for nursing home care for state residents who are medically and financially eligible for such care. HI Medicaid also offers Medicaid programs for seniors who require nursing home level of care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.
1) Med-QUEST – This is a managed care program, previously called Expanded Access (QExA), that covers care services in a variety of settings, including program participants’ homes, assisted living residences, and community care foster family homes. Other benefits via this program include adult day care, homemaker services, personal emergency response systems, home modifications, respite care, and chore services.
How to Apply for Hawaii Medicaid
Seniors in Hawaii can apply for MedQuest online on the State of Hawaii My Medical Benefits website, by calling 1-800-316-8005 to reach MedQuest enrollment services, or by contacting their local MedQuest Office.
It is vital that HI Medicaid applicants be certain that all eligibility requirements are met prior to applying for Medicaid benefits. Seniors who are uncertain, or who have excess income and / or assets, should make preparations to ensure all eligibility requirements will be met. This is where Medicaid planning comes in. Applying for Medicaid can be a complicated process, and if not done correctly, it can cause a delay or denial of benefits. To learn more about the application process for long-term care Medicaid, click here.