Hawaii Medicaid Long-Term Care Definition
Medicaid, or Med-QUEST in HI, is a health insurance program for low-income individuals of all ages. While this program provides coverage for various groups of Hawaii residents, the focus here is long-term care Medicaid eligibility for elders, aged 65 and over. In addition to providing care in nursing homes, community care foster family homes, expanded adult residential care homes, and assisted living residences, Med-QUEST pays for non-medical services and supports to help frail seniors live in their homes. There are three categories of long-term care programs for which HI seniors may be eligible.
1) Institutional / Nursing Home Medicaid – An entitlement; 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, expanded adult residential care homes, or in assisted living residences via a managed care system. This allows program participants to receive all needed services via one administering agency. There may be an enrollment cap for HCBS, and therefore, there may be a waiting list to receive services.
3) Regular Medicaid / Aged, Blind, and Disabled – An entitlement; anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.
In Hawaii, the Medicaid program is called Med-QUEST. While this is a state and federally funded program, the state administers the program under federally set parameters. The Hawaii Department of Human Services is the administering agency.
Income & Asset Limits for Eligibility
The three categories of Med-QUEST long-term care programs have varying financial and medical (functional) eligibility requirements. Further complicating eligibility is that the financial requirements change annually, vary with marital status, and Hawaii offers multiple pathways towards Medicaid eligibility.
Hawaii seniors must have limited financial means and a medical need to qualify for Medicaid long-term care. In 2024, a single Nursing Home Medicaid applicant must meet the following criteria: 1) Contribute nearly all of their monthly income towards care costs 2) Assets under $2,000 2) Require a Nursing Home Level of Care.
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 of the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Hawaii. More.
| March 2024 – February 2025 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 limit* | $2,000 | Nursing Home | No hard limit* | $3,000 | Nursing Home | No hard limit* | $2,000 for applicant & $154,140 for non-applicant |
Nursing Home |
| Home and Community Based Services | $1,443 / month (eff. 2/4/24)† | $2,000 | Nursing Home | $1,443 / month per spouse (eff. 2/4/24)† | $3,000 | Nursing Home | $1,443 / month for applicant (eff. 2/4/24)† | $2,000 for applicant & $154,140 for non-applicant |
Nursing Home |
| Regular Medicaid / Aged, Blind, and Disabled | $1,443 / month (eff. 2/4/24) | $2,000 | Help with ADLs | $1,958 / month (eff. 2/4/24) | $3,000 | Help with ADLs | $1,958 / month (eff. 2/4/24) | $2,000 | Help with ADLs |
†The income limit varies based on where the senior lives. While the income limit for a senior living at home is $1,443 / 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 $1,594.90 / month), with the exception of $50 – $70 / month for a Personal Needs Allowance (PNA), 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 PNA between $50 and $70 / month, must go to the foster home caregiver.
Income Definition & Exceptions
Countable vs. Non-Countable Income
Nearly any income from any source that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, Supplemental Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in HI, the VA Aid & Attendance and Housebound Pensions, which are above and beyond the Basic VA Pension, do not count as income.
Treatment of Income for a Couple
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 Monthly Maintenance Needs Allowance (MMNA) to prevent spousal impoverishment. In 2024, the MMNA in HI is $3,853.50 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred to them from their applicant spouse, bringing their monthly income up to $3,853.50. A non-applicant spouse who already has a monthly income of $3,853.50 or more is not entitled to a MMNA / 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. Furthermore, the non-applicant spouse cannot receive a Spousal Income Allowance. More on how Medicaid calculates income.
Asset Definition & Exceptions
Countable vs. Non-Countable Assets
The value of countable assets are added together and counted towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, promissory notes, bank accounts (credit union, savings, and checking), and real estate in which one does not reside. In Hawaii, IRAs are counted. 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, burial spaces, and generally one’s primary home.
Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This holds true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. The non-applicant spouse of a Nursing Home Medicaid or Home and Community Based Services applicant, however, is permitted a Community Spouse Resource Allowance (CSRA). This is a Spousal Impoverishment Provision, and in 2024, allows the community spouse (the non-applicant spouse) to retain up to $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.
Medicaid’s Look-Back Rule
Hawaii has a 60-month (5 year) Medicaid Look-Back Period that immediately precedes the date of one’s Nursing Home Medicaid or Home and Community Based Services application. During the “look back”, Medicaid checks all past asset transfers to ensure none were sold or gifted for less than fair market value. This includes asset transfers made by one’s spouse. If these types of transfers have 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”.
The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, this rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule is a violation of Medicaid’s Look-Back Period.
There is no Look-Back Period for Regular Medicaid applicants and their spouses.
Hawaii Medicaid Home Exemption Rules
For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $1,071,000 (in 2024). Home equity is the value of the home after subtracting any debt against it. Equity interest is the amount of home equity owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.
While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Hawaii’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.
Medical / Functional Need Requirements
For Hawaii long-term care Medicaid eligibility, an applicant must have a functional need for such care. For Nursing Home Medicaid and Home and Community Based Services, an applicant must require a Nursing Home Level of Care (NHLOC). Furthermore, for some program benefits, additional eligibility criteria may need to be met. For example, for Medicaid to pay for home modifications, an inability to safely live at home without modifications may be necessary. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NHLOC is not necessarily required.
Qualifying When Over the Limits
For elderly residents (aged 65 and over) in Hawaii who do not meet the financial eligibility requirements 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 2024, 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 income-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 this rule was not violated.
3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, 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. Connect with a Medicaid Planner.
Specific Hawaii Medicaid Programs
1) QUEST Integration Program – The QI Program is a managed care program that combined two previous programs: QUEST and QUEST Expanded Access (QExA). While medical care is provided via QI, nursing home care and long-term home and community based services are also available to help seniors remain living in their homes, assisted living residences, expanded adult residential care homes, and community care foster family homes. Long-term services and supports may include adult day care, homemaker services, personal emergency response systems, home modifications, respite care, and chore services.
2) Money Follows the Person – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.
How to Apply for Hawaii Medicaid
Seniors in Hawaii can apply for Med-QUEST online on the State of Hawaii My Medical Benefits website, by calling 1-800-316-8005 to reach Med-QUEST enrollment services, or by contacting their local Med-QUEST Office. The application process may vary based on the program for which one is applying.
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. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.