Hawaii Medicaid (Med-QUEST) Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid’s rules, benefits and name can all vary by state. In Hawaii, Medicaid is also called Med-QUEST. This article focuses on Hawaii Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.
Hawaii Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Hawaii Medicaid, which is called Med-QUEST, will cover the cost of long-term care in a nursing home for financially limited Hawaii seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
- Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
- Skilled nursing care
- Physician’s visits
- Prescription medication
- Medication management
- Mental health counseling
- Social activities
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Hawaii Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $50/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Hawaii Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
Home and Community Based Services (HCBS) Waivers
Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Med-QUEST (Hawaii Medicaid) recipients who require a Nursing Facility Level of Care remain living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care benefits for Hawaii residents who live in their home, the home of a loved one, an expanded adult residential care home, a community care foster home or an assisted living residence. While Hawaii HCBS Waivers can cover long-term care benefits in those settings, it will not cover room and board costs.
Hawaii residents can receive HCBS Waiver long-term care benefits through the state’s QUEST Integration Program.
QUEST Integration Program
The QUEST Integration Program, also known as the QI Program, is a Medicaid managed care program. Med-QUEST (Hawaii Medicaid) beneficiaries can receive all of their Medicaid benefits through this program – medical care, hospital services, prescription medication and long-term care services and supports. QI Program participants must require a Nursing Facility Level of Care or be at risk of requiring it. The state will conduct a functional assessment to see if this level of care criteria is met. The assessment takes into consideration the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.). Cognitive impairments such as Alzheimer’s disease and related dementias are also considered.
QI Program participants can live in their own home, the home of a loved one, an expanded adult residential care home, a community care foster home or an assisted living residence (including memory care facilities specializing in Alzheimer’s disease and other dementias). While the QI Program will provide benefits in those settings, it will not cover room and board costs such as mortgage payments, rent, facility fees, utility bills or food expenses.
QI Program benefits include adult day care, private skilled nursing, meal delivery, homemaker services, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). For QI Program participants who require a Nursing Facility Level of Care, and are not just at risk of requiring it, there are more available benefits, such as chore services, home modifications, specialized medical equipment, transportation assistance and specialized case management. These benefits will be made available depending on the needs and circumstances of each individual.
All Med-QUEST (Hawaii Medicaid) recipients who require a Nursing Facility Level of Care or are at risk of requiring it can have their Medicaid benefits delivered by one plan through the QI Program’s managed care organization. There is no waitlist for that service. However, there can be waitlists for some of the long-term care services and supports.
Aged, Blind, and Disabled (ABD) Medicaid
Hawaii’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care benefits to financially limited Hawaii residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. There may be a wait for long-term care benefits depending on available funds, programs and caregivers.
ABD Long Term Care Benefits
Hawaii ABD Medicaid beneficiaries and applicants who show a medical need for long-term care services and supports can receive some of them through ABD Medicaid. These long-term care benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Hawaii seniors will be evaluated by the state to determine what kind of long-term care benefits they need and Medicaid will cover.
Eligibility Criteria For Hawaii Medicaid Long Term Care Programs
To be eligible for Med-QUEST (Hawaii Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Hawaii Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Hawaii residents have to meet an asset limit in order to be financially eligible for nursing home coverage through Med-QUEST (Hawaii Medicaid). The asset limit for a singe applicant from March 2023 through Feb. 2024 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
For married applicants with both spouses applying for Hawaii Nursing Home Medicaid, the asset limit is a combined $3,000 from March 2023 through Feb. 2024. And for a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance.
There is no set income limit for nursing home coverage through Med-QUEST. However, Hawaii Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $50/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are dual eligible, and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Med-QUEST (Hawaii Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. An applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.) are considered when determining the level of care required. Cognitive impairments such as Alzheimer’s disease and related dementias are also considered, but a diagnoses of those impairments is not an automatic qualifier for needing a NFLOC.
Hawaii Home and Community Based Services (HCBS) Waivers Eligibility Criteria
Financial Requirements
Hawaii residents have to meet an asset limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers through Med-QUEST (Hawaii Medicaid). The asset limit for a single applicant from March 2024 through Feb. 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for Hawaii HCBS Waivers from March 2024 through Feb. 2025 for a single applicant is $1,443/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying for HCBS Waivers in Hawaii from March 2024 through Feb. 2025, the asset limit is a combined $3,000, and the income limit is $1,443/month per spouse. For a married applicant with just one spouse applying, the asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,443/month for the applicant, and the income of the non-applicant spouse is not counted.
Functional Requirements
The functional, or medical, criteria for HCBS Waivers through Med-QUEST (Hawaii Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. An applicant’s ability to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.) are considered when determining the level of care required. Cognitive impairments such as Alzheimer’s disease and related dementias are also considered, but a diagnoses of those impairments is not an automatic qualifier for needing a NFLOC.
Hawaii Aged, Blind, and Disabled Medicaid Eligibility Criteria
Financial Requirements
Hawaii residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid through Med-QUEST (Hawaii Medicaid). The asset limit for a single applicant from March 2024 through Feb. 2025 is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The income limit for Hawaii ABD Medicaid for a single applicant from March 2024 through Feb. 2025 is $1,443/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the asset limit for Hawaii ABD Medicaid from March 2024 through Feb. 2025 is a combined $3,000, and the income limit is a combined $1,958/month. This applies to married couples with both spouses applying or with just one spouse applying.
Functional Requirements
The only functional requirement to receive basic healthcare coverage through Hawaii ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.
How Hawaii Medicaid Treats the Home for Eligibility Purposes
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
- If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $1,071,000 (as of 2024) then the home is exempt.
- If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
- If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $1,071,000.
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
Hawaii Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Hawaii and how you can protect your home from it, click here.
Applying For Hawaii Medicaid Long Term Care Programs
The first step in applying for Med-QUEST (Hawaii Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Med-QUEST when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Med-QUEST applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Hawaii residents can apply online at the state’s My Medical Benefits webpage. They can also apply over the phone at 800-316-8005 or in person at their local Med-QUEST office.
For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Choosing a Hawaii Medicaid Nursing Home
After being approved for nursing home coverage through Med-QUEST (Hawaii Medicaid), seniors have to choose which Medicaid-accepting nursing home will best meet their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have available spaces. Finding the right nursing home can be time-consuming, especially if you are looking in a specific geographic region.
Hawaii has roughly 40 nursing homes that accept Medicaid. More than half are on the island of Oahu, with about 15 of them in Honolulu. There are eight on the island of Hawaii, five on Kauai and three on Maui. Having full coverage through Nursing Home Medicaid is especially valuable in Hawaii, where nursing homes average $13,000/month, which is much more the national average of $8,000/month.
Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also use the Hawaii Aging and Disability Resource Center to find out more information about nursing homes in the state.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? Does it provide transportation? Who are the staff doctors? What are the meals like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
Data collected by CMS reveals that Hawaii nursing homes averaged 30.3 health deficiencies from 2019-2022, which is more than the national average of 25.7. By most other metrics, Hawaii nursing homes were average or above average. They had just 6.5 fire deficiencies from 2019-2022, much less than the nationwide average of 13.5. The nursing staffing hours per resident per day in Hawaii nursing homes was 4.6 during that three-year window, while the national average was 3.7, meaning Hawaii nursing home residents received almost an extra hour of staffed care per day. Only 1.5% of those residents reported depressive symptoms, which is drastically lower than the national average of 8.1%.