How Med-QUEST pays for long-term care

How does Med-QUEST pay for long-term care in Hawaii?

Med-QUEST, the Medicaid program run by the Hawaii Department of Human Services' Med-QUEST Division, pays for long-term services and supports through its QUEST Integration (QI) health plans for members who meet its financial rules and are assessed at the needed level of care; covered settings include nursing facilities, expanded ARCHs, community care foster family homes, assisted living and services at home.

Instead of a separate waiver office, a member's QI health plan assigns a service coordinator who arranges the long-term care, including the case management agency for foster family home and expanded ARCH placements. Home and community-based services can include personal assistance, adult day care or adult day health, home-delivered meals, respite, personal emergency response systems and skilled nursing, depending on the assessment.

What are the Med-QUEST income and asset limits in 2026?

For aged, blind and disabled applicants, Med-QUEST's resource limit is $2,000 for an individual and $3,000 for a couple, and its income standard is tied to Hawaii's federal poverty guideline, which for 2026 is $18,360 a year for one person (about $1,530 a month) and $24,890 for two (about $2,074 a month).

Hawaii's poverty guideline is higher than the mainland's, which is why Hawaii figures differ from what families read on national websites. People with income above the standard may still qualify for long-term care, because the cost of care is taken into account; the resident then contributes income toward their care. The exact budget depends on the setting and household, so apply rather than self-screen out.

The home, one car, personal belongings and some burial funds are usually not counted, within federal limits. Confirm details with Med-QUEST, because individual circumstances change the answer.

What is the look-back period, and what protects a spouse?

Med-QUEST reviews asset transfers in the 60 months before a long-term care application; gifts or sales below fair value in that window can cause a penalty period, and federal spousal impoverishment rules let a spouse at home keep a share of the couple's assets (in 2026, a community spouse resource standard between $32,532 and $162,660).

Source: CMS Informational Bulletin, Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026).

A spouse at home may also keep part of the applicant's income through a monthly maintenance allowance. Talk to an elder law attorney before moving assets. See spousal rules and the look-back.

Does Med-QUEST pay room and board in a care home?

Generally no: in community settings such as expanded ARCHs, foster family homes and assisted living, Med-QUEST pays for the care services, while the resident's own income covers room and board, with the amount set by the state's rules for that setting.

In a nursing facility, Medicaid pays the facility's full rate and the resident contributes most of their income, keeping a small personal needs allowance. This difference is why the monthly cash flow looks so different from one setting to another even when the care need is identical.

How do we apply for Med-QUEST long-term care on Oahu?

Apply to Med-QUEST for coverage (online, by mail or at a Med-QUEST eligibility office), ask for a long-term care level-of-care assessment, and once enrolled, work with the QUEST Integration plan's service coordinator to choose the setting; the Hawaii ADRC at (808) 643-2372 and the Elderly Affairs Division at (808) 768-7700 can help families start.

Hospital social workers at Queen's, Kaiser Moanalua, Straub, Pali Momi and Castle start many of these applications at discharge. If your parent is in the hospital now, ask the social worker on the first day, not the last. Med-QUEST's Going Home Plus program helps people move from a nursing facility or hospital back to a community setting.