Determining whether you or a loved one is eligible is the first crucial step toward tapping into this valuable assistance. Fortunately, Hawaii has streamlined its eligibility criteria under the Med-QUEST Division (MQD), aligning with federal income and clinical guidelines.

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To qualify for Medicaid in Hawaii, an individual must generally meet the following criteria:

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• Be a U.S. citizen or qualified non-citizen
• Be a Hawaii resident
• Meet income and asset limits based on household size
• Require a level of care typically provided in a nursing facility but opt for community-based alternatives

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As of 2024, an individual applying for long-term services and supports (LTSS) under Hawaii Medicaid must have an income at or below 138% of the Federal Poverty Level. That’s approximately $21,186 annually for an individual. For asset limits, individuals may not have more than $2,000 in countable resources (excluding primary residence and one vehicle).

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In addition to financial eligibility, clinical eligibility is assessed through a formal evaluation process. The state's Medicaid program conducts what’s known as a Level of Care (LOC) determination. Health professionals and care managers assess functional limitations such as the need for assistance with daily living activities (e.g., dressing, bathing) and cognitive functioning.

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Specific populations prioritized under Hawaii's HCBS waivers include:

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• Seniors 65 and older
• Individuals with intellectual or developmental disabilities
• Adults with physical disabilities
• Medically fragile children
• People recovering from traumatic injuries or chronic illnesses

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It’s worth noting that people already enrolled in Medicaid don’t automatically receive HCBS services—they will need to specifically apply and be assessed for these supports.

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For caregivers, this process can seem daunting, but there are state caseworkers and community organizations ready to guide you. Don’t be afraid to ask for help. Early planning and persistence often make the difference between delayed care and timely, transformative support.

Applying for Medicaid and its waiver programs in Hawaii may feel like learning a new language—but taking it step by step can simplify the journey. Whether you’re applying for yourself or helping a loved one, understanding the process in detail will save time and cut through confusion.

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1. Begin with Med-QUEST Enrollment

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Before accessing HCBS Waiver services, the individual must first be enrolled in Hawaii’s Medicaid program through the Med-QUEST Division. You can apply:

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• Online at MyBenefits.Hawaii.gov
• By phone at 1-877-628-5076
• In person at local Med-QUEST Eligibility Offices

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At this stage, you’ll provide documentation verifying residency, income, assets, and identity. Once approved for Medicaid, the individual will be assigned to a managed care plan like AlohaCare, HMSA, or UnitedHealthcare Community Plan.

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2. Request a Level of Care Determination

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Next, the individual’s need for HCBS must be officially assessed. The Medicaid program and selected MCO will initiate a Level of Care (LOC) review. This usually involves a nurse or assessor visiting the home to evaluate the individual’s:

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• Ability to perform daily tasks independently
• Cognitive or behavioral functioning
• Medical conditions and need for supervision

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This step is critical in determining whether HCBS is medically justified instead of institutional care.

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3. Participate in Care Planning

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If the individual is approved for HCBS, the managed care organization will help create a personalized care plan. This plan outlines which services are necessary, how often they’ll be provided, and who will deliver them. Examples may include weekly visits from a home health aide, transportation to dialysis, or monthly check-ins with a case manager.

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4. Begin Receiving Services

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Services typically begin quickly after the care plan is approved. Providers may include agency staff or, in some cases, self-directed supports where the beneficiary or their family hires their own workers.

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Important Tip for Families: Keep thorough records of all communication, applications, and assessments. Incomplete documentation is the number one reason for delays in services.

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Understanding this process also allows you to advocate more effectively. If something doesn’t seem right or you’re facing long wait times, don’t hesitate to file a grievance or ask for a reassessment—it’s your right as a participant in Hawaii’s Medicaid system.