Hawaii Medicaid (Med-QUEST) planning and eligibility
A study by the Kaiser Family Foundation in 2003 found that if you are 65 years of age or older, there is a 45% chance that you will spend some time in a nursing home.
The study also found that the average nursing home stay is 2.4 years. The State of Hawaii in November 2008 determined that the average nursing home cost in Hawaii is $8,850 per month. That amounts to $106,200 a year. For the average nursing home stay of 2.4 years, the cost would be $254,880! This means that 45% of the population who are over 65 years of age, face potential nursing home costs of $254,880!
For the person who is not a multi-millionaire, the greatest threat to the estate is not probate. It is not estate taxes. The greatest threat is nursing home costs.
Our firm has been a pioneer in developing Hawaii Elder Law strategies to get clients qualified for long-term care Medicaid while protecting their assets.
“We have saved multiple clients estates from $100,000 to $3,500,000 each. Let us show you how you can protect your assets.”
Need Medicaid ASAP?
For a client who is already in a nursing home or about to enter a nursing home, we use creative techniques to protect as much of the assets as possible, and to get the client qualified for Med-QUEST as soon as possible.
We have had many clients marvel that we have been able to quickly get them qualified for Medicaid for nursing home costs, when they thought they would have to spend down their assets to almost nothing.
Here are some tips to be aware of:
1. Don’t spend down assets.
There are multiple techniques available that are more effective than spending down to qualify for Medicaid.
2. Don’t give away assets without a plan in place.
Gifting prematurely, or to the wrong person, or the wrong types of assets can prevent us from saving your assets.
3. Before bringing your loved one home from the nursing facility, be aware of the consequences.
There is an opportunity to protect assets by gifting and starting a penalty period while still in the nursing home. This opportunity is lost once the patient comes home.
4. Make sure you have a Power of Attorney with unrestricted gifting powers.
We often see Power of Attorney documents that limit the ability of family members to implement our plan.
5. Consult an attorney who specializes in Medicaid.
This is a highly specialized area of law. In our experience, clients who tried to apply on their own, or with the help of a social worker or general estate planning attorney, failed to save as many assets. In many cases they were denied before coming to us, and we were able to get them approved.
Plan Ahead Without Changing Your Lifestyle
For a client who does not need to enter a nursing home right away, we use long-range planning techniques to protect the family home and other assets from Medicaid liens.
As long as you have at least 5 years to plan ahead, or in some cases as little as 1 or 2 years, we can provide a legal solution that will:
- Allow you to stay in your home for the rest of your life or until you need nursing home care.
- Preserve your homeowners’ exemption for annual property tax.
- Allow your heirs to avoid capital gains tax on your home.
- Protect your heirs’ inheritance from lawsuits & other threats.
- Get you qualified for Med-QUEST without a transfer penalty.
If you plan ahead, we are able to save substantially more than if you wait until the last-minute. In addition to the assets saved, legal costs are considerably less for pre-planning.
Contact us to explore your options.
Our Story: Hawaii Medicaid Law Pioneers
In 1996, Sanford Okura, the founder of Okura & Associates, did some estate planning for his own mother, Kishiye Okura. She had suffered a stroke earlier, and was paralyzed on the right side of her body. She was not wealthy. She owned her home and some bank accounts.
The Greatest Threat
In analyzing his mother’s estate, Mr. Okura realized that the greatest threat to her estate was not estate taxes, because she did not have enough assets to be taxed by the estate tax. Probate would have been an inconvenience but would cost only a few thousand dollars.
He realized that the greatest threat to mother’s estate was potential nursing home costs. He was already specializing in estate planning, but then began his study of Elder Law. He devised an estate plan for his mother which would protect her home from Medicaid liens if she ever had to enter a nursing home.
Later, after suffering a second stroke, Kishiye Okura lived for a while with her son, then her daughter, then her son again. She then became so incapacitated that it became necessary to admit her into a nursing home.
An Error in Calculations
Sanford Okura applied for Medicaid for his own mother to pay the very expensive monthly nursing home bill. To his surprise, the Medicaid application was denied.
The Medquest office claimed that an earlier transfer of assets by Kishiye Okura had created a penalty period that had not yet expired. Sanford rechecked his calculations and confirmed that the penalty period had expired and that his mother’s application should have been approved. He asked the Medquest office to show him the table they used to calculate the value of the property interest which his mother had transferred. When he received a copy of their table, he discovered that they were using the wrong table!
Mr. Okura had obtained his copy of the table directly from the Health Care Finance Administration, which was the agency of the federal government then in charge of the Medicaid program. He gave to the Medicaid eligibility worker a copy of the correct table. It was forwarded to the office in the Department of Human Services which writes and interprets the Hawaii Medicaid rules. They reviewed the table. The answer came back: they had made a mistake, and Kishiye Okura’s Medicaid application is approved.
Mother died in 1998, but her legacy lives on. To Sanford’s knowledge, as a result of his own mother’s case, the Medquest offices throughout the State of Hawaii began using the correct table to perform the kind of calculations which were necessary for his mother’s Medicaid application.
Successfully Challenging Denied Applications
Since then, Sanford and other attorneys at Okura & Associates have studied the complicated federal and state Medicaid laws much more carefully. We have had other Medicaid applications that were initially denied by a Medicaid eligibility worker, but which were later approved after the denial was challenged by our law firm.
We do not at all blame the Medicaid eligibility workers or the Medquest office that interprets the Medicaid rules. Their job is so difficult, the federal and state Medicaid laws are so complicated, and the workers are often so overworked, that it is understandable that they sometimes make mistakes. We have found that most Medicaid workers take their jobs seriously and sincerely do their best under difficult circumstances.
When we use creative techniques to protect assets from nursing home costs and to qualify a client for Medicaid benefits, we try to work cooperatively with the Medicaid workers to show them why the technique is legal. We have a good relationship with a number of Medicaid workers, and try to work harmoniously with them. Occasionally, we have to disagree and appeal their decision.
The Best Possible Experience
With over 30 years in business, our goal is to provide you with the most effective legal solutions.
“Our overall experience with your office has been most positive. The service was just outstanding.
We were so impressed with your expertise, the professional way your staff conducted themselves, their friendliness, and the high quality of your work.”
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Med-QUEST Long-Term Care FAQ
What is Med-QUEST and how is it different from Medicare in Hawaiʻi?
Med-QUEST is Hawaiʻi’s Medicaid program that provides free or low-cost health coverage to eligible low-income residents and for those who need long-term care. Medicare is federal health insurance (usually for retirees age 65+). Many people have both.
Who qualifies for Med-QUEST, and does it help with long-term care (nursing homes or in-home services)?
Eligibility looks at income, assets, residency, and medical need. If approved, Med-QUEST can cover nursing home costs and home and community-based services.
What are the 2025 spousal allowances in Hawaiʻi Medicaid (Med-QUEST)?
For 2025, the Community Spouse Resource Allowance (CSRA) is up to $157,920. The Community Spouse Monthly Maintenance Needs Allowance (MMMNA) in Hawaiʻi is up to $3,948 per month.
What is the 2025 home-equity limit for Medicaid long-term care?
Federal rules set a range of $730,000–$1,097,000. Hawaiʻi has set $1,097,000 as the home equity limit for 2025.
What are the 2025 individual asset and income limits commonly referenced?
For long-term care, the individual asset allowance remains $2,000. There is no income limit if the individual’s income is not enough to cover the long-term care costs.
Can non-citizens or COFA migrants qualify for Med-QUEST?
Some non-citizens, including permanent residents in the U.S. for 5+ years (Green Card holders), humanitarian immigrants (such as refugees and asylees), and citizens of the Federated States of Micronesia, Marshall Islands, and Palau (COFA Treaty residents) may qualify. It depends on the immigration status and rules for the specific Med-QUEST program.
How does Medicaid “spend-down” work in Hawaiʻi?
If income is over the limit, certain medical costs may reduce countable income. A Medicaid spend-down allows someone whose income or assets are too high to qualify for Medicaid (Med-QUEST) to reduce their countable income or assets by paying certain medical expenses—effectively “spending down” their resources until they meet the eligibility threshold. Usually this applies to individuals in the Aged (65+), blind, or disabled (ABD) category. Legitimate spend-downs must follow program rules. This phrase is often misused to advise prospective Medicaid applicants to sell all their assets and spend all of the proceeds before applying for Medicaid. This is usually NOT the best advice for most people, is not required, and is usually not advisable.
How do I apply for Med-QUEST (online, phone, or in person)?
Apply online via KOLEA, by phone, mail, or at a Med-QUEST office in person. We can help you prepare and submit.
Which documents do I need when I apply (ID, proof of residence, assets, medical need)?
You’ll need your ID, proof of Hawaiʻi residency, income and asset statements, and medical information supporting your need for care.
How long does approval usually take in Hawaiʻi?
Timelines vary, but most cases are decided within several weeks if paperwork is complete. For Long-Term Care it can take up to 90 days.
Will Med-QUEST pay for a nursing home in Hawaiʻi? What about home and community-based services (HCBS)?
Yes, if you meet financial and medical criteria Med-QUEST will pay for your eligible nursing home costs. HCBS may be available to help you receive care at home or in the community, including at Community Care Foster Family Homes (Adult Foster Homes).
Do I have to switch doctors or pick a QUEST Integration health plan?
Most enrollees choose a QUEST Integration plan. You can review networks and benefits; if you don’t choose, one may be assigned. It may not be necessary for Institutional Long-Term Care (nursing home) or Aged, Blind, and Disabled Long-Term Care Fee-For-Service.
Does owning a home in Hawaiʻi disqualify me from Medicaid?
A primary residence is treated differently from other assets. Rules protect certain spouses and relatives, but recovery may apply later. There is also an equity limit allowed for the home, but we can help design a plan to qualify despite initially exceeding the equity limits.
What is the “5-year look-back” for Medicaid in Hawaiʻi, and what counts as an uncompensated transfer?
The State reviews transfers made in the 5 years up to and before you apply. Gifts or below-market transfers can cause a penalty period, and the penalty period could be for much longer than 5 years. There are some allowable exceptions to this rule.
Can I legally protect assets and still qualify (trusts, annuities, spend-down strategies)?
Yes—within strict rules. Planning tools exist, but they must be set up correctly. Get guidance before moving any assets.
If one spouse needs long-term care, can the “community spouse” keep some income and assets?
Yes. Spousal impoverishment rules allow the well (healthy) spouse to keep a protected share of income and resources. We can use certain financial instruments and exceptions in the rules to preserve much more of the assets for the well spouse than appears allowable at first glance.
What happens to my income once I’m on long-term care Medicaid (patient-liability / post-eligibility rules)?
Most recipients contribute part of their income toward care after certain deductions and allowances.
Can I change my QUEST Integration health plan later?
Usually yes, during allowed change periods or for qualifying reasons.
What is Hawaiʻi Medicaid estate recovery and when does it apply?
After certain benefits are paid, the State may seek repayment from your estate, with some exemptions and hardship waivers. Many planners help a Medicaid applicant get qualified for long-term care benefits but don’t adequately consider potential estate recovery, which can cost families hundreds of thousands of dollars later. It’s important to plan to minimize or avoid estate recovery, not just to qualify upfront.
Can the State place a lien on my home if I’m in a nursing facility?
In many cases, yes. There are important exceptions for spouses and certain family members. The best practice in planning will anticipate how to avoid a State Medicaid lien—not just at the time of qualifying for Medicaid, but also in the future if and when family situations change (e.g., the well spouse passes away first).
How does third-party recovery work if there’s a settlement (e.g., accident case)?
If Medicaid paid for care related to an injury, the State may be reimbursed from any settlement proceeds. Only the medical-expense portion of the settlement is available to the State for reimbursement (not any portion allocated to pain and suffering or lost wages). The State will recover third-party funds after attorney fees are paid, but before the client can receive any of the settlement funds.
What if I’m denied—how do appeals and fair hearings work in Hawaiʻi?
You can appeal and request a fair hearing within 90 days after the application is denied. If you exceed the deadline, you lose your right to appeal. The 90-day period starts on the mailing date shown on the Med-QUEST denial notice, not on the date you receive it. Also, your request for a fair hearing is considered filed within 90 days if received by the Department of Human Services, not when you drop it in the mail. We can help correct issues with applications and represent clients through the process.
Last updated: October 21, 2025. Figures change periodically; confirm current amounts with Med-QUEST.