Hawaii Medicaid & Elder Law Attorneys

Protect Your Assets From Nursing Home Costs

For many Hawaii residents, the greatest threat to their estate is nursing home costs.

We specialize in protecting assets while getting you qualified for Medicaid as quickly as possible.

Medicaid Strategies & Planning

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.”

Ethan Okura

Managing Attorney

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 Medicaid 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 Medicaid 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.

Hawaii Medicaid Lawyers

We provide expert guidance and work with you to create the best possible strategy for your situation.

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.

Free Initial Consultation

No charge for your first meeting

Please select the option that best describes your interest.


I am or loved one is in a nursing home now or planning to be in one soon.


I am interested in estate planning & protecting my assets from future nursing home costs.

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.”

Art & Elsie Kunimitsu

Medicaid & Nursing Home Costs Articles

Creative Medicaid Spend Down Techniques (May 2013)

As you are probably well aware, my father, Sanford K. Okura, and I have both written extensively on qualifying for Medicaid to pay for long term care costs while protecting your assets from nursing home costs.  Our law practice focuses on this problem as a key...

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2012 Estate Planning Update (January 2012)

Here is a 2012 update on important numbers used in Estate Planning and Medicaid Planning in Hawaii. How much money and property can a person have at death without paying estate taxes? Under a temporary federal law, $5,000,000 is tax free this year. From January 1,...

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Protect Your Home From Medicaid Liens – Part 3 (May 2010)

PROTECT YOUR HOME FROM MEDICAID LIENS (PART 3) Last month and the month before, I explained how to protect your home from Medicaid liens.  In my April column, I described how a parent can transfer the family residence to the children, and keep a "life estate." The...

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Protect Your Home From Medicaid Liens (March 2010)

PROTECT YOUR HOME FROM MEDICAID LIENS More and more senior citizens are becoming concerned about nursing home costs.  No one really wants to go to a nursing home.  Nearly every elderly person would prefer to stay at home.  However, no matter how much children love...

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Okura & Associates
1314 S King St #760
Honolulu, HI 96814