Guides → Hawaii

Getting paid to care for a parent in Hawaii

Updated 2026-08-10 · Every figure below is dated and sourced · Rules change — confirm with the agency
The short answer: Hawaii's door is QUEST Integration (Med-QUEST) — self-directed Personal Assistance services ("consumer-directed" option inside Hawaii's 1115 managed-care program), run by Med-QUEST Division, Hawaii Department of Human Services (LTSS delivered through QUEST Integration health plans: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, UnitedHealthcare Community Plan). Pay: Hawaii minimum wage is $16.00/hr as of Jan 1, 2026 (was $14.00 from Jan 1, 2024; rises to $18.00 on Jan 1, 2028). Note the Jan 2025 fee-schedule rate of $15.25/hr now sits below the 2026 minimum wage; actual caregiver wages through the plan's fiscal agent must comply with the $16.00 minimum.

Who can be the paid caregiver

Adult children, other relatives, legal guardians, and even legally responsible individuals (including spouses) may be the paid caregiver — CMS's Jan 8, 2025 approval of QUEST Integration explicitly authorizes "personal assistance Level I and Level II services provided by relatives, legal guardians, or legally responsible individuals." Caregiver must be an adult, complete the plan/fiscal agent hiring process (background check, timesheets), and can only bill the hours the plan authorizes after your parent's needs assessment.

The spouse question

Yes — spouses can be paid in Hawaii. The QUEST Integration demonstration (CMS approval Jan 8, 2025, building on HCBS flexibilities approved June 2024) allows payment to "legally responsible individuals," which covers spouses. In practice the member must be approved for LTSS, choose self-direction through their QUEST health plan, and the spouse must complete the plan's caregiver enrollment. For an adult child caring for a parent (Resbit's core question), there is no legal-responsibility barrier at all.

Waitlist reality

Better than most states. QUEST Integration delivers LTSS through managed care under an 1115 waiver, not a slot-capped 1915(c) waiver, so people who meet nursing-facility level of care and enroll generally get home-and-community services without a years-long waitlist. Caveat: the "at-risk" group (people not yet at nursing-facility level) has limited slots and a waitlist can form there. The main delay families actually hit is the Medicaid eligibility process itself (45-90+ days). Hawaii's separate DD waiver (I/DD only) is a different program.

Worth knowing: Disqualifiers and traps: (1) Money eligibility is the gate — your parent, not you, must qualify for Med-QUEST, and long-term-care Medicaid limits are strict (about $2,000 countable assets for a single person; a 5-year look-back applies to asset transfers). (2) Your parent must need nursing-facility level of care, or hours will be minimal or denied. (3) You are paid only for plan-authorized hours — typically nowhere near 24/7; expect a capped weekly schedule. (4) The exact wage varies by health plan; the state's own fee schedule pegs self-directed personal assistance at $15.25/hr (Jan 2025), so treat quotes far above that skeptically. (5) The Kupuna Caregivers $70/day program is dead — unfunded for years — even though it still shows up in search results; do not plan around it. (6) The old standalone Chore Services Program has been folded into QUEST. Recent rule change worth knowing: CMS's June 2024/January 2025 approvals expressly allow legally responsible individuals (spouses) to be paid, which older Hawaii guides say was not allowed — the current answer is yes, through self-direction.

Other doors in Hawaii

ProgramWhat to know
Kupuna Caregivers Program (defunct — beware old articles)Originally up to $70/day (2017 law), later reduced to up to $210/week before it stopped operating; program is defunct — 'no longer exists... maintained for historical purposes only.'
Kupuna CareState-funded in-home services (personal care, homemaker, meals, transportation, adult day care) for residents 60+ who don't qualify for Medicaid. Pays agencies for services — it does not pay family members — but it takes real pressure off caregivers. Apply through the ADRC, 808-643-2372. Funding-limited; waitlists possible.
Veteran-Directed Care (VA)Available in Hawaii through the VA Pacific Islands Health Care System (Spark M. Matsunaga VAMC, Honolulu). If your parent is a veteran, they get a flexible budget and can hire family — including a spouse — as the paid caregiver. Ask the VA social worker or Caregiver Support Coordinator; VA Pacific Islands main line 800-214-1306.
VA PCAFC and Aid & AttendancePCAFC pays a monthly stipend to caregivers of eligible veterans (spouses and adult children can qualify); Aid & Attendance adds cash to a VA pension that can informally pay family. Both run through the VA, not the state.
DOH DDD Consumer-Directed (CD) OptionHawaii Department of Health's self-direction option for people on the I/DD (1915c) waiver — relevant only if the person needing care has an intellectual/developmental disability. That waiver, unlike QUEST LTSS, can have registry waits.
No structured family caregiving per-diem modelHawaii has no Georgia/Indiana-style 'structured family caregiving' daily-stipend benefit. The closest analog is the Community Care Foster Family Home model, but it requires the caregiver to be a licensed CCFFH operator with CNA certification — a heavy lift, not a quick path.

Wartime veteran or surviving spouse in the family? VA Aid & Attendance stacks on top of state programs — see the national guide.

How to apply — step by step

  1. 1. Get your parent onto Med-QUEST (Hawaii Medicaid). Apply online at medical.mybenefits.hawaii.gov or call the Med-QUEST Division at 1-800-316-8005 (Oahu: 808-524-3370). Expect strict financial limits: roughly $2,000 in countable assets for a single person; income limits apply (spousal protections exist if your parent is married).
  2. 2. Ask for a long-term services and supports (LTSS) assessment — this is the nursing-facility level-of-care determination (DHS Form 1147, completed by a doctor) that unlocks home-care hours.
  3. 3. Once approved, your parent picks a QUEST Integration health plan (AlohaCare, HMSA, Kaiser, Ohana, or UnitedHealthcare Community Plan) and is assigned a service coordinator.
  4. 4. Tell the service coordinator you want SELF-DIRECTED personal assistance and that a family member will be the paid caregiver. The assessment sets the authorized weekly hours.
  5. 5. Complete the caregiver hiring paperwork through the plan's fiscal/employer agent (background check, employment forms, timesheets), then start logging paid hours.
  6. 6. For free local navigation at any point, call Hawaii's statewide Aging and Disability Resource Center (ADRC) at 808-643-2372.

Where to start: Med-QUEST Division (Hawaii DHS): 1-800-316-8005 statewide (Oahu 808-524-3370), online application at medical.mybenefits.hawaii.gov. Free guidance: Hawaii statewide ADRC, 808-643-2372.

Do it yourself vs. get help

Free, accredited help first, always: your Area Agency on Aging (eldercare.acl.gov) walks families through these applications at no charge, and your county Veterans Service Officer files VA claims free. Where Resbit fits: if you're working a job and don't have hours for hold music, Resbit finds what your family qualifies for, fills out the paperwork down to the signature line, and does the chasing — flat $49/month, and the screener that starts it is free.

Find out what your family qualifies for

Free · 10 questions · No account needed · Honest when the answer is "not yet"

Try the free screener Join the waitlist
No spam. Unsubscribe anytime.
You're on the list. 🌿
Sources & dates checked: Program rules and payment rates change. Everything here is educational — real eligibility is decided by the agencies, based on your family's details.