In Hawaii, the type of adult residential care home decides whether it can take a parent at nursing-home level of care and whether Med-QUEST, the state's Medicaid program, covers it. Hawaii's expanded ARCH and community care foster family home (CCFFH) can take a parent at nursing-home level of care, and Med-QUEST lists both as covered residential care, while a plain adult residential care home (ARCH) serves adults who don't need nursing-home care. This guide covers those three kinds of home, which Hawaii's Office of Health Care Assurance oversees. If a discharge planner has told you to "look at care homes," start with the type, not the neighborhood.,,,,

In This Guide

Hawaii's Adult Residential Care Home Types at a Glance

Hawaii law defines an ARCH as a home giving 24-hour living accommodations, for a fee, to unrelated adults who need at least minimal help with daily living but not the professional health services of an intermediate, skilled nursing or acute care facility. Hawaii Revised Statutes (HRS) 321-15.6 splits licensed ARCHs into Type I and Type II by size.

Home type Size Who it serves Medicaid (QUEST Integration) State supplement cap for SSI residents
ARCH Type I Five or fewer (six at state discretion if the primary caregiver or operator is a certified nurse aide with state-approved training) Daily help, not nursing-home care $829 a month
ARCH Type II Six or more Daily help, not nursing-home care $937 a month
Expanded ARCH Nursing-home level of care, certified by a physician or advanced practice registered nurse (APRN) Listed as residential care
Foster family home (CCFFH) Up to two (a third Medicaid resident at state discretion, after a year in operation, with a certified nurse aide as primary caregiver) Nursing-facility level; at least one resident on Medicaid Listed as residential care $829 a month

A blank cell means our sources don't settle it, so ask the home or the state.,,

Which Care Home Fits Your Parent's Care Level?

This is usually the hardest part, because it means looking honestly at how much help your parent needs now. Start there, not with the vacancy list.

A plain ARCH fits a parent who needs daily help and personal care but not nursing-home services. To be licensed, a Hawaii ARCH operator must, among other things, be at least a nurse aide with a year of full-time (or equivalent) direct-care experience and have completed state-approved ARCH training.

An expanded ARCH is the step up. Under Hawaii's ARCH rules, an expanded ARCH admits nursing-facility-level residents as certified by the resident's physician or APRN. Your parent or family, together with the home's primary caregiver and your parent's physician or APRN, chooses the expanded ARCH resident's case manager, who must write an interim care plan within 48 hours of admission and a full plan within seven days; for a Medicaid resident, whoever provides that case management must hold the state's home and community-based case management agency license under HRS 321-482. Before you tour, ask whether the home has an opening for a resident at nursing-home level.

A community care foster family home is the smallest setting. Under HRS 321-481, a Hawaii CCFFH cares for no more than two adults at a time, at least one of whom must be a Medicaid recipient, all at the nursing-facility level of care and served by a licensed case management agency. Hawaii's Department of Health may approve a third Medicaid resident at the nursing-facility level once a CCFFH has been certified and running for at least a year with a certified nurse aide as primary caregiver, among other conditions.

If your parent needs more than any of these can give, see our guide to nursing homes in Hawaii.

Who Pays for an Adult Residential Care Home in Hawaii?

Money is where most families feel the floor shift, so take this in pieces.

Paying privately

We don't publish a private-pay price for these homes, because we haven't found an official source for one. Ask each home for its monthly rate and what it includes, in writing. For what the alternatives cost, see the cost of senior care in Hawaii.

Med-QUEST (QUEST Integration)

Hawaii's Medicaid program, Med-QUEST, lists "residential care including E-ARCH and CCFFH" (E-ARCH is its term for an expanded ARCH) among its QUEST Integration long-term care services, available based on a physician's evaluation of the level of care your parent needs. In 2026, Med-QUEST says people 65 and over may qualify with income up to 100% of the federal poverty level and assets up to $2,000 for a single person or $3,000 for a household of two. People 65 and over with income above 100% of the poverty level may qualify through Med-QUEST's Medically Needy Spenddown program, under the same 2026 asset limits of $2,000 for a single person and $3,000 for a household of two, if their medical expenses exceed their spenddown amount. You apply through KOLEA. See our guides to Hawaii Medicaid income and asset limits, HCBS services and applying for Med-QUEST.

What a Medicaid resident keeps

Med-QUEST's 2026 rate memo sets a $75 monthly personal needs allowance for Medicaid residents of Hawaii foster family homes and expanded ARCHs. In 2026, Med-QUEST's fee-for-service room-and-board rate in Hawaii foster family homes and expanded ARCHs is $1,748 a month for a resident on Supplemental Security Income (SSI) ($1,823 minus the $75) and $418 a month for cost-share, spousal and non-SSI members ($493 minus the $75). Med-QUEST says the home's total payment (room and board plus the Medicaid service payment) is nearly the same whether or not your parent receives SSI, though QUEST Integration health plans may pay different amounts.

In 2026, the $75 Med-QUEST personal needs allowance is what a Medicaid resident of a Hawaii foster family home or expanded ARCH keeps each month, so ask the home in writing what its rate includes and talk through what the $75 has to cover before the move. Our Hawaii personal needs allowance guide explains the allowance.

SSI and the state supplement

Hawaii adds a state supplement to federal SSI for recipients in care homes. In 2026, the Social Security Administration (SSA) payment chart puts Hawaii's total monthly SSI payment level at $1,823 ($994 federal plus an $829 state supplement) for a recipient in a state-approved care or foster care home, and $1,931 ($994 plus $937) in a domiciliary care facility for six or more residents. Separately, as of 2026, Hawaii's HRS 346-53(c) caps the state supplement at $829 a month for Type I ARCHs and foster family homes and at $937 a month for Type II ARCHs. If your parent is on SSI, ask each home in writing, before move-in, whether it takes residents at the SSI rate, so the move isn't followed by a bill nobody planned for. Our explainer on SSI state supplements for board and care covers the national picture.

If the Home Asks Your Parent to Leave

Being told your parent may have to move is frightening, especially from another island or the mainland. For residents on the state supplement, HRS 346-53(c) gives one protection: it does not allow the director "to remove a recipient from an adult residential care home or other similar institution if the recipient does not desire to be removed and the operator is agreeable to the recipient remaining, except where the recipient requires a higher level of care than provided or where the recipient no longer requires any domiciliary care." HRS 346-53(c) also lets Hawaii's Department of Human Services move a recipient to another facility if the operator's care doesn't meet their needs.

If you're worried about how a home treats your parent, Hawaii's Long-Term Care Ombudsman investigates complaints by or for residents of long-term care settings, including adult residential care homes. For a foster family home, complaints about services go to Community Ties of America, which the state's Office of Health Care Assurance designated to certify those homes, at (808) 234-5380.

How to Check a Care Home Before You Choose

You can do much of this from afar, even from the mainland. Under HRS 321-1.8, the Department of Health posts its inspection reports online within five working days of each inspection, with any violations and the home's plan of correction.

1
Step 1

Search the home's name on the Office of Health Care Assurance's inspection reports page, which covers ARCHs, expanded ARCHs and foster family homes. On that Office of Health Care Assurance page, a year marked "Not Required" means the Hawaii home is licensed or certified for two years, so no report was due that year, not that something was skipped.

2
Step 2

Check the State Licensing Section page for its combined ARCH and expanded ARCH vacancy reports and its foster family home list, or call (808) 692-7400.

3
Step 3

Visit if you can, and ask who the primary caregiver is and what training they hold

If a home isn't licensed or certified at all, read our guide to unlicensed care homes before you go further.

Frequently Asked Questions

What is the difference between an ARCH and a foster family home in Hawaii?

The biggest difference is care level: a Hawaii ARCH serves adults who don't need nursing-home care, while a community care foster family home serves only adults at the nursing-facility level (see the table above). They're also overseen differently: Hawaii's Office of Health Care Assurance licenses ARCHs directly, and it has designated Community Ties of America to certify foster family homes.,

Does Medicaid pay for care homes in Hawaii?

For expanded ARCHs and community care foster family homes, yes: Med-QUEST names both as covered residential care for members who meet the level of care and its income and asset rules, as covered above. A plain ARCH isn't on that list; there, an SSI recipient's payment includes Hawaii's state supplement, capped as of 2026 at $829 a month for Type I and $937 a month for Type II homes under HRS 346-53(c).,

Can a married couple live together in a Hawaii foster family home?

Possibly. Under HRS 321-481, a Hawaii community care foster family home may care for up to two adults at a time, all at the nursing-facility level of care and at least one of them a Medicaid recipient. If both spouses would pay privately, Hawaii's Department of Health may still allow two private-pay residents in one home, but only after weighing factors that include whether they're married or in a civil union with one already living there at least six months, whether the home is certified for three beds and has had a vacant Medicaid bed for six months, and whether any other care home in the area could take both.

Learn More

Care TypesBoard and Care HomesBoard and care homes are small homes, usually 20 or fewer residents, with meals, personal care and 24-hour staff. What they cost, who pays, and how to vet one. Care TypesAssisted Living in HawaiiAssisted living in Hawaii is among the nation's costliest and rising fast. How OHCA licenses it, what care costs, and what Med-QUEST does and doesn't cover. Care TypesNursing Homes in HawaiiNursing homes in Hawaii in 2026: a private room runs about $196,735/year, among the highest in the nation. What it costs, who pays, and how to vet a facility. Care TypesMemory Care in HawaiiHawaii issues no separate memory care license, and its assisted living rule sets no dementia standard. Here's what to vet yourself, what it costs, and who pays. Care TypesPaying for Assisted Living in HawaiiPay for assisted living in Hawaii using private pay, long-term care insurance, VA Aid and Attendance, and Med-QUEST. A worked plan with 2026 figures. Care TypesLong-Term Care OmbudsmanEvery state has a free, confidential long-term care ombudsman for nursing home and assisted living residents. What they do, whose side they're on, how to call.

Find personalized help choosing the right Hawaii care home for your parent, and checking whether Med-QUEST will pay, at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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