Nursing Homes in Hawaii: Cost & Medicaid (2026)

A private nursing-home room in Hawaii runs about $196,735 a year, among the highest figures in the country.1 What makes a long stay affordable for many families is Hawaii Med-QUEST, the state's Medicaid program, which pays for nursing-facility care once a person meets the level-of-care and financial rules.

This guide covers how Hawaii oversees its nursing homes, what a stay costs across the islands, who pays for it (Medicare's limited skilled benefit versus Medicaid for long-term care), and how to check a facility's record before you choose one.

In This Guide

• Key Takeaways
• How Hawaii Oversees Nursing Homes
• What a Nursing Home Costs in Hawaii
• Who Pays: Medicare vs. Medicaid
• How to Vet a Facility
• Frequently Asked Questions

How Hawaii Oversees Nursing Homes

A nursing home, also called a skilled nursing facility, typically provides nursing care, 24-hour supervision, three meals a day, and help with everyday activities, with rehabilitation such as physical, occupational, and speech therapy also available. Its services focus more on medical care than most assisted living facilities do, and the federal Administration for Community Living describes nursing facilities as the most service-intensive housing option.5 Before you weigh cost or payment, it helps to know who watches over these facilities in Hawaii, because that oversight is what gives you a record to check.

Two layers of regulation apply, and they work together. At the state level, nursing facilities are licensed and inspected by the Hawaii Office of Health Care Assurance, a branch of the Department of Health, under Hawaii Administrative Rules Title 11, Chapter 94.2.2 Hawaii nursing homes are also measured against federal skilled-nursing-facility standards, and the same state office carries out the Medicare certification surveys for the federal Centers for Medicare & Medicaid Services. For certified facilities, Medicare's Care Compare tool publishes an overall rating of one to five stars that combines health inspections, staffing, and quality measures, each with its own star rating as well.2

There's also an advocate you should know about before you need one. Hawaii's Long-Term Care Ombudsman Program, housed at the Executive Office on Aging, identifies, investigates, and resolves complaints made by or on behalf of residents of nursing homes and other long-term care settings about anything that may harm their health, safety, welfare, or rights.2 The ombudsman investigates and resolves complaints but does not license or inspect, so it's a different kind of help than the state survey process.

What a Nursing Home Costs in Hawaii

Nursing-home care is the priciest long-term care in Hawaii, and the state carries among the highest such costs in the country. According to the CareScout 2025 Cost of Care Survey, a private nursing-home room in Hawaii runs about $196,735 a year.1 These are medians from an industry survey, not government rates and not maximums. The figure at any one facility can land higher or lower; CareScout cautions that actual costs vary with individual care needs, provider availability, and local market conditions.

What stands out about Hawaii is how far and how fast its costs have risen across care settings, not just nursing homes. In CareScout's comparison of its 2022 and 2025 surveys, Hawaii's senior-care costs rose faster than any other state's, placing in the top 10 for growth in all four care settings measured; between 2022 and 2025, its private nursing-home room rose 34.4 percent and its semi-private room 44.9 percent. By comparison, the CareScout 2025 national medians were about $114,975 a year for a semi-private nursing-home room and $129,575 for a private room, with assisted living at a national median of about $74,400 a year.1 So a family pricing care in the islands faces a higher starting point in nearly every setting, which is why so many families look to Medicaid rather than paying privately for years.

Nursing-home care in Hawaii runs well above the national medians across every room type, and it is the most expensive long-term-care setting in the islands.1 That gap is the reason families look hard at whether assisted living or in-home care can meet the need before moving to a nursing home, and it's the reason so many families turn to Med-QUEST rather than private funds.

Who Pays: Medicare vs. Medicaid

People often assume Medicare covers a nursing home. It does, but only in a narrow way, and confusing the two programs is one of the most expensive mistakes a family can make. Here's how they divide the work.

Medicare covers short rehab, not a long stay. Medicare Part A covers skilled nursing facility care only on a short-term basis after a hospital stay. To qualify, a person generally needs a qualifying inpatient hospital stay of at least three consecutive days, then enters a Medicare-certified facility for skilled care related to that stay. Time under observation or in the emergency room does not count toward the three days, but a Medicare Advantage plan may waive the three-day requirement, and you may not need it if your doctor participates in an Accountable Care Organization approved for a three-day-rule waiver. Under Original Medicare, coverage then runs up to 100 days per benefit period: days 1 through 20 at $0 a day after the $1,736 Part A deductible (usually already paid for the hospital stay in the same benefit period), and days 21 through 100 with a daily coinsurance of $217 in 2026, after which coverage ends. A Medicare Advantage plan may charge copayments during the first 20 days, so check with the plan.3 These amounts change each year, so confirm the current figures on Medicare's own coverage page before you count on a number. Medicare does not pay for long-term custodial care, the ongoing help with daily living that someone needs once skilled rehab is finished.3 That is the care most families worry about affording, and it's where Medicaid takes over.

Medicaid covers long-term nursing-facility care. Hawaii's Medicaid program, Med-QUEST, delivers long-term care through its QUEST Integration managed-care program, which covers institutional care, including nursing-facility care, on medical-necessity and clinical criteria.4 Qualifying turns on two findings on separate tracks: the medical side is a level-of-care evaluation you complete with a physician after applying, and the money side is the financial test. Med-QUEST determines eligibility for people 65 and over on income up to 100 percent of the federal poverty level, with up to $2,000 in assets for a single person or $3,000 for a household of two. Someone whose income is above that level, with assets within the same limits, may still qualify under the Medically Needy Spenddown program if their medical expenses exceed the determined spenddown amount.4 Hawaii does not impose a hard income cap or require a Miller trust. A nursing-facility resident contributes income above certain protected allowances toward the cost of care, and residents of certain long-term care facilities keep a personal needs allowance of $75 a month.6

A married couple is not held to the single-person numbers. When one spouse enters a nursing home and the other stays in the community, federal spousal-impoverishment rules set a total amount of resources the at-home spouse may keep. For 2026 that total runs from a $32,532 minimum to a $162,660 maximum, but the maximum is not a hard ceiling: a fair hearing or a court order can set a higher amount. The community spouse resource allowance is only the part of that total not already otherwise available to the at-home spouse, so it is not an extra amount on top of what they have.4 Two more rules shape long-term-care eligibility. Hawaii applies a five-year, or 60-month, look-back to assets transferred for less than fair market value, which can trigger a penalty period for long-term-care coverage. The penalty is not automatic: some transfers, such as a home transferred to a spouse, are exempt, and the state may waive a penalty that would cause undue hardship.6 And as every state must, Hawaii operates a Medicaid estate recovery program.6 Because these rules are detailed and the dollar figures change, it's worth getting professional advice before assuming any outcome.

How to Vet a Facility

Quality varies widely from one nursing home to the next, and Hawaii gives you several free tools to check a place before you commit. Use more than one, because each shows you something the others don't.

Start with the federal scorecard. On Medicare Care Compare, CMS rates certified nursing homes from one to five stars, combining an Overall rating with separate ratings for health inspections, staffing, and quality measures.2 Read the component ratings, not just the headline star count, because a strong Overall can hide a weak staffing or inspection score. The staffing rating deserves a close look on its own, since it reflects the nurses and aides who provide day-to-day care.

Then go to the source of those ratings. When you tour a facility, ask to see its most recent state survey results from OHCA, and watch for a pattern of repeat deficiencies rather than reacting to a single old citation.2 Finally, call the Hawaii Long-Term Care Ombudsman before you sign anything. The ombudsman handles complaints made by or on behalf of residents, so it is the place to turn if a problem comes up after a move.2

Learn More

Find personalized help comparing nursing homes in Hawaii 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.