How to Get Paid as a Family Caregiver in Hawaii: 5 Pathways

How to get paid as a family caregiver in Hawaii runs through two routes with a dollar figure: VA Aid and Attendance pays a veteran with one dependent up to $34,488 a year in 2026. VA pays the difference between the veteran's income for VA purposes and that ceiling.1 The Program of Comprehensive Assistance for Family Caregivers (PCAFC) adds a monthly stipend for a designated Primary Family Caregiver, and a spouse can fill that role.2 VA treats that stipend as a non-taxable benefit.3

On the Medicaid side, Hawaii's Med-QUEST program (QUEST Integration) has a self-direction option for personal assistance, and self-direct caregivers must use electronic visit verification (EVV) to get paid for in-home personal assistance.4 To qualify financially, a single aged, blind, or disabled applicant is capped at $2,000 in countable resources and an income standard of $994 a month for a household of one ($1,491 for two) in 2026, and an applicant above that standard can still qualify through a medically needy spend-down of the income they have over the medically needy income limit of $469 a month ($632 for two). The $2,000 resource cap still applies on that spend-down pathway.5 Hawaii may allow a relative or a spouse to be the paid worker for Personal Assistance Level I and II, but only in limited circumstances, so confirm with your QUEST health plan or Med-QUEST at 1-800-316-8005 before counting on it.4

The Short Version

If the care recipient is a veteran, start with VA. PCAFC pays a monthly stipend to an approved Primary Family Caregiver, who can be a spouse or another family member, when the veteran has a 70% or higher disability rating and meets VA's other requirements.2 Veteran-Directed Care, where available, gives the veteran a flexible budget to hire their own aides, including family, friends or neighbors.6 A veteran with wartime service who needs another person's help with daily activities may also qualify for Aid and Attendance pension, which is paid to the veteran.7

If the care recipient qualifies for Med-QUEST personal assistance, ask for QUEST Integration's self-direction option by name. Under the demonstration's Special Terms and Conditions, Hawaii may allow family caregivers or legally responsible individuals (a category that typically includes a spouse) to be paid for Personal Assistance Level I and II, but only when the state finds a need for extraordinary care, for no more than 40 hours in a seven-day period, and not for help they would ordinarily give a household member of the same age without a disability or chronic illness.4 Income over the $994-a-month standard does not by itself disqualify, because Hawaii uses a medically needy spend-down, but the $2,000 resource limit ($3,000 for a couple) still applies.5 Ask your QUEST health plan, or Med-QUEST at 1-800-316-8005, whether a spouse or other relative may be the paid self-direct worker.4

If neither VA benefits nor Medicaid applies, a private arrangement is the fallback. If the person you care for might later need Hawaii Medicaid for long-term care, remember that transfers for less than fair market value in the 60 months before applying can draw a penalty, so settle the terms with a Hawaii elder-law attorney before care begins.5

How to Get Paid as a Family Caregiver in Hawaii: What the State Offers

Med-QUEST Quest Integration Personal Care

Hawaii's Med-QUEST Division administers QUEST Integration, the state's section 1115 Medicaid demonstration. QUEST Integration covers home- and community-based long-term services and supports, including personal assistance services Level I and Level II, for members who meet the required level of care on a physician's evaluation.4 Financial eligibility follows Hawaii's medically needy (209(b)-style) rules: a single aged, blind, or disabled applicant is limited to $2,000 in countable resources ($3,000 for a couple) and is tested against the SSI-related Mandatory Categorically Needy income standard of $994 a month for a household of one ($1,491 for two) in 2026. Above that standard Hawaii uses no hard income cap or Miller trust, so an applicant over it can qualify by spending down the income they have over the medically needy income limit of $469 a month ($632 for two) on care each month. Only income is spent down. The $2,000 and $3,000 resource limits still apply on the medically needy pathway, because Hawaii has no asset-free medically needy route.5

Adult Day Health Through Quest Integration

Hawaii's Med-QUEST lists adult day health, and adult day care, among QUEST Integration's home- and community-based long-term services and supports, which the member's health plan provides to members who meet the required level of care. It is a service for the member, not a payment to a family caregiver.4

NFCSP Through Hawaii's Area Agencies on Aging

The Hawaii Executive Office on Aging, the state unit on aging, oversees the National Family Caregiver Support Program, delivered through the county Area Agencies on Aging. Its services are information about available services, help getting access to them, individual counseling, support groups and caregiver training, respite care, and supplemental services on a limited basis. None of them is a wage for the caregiver.4

To reach your county's Area Agency on Aging, start from the Executive Office on Aging's aging network page.

Five Ways to Get Paid as a Family Caregiver in Hawaii

Pathway 1: Med-QUEST Self-Directed Personal Care

For Medicaid-eligible Hawaii residents who qualify for personal assistance under QUEST Integration, the self-direction option is the route to ask for by name. Med-QUEST names the self-direct services as Personal Assistance Level I (chore), Personal Assistance Level II (bathing, feeding) and Personal Assistance Level II Delegated (nursing tasks).4 Financial eligibility is the test above: the $2,000 resource limit ($3,000 for a couple) on every route, and the $994 income standard with a medically needy spend-down above it.5 Services are available based on a physician's evaluation of required level of care, the member's QUEST Integration health plan provides them, and self-direct caregivers must use EVV to get paid for in-home personal assistance. A relative or a legally responsible individual such as a spouse may be allowed as the paid worker for Personal Assistance Level I and II, but only for extraordinary care, up to 40 hours in a seven-day period, and not for anything they would ordinarily do in the household for someone the same age without a disability or chronic illness.4

Pathway 2: VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The Program of Comprehensive Assistance for Family Caregivers pays a monthly stipend to a designated Primary Family Caregiver of an eligible veteran. The caregiver must be at least 18 and either a family member of the veteran (a spouse, son, daughter, parent, stepfamily member, or extended family member) or someone who lives full time with the veteran, or is willing to if VA designates them. Those are alternatives, so a spouse meets the caregiver-side requirement, and so can an unrelated partner or friend who lives with the veteran.2

A 70% rating is necessary but nowhere near enough on its own. VA's first screen lists four requirements, and all of them must be true for the veteran: a disability rating of 70% or higher (single or combined), a discharge from the military or a date of medical discharge, a need for at least six months of continuous, in-person personal care, and enrollment in VA health care. Even those four aren't the decision: you and the veteran apply together, and VA's application process determines whether you're eligible. The monthly stipend starts from the OPM General Schedule grade 4, step 1 annual salary for the veteran's geographic locality, divided by 12. That monthly figure is then multiplied by one of four factors set at 38 CFR 71.40(c)(4)(i), and which one applies turns on whether the veteran is in the current program or is a legacy participant or legacy applicant.2

• Current program (38 CFR 71.20(a)). The multiplier is 0.625, or 1.00 if the VA determines the veteran is "unable to self-sustain in the community."2
• Legacy participant or legacy applicant (38 CFR 71.20(b) or (c)). The multiplier is set by the sum of the veteran's 2019 clinical ratings instead: 1.00 if the sum is 21 or higher, 0.625 if it is 13 to 20, and 0.25 if it is 1 to 12. No self-sustain determination is needed on this route, so a legacy household can reach the full 1.00 on the rating schedule alone.2
• Meeting both. A veteran who qualifies under the current and the legacy criteria is paid whichever amount is higher. A legacy participant's stipend also cannot fall below what the caregiver was eligible for the day before October 1, 2020, while the veteran remains at the address on record. The legacy schedule lapses October 1, 2028.2

VA treats the Primary Family Caregiver's monthly stipend as a non-taxable benefit.3 Primary and Secondary Family Caregivers both get caregiver education and training, mental health counseling, and certain travel benefits when traveling with the veteran for care. A Primary Family Caregiver may also get access to health care benefits through CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) if they don't already qualify for care under another health care plan, at least 30 days of respite care a year, and free legal and financial planning help related to the veteran's needs.2 The stipend itself won't arrive until the caregiver enrolls in direct deposit through VA's customer engagement portal.2 Ask VA for the locality rate that applies where the veteran lives.

Pathway 3: VA Veteran-Directed Care (VDC)

VA Veteran-Directed Care (VDC) is VA's consumer-directed home care program, developed with the Administration for Community Living. The veteran gets a flexible budget for services, managed by the veteran or the family caregiver, and can hire their own personal care aides, which VA says might include a family member or neighbor. All veterans enrolled in VA health care who meet the clinical need are eligible where the program is offered, but VA says it is only available in certain locations, so ask a VA social worker whether it is available to you.6

VA medical centers deliver VDC through partner agencies such as Area Agencies on Aging. In ACL's model handbook, a financial management services provider acts as the veteran's payroll agent, pays payroll taxes on the veteran's behalf and issues W-2 forms to employees, and the veteran cannot hire anyone until the spending plan and budget are approved and background checks are done. Local programs can vary.8

Pathway 4: VA Aid and Attendance

VA Aid and Attendance is a monthly payment added to a VA pension. A veteran needs wartime service, income and net worth within VA's limits, and at least one aid-and-attendance need, such as needing another person's help with bathing, feeding or dressing.7 Survivors Pension has its own Aid and Attendance rates for a surviving spouse.1

2026 Aid and Attendance maximum annual pension rates (MAPR, effective December 1, 2025 through November 30, 2026) are ceilings, not guaranteed payments: VA pays the difference between the claimant's countable income and the MAPR, so someone with income receives less than the full amount. Pension is paid monthly: the MAPR less countable income, divided by 12 and rounded down to the whole dollar.1

• Veteran with no dependents: MAPR up to $29,093 per year
• Veteran with one dependent: MAPR up to $34,488 per year
• Surviving spouse (no dependents): MAPR up to $18,697 per year1

The net worth limit is $163,699. VA pension is subject to a 36-month look-back on asset transfers under 38 CFR 3.276, and that look-back does not include any date before October 18, 2018.1

The pension is paid to the veteran, not to the caregiver. A veteran who wants to use it to pay a relative for care should see the cautions under Pathway 5.

Pathway 5: Private Personal Services Contract

For families outside both the VA and Hawaii Medicaid systems, the care recipient can pay a relative privately under a written agreement. The risk is Medicaid. For long-term-care coverage, Hawaii Medicaid assesses a penalty period when the applicant or spouse transferred an asset for less than fair market value within a 60-month look-back. Some transfers are exempt, and the penalty can be waived for undue hardship.5 Hawaii's rules also apply no penalty when the individual can show the transfer was made for fair market value or other valuable consideration, or exclusively for a purpose other than qualifying for Medicaid.4 The rules cited here do not say what a caregiver agreement must contain, so before care begins, settle with a Hawaii elder-law attorney what services, schedule and rate to write down and what records to keep, and confirm with Med-QUEST at 1-800-316-8005 how the transfer rules apply.4

How to Choose

Veteran household: If the veteran has a 70%+ rating and needs at least six months of continuous, in-person personal care, start with PCAFC, knowing the rating is only one of VA's requirements. A spouse can be the Primary Family Caregiver, and the primary caregiver may also get CHAMPVA health care if not already covered by another plan.2 Ask VA separately whether the veteran qualifies for Aid and Attendance pension, and ask a VA social worker whether Veteran-Directed Care is offered where the veteran lives.6

Non-veteran Medicaid household: Ask your QUEST health plan, or Med-QUEST at 1-800-316-8005, whether the specific family relationship, including a spouse, can be the paid self-direct worker.4 If income runs above the $994 standard, ask about the medically needy spend-down; the $2,000 resource limit ($3,000 for a couple) still applies.5

Private-pay household: A written private agreement is the usual structure for families outside both systems. Involve a Hawaii elder-law attorney if the care recipient might apply for Hawaii Medicaid long-term care within the next five years, the length of Hawaii's 60-month look-back.5

IRS Notice 2014-7 and Taxes

IRS Notice 2014-7 lets a caregiver exclude certain Medicaid payments from federal gross income, but it is written for section 1915(c) home and community-based services waivers, and only for care given in the caregiver's own home where the care recipient lives.9 QUEST Integration is a section 1115 demonstration, not a 1915(c) waiver.4 For a program other than a 1915(c) waiver, the IRS says the answer depends on the nature of the payments and the purpose and design of the program, so a Hawaii family caregiver should not assume the exclusion applies and should confirm with a tax professional.9

VA treats the PCAFC stipend paid to a Primary Family Caregiver as a non-taxable benefit.3

Ask a tax professional how payments under a private caregiver agreement should be reported.

Common Misconceptions

"Med-QUEST automatically allows any family member as the paid caregiver." It does not. The QUEST Integration terms say Hawaii may allow a relative or a legally responsible individual, such as a spouse, to be paid, and only when the state finds a need for extraordinary care, such as when no other qualified caregiver can be found. Paid hours are capped at 40 in a seven-day period, and the relative can't be paid for what they would ordinarily do in the household for someone the same age without a disability or chronic illness. Confirm with your QUEST health plan or Med-QUEST at 1-800-316-8005 before assuming.4

"Medicare pays for ongoing personal care." Medicare doesn't pay for long-term care, which Medicare.gov also calls custodial care: help with daily activities like dressing and bathing. Part A covers skilled nursing facility care after a qualifying hospital stay and some home health care, and Medicare.gov points to Medicaid for long-term care.10

"A verbal arrangement is enough for Medicaid purposes." For long-term-care coverage, Hawaii's 60-month look-back penalizes transfers for less than fair market value by the applicant or spouse; some transfers are exempt, and the penalty can be waived for undue hardship.5 Hawaii applies no penalty when the individual can show a transfer was for fair market value or other valuable consideration, and a verbal arrangement leaves little to show. Ask a Hawaii elder-law attorney how to document it.4

Learn More

Find personalized help choosing the right Hawaii paid-caregiver pathway 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.