Hawaii caregiver programs for a family member caring for a parent, spouse or adult child at home include Med-QUEST self-directed personal care, county respite, and VA benefits.

When you are the one doing the caring, the hard part is rarely whether help exists. It is knowing what is there and where to start.

You don't have to figure this out alone, and you don't have to fund all of it from your savings.

In This Guide

Hawaii Caregiver Programs at a Glance

Program What It Offers Pay a spouse? Cost to You
Med-QUEST self-directed personal care Pays a self-direct caregiver for in-home personal assistance Only in extraordinary circumstances Paid by Medicaid
Kupuna Care and Community Living Program Kupuna Care pays a provider for services; the Community Living Program lets an older adult hire their own care workers Not stated; Community Living Program workers may include family or friends Ask your Area Agency on Aging
NFCSP respite grants Respite, counseling, support groups, caregiver training N/A Ask your Area Agency on Aging
VA PCAFC Monthly stipend to the Primary Family Caregiver; pays spouses Yes Free (VA benefit)
VA Aid and Attendance Pension up to $29,093/yr, less countable income, to a veteran with no dependents Pension to veteran Office of Veterans' Services helps file

Which Hawaii Caregiver Programs Pay Family Members?

If money is the worry keeping you up at night, start here. In Hawaii, the care you are already giving can sometimes become paid work.

Hawaii Medicaid, called Med-QUEST, covers home- and community-based long-term services and supports, including personal assistance, through its QUEST Integration health plans. QUEST Integration also has a self-direction option, and self-direct caregivers are paid for the in-home personal assistance they provide. Med-QUEST's self-direct materials name three services: Personal Assistance Level I (chore), Personal Assistance Level II (bathing, feeding), and Personal Assistance Level II Delegated (nursing tasks). Med-QUEST's 2026 fee-for-service rate list reimburses self-directed personal assistance at $17.40 an hour ($22.72 an hour for nurse-delegated tasks), though QUEST Integration health plans may pay different rates, so ask your plan what it pays.

Hawaii's federally approved QUEST Integration terms say Hawaii may pay a relative, a legal guardian, or a spouse for Personal Assistance Level I and Level II, but only in extraordinary circumstances that Hawaii finds during assessment and care planning, such as when no other qualified caregiver can be found and kept while the spouse or guardian would be away from home, so the family member must stay home to keep the person safe and out of an institution. A paid family caregiver can work no more than 40 hours in a seven-day period, must meet Hawaii's employment and training standards, must use electronic visit verification, and cannot be paid for help they would ordinarily give someone the same age without a disability or chronic illness. Confirm how the rule applies to your family with your QUEST health plan or Med-QUEST at 1-800-316-8005.

If you care for an adult child with an intellectual or developmental disability, also ask about Hawaii's HCB Services for People with Intellectual and Developmental Disabilities (I/DD) Waiver, which serves people of any age who meet an institutional (ICF/IID) level of care.

Does Your Loved One Qualify for Med-QUEST Long-Term Care?

The real gate for paid care is whether your loved one qualifies for Med-QUEST long-term care. The 2026 tests for an aged, blind, or disabled applicant:

  • Assets: $2,000 in countable resources for a single applicant ($3,000 for a couple). The home, motor vehicles, and household goods of limited value are exempt.
  • Home equity: Hawaii's rule bars long-term care coverage when home equity exceeds $750,000, a figure indexed each year (the 2026 federal minimum is $752,000), unless a spouse, a child under 21, or a blind or disabled child lives there.
  • Income: the standard is $994 per month for a household of one ($1,491 for two), and there is no hard income cap above it. Hawaii is a medically needy state, so income above the medically needy income limit of $469 per month for one ($632 for two) is spent down on care each month instead of disqualifying the applicant. The spend-down covers income only; the resource limits still apply.
  • Gifts and transfers: Hawaii looks back 60 months. A transfer of assets for less than fair market value in that window triggers a penalty period for long-term care coverage, but some transfers are exempt and the penalty can be waived for undue hardship.

If you have already helped a parent with money, or the numbers look out of reach, don't assume the answer is no. Ask Med-QUEST at 1-800-316-8005 how these rules apply before you move any assets.

Outside Medicaid, Hawaii's Kupuna Care program (HRS §349-17), run by the Executive Office on Aging through the county Area Agencies on Aging, pays its funds directly to a service provider or financial management service provider on an invoice, rather than directly to the caregiver. It offers traditional services from a contracted provider, or a participant-directed option in which the older adult manages their own budget, and the statute does not say who may be hired under that option. A separate Community Living Program, with eligibility similar to Kupuna Care's, lets older adults hire and direct their own care workers, who may include family or friends.

To qualify for Kupuna Care, the Executive Office on Aging says a person must:

  • be 60 or older
  • be a U.S. citizen or qualified alien
  • not live in an institution or be enrolled in a comparable home- and community-based program
  • have a cognitive impairment such as Alzheimer's disease or a disability
  • need help with two or more activities of daily living or instrumental activities of daily living

The law's separate kupuna caregivers section, HRS §349-18, was repealed in 2022, so ask your Area Agency on Aging about Kupuna Care and the Community Living Program instead.

For the full guide to who can be paid and how, see How to Get Paid as a Family Caregiver in Hawaii.

How to Apply for Med-QUEST Paid Caregiving

Because the paid pathway depends on Med-QUEST enrollment, here is the practical order of operations, from the application to setting up self-direction with the health plan.

1
Step 1

Apply for Med-QUEST

Med-QUEST accepts applications online, over the phone, by mail or by fax; call Med-QUEST Customer Service at 1-800-316-8005 to start. If your loved one needs long-term care, include forms DHS 1100, 1100B, 1167, 1169, 1169A, 8003 and 8004 with the application.

2
Step 2

Expect two separate decisions

Med-QUEST decides whether your loved one qualifies for Medicaid, including the income and asset limits above, while long-term services and supports are available based on a physician's evaluation of the level of care they need. Have income, asset, and medical records ready.,

3
Step 3

Ask for self-direction by name

Once enrolled in a QUEST Integration health plan, tell the plan you want to self-direct personal assistance, and ask whether the family member or spouse you have in mind can be approved as the paid caregiver under the extraordinary-circumstances rule.,

4
Step 4

Set up visit verification

Self-direct caregivers must use electronic visit verification (EVV) to get paid for in-home personal assistance, and live-in caregivers must also check in and out. Med-QUEST tells self-directed members to contact their own health plan for EVV training and help, and its EVV page lists Acumen as the consumer-directed fiscal agent for developmental-disabilities services.

Where to Find Respite in Hawaii

Everyone who does this work needs a break, and needing one does not make you any less devoted. Hawaii has two routes: one inside Med-QUEST, and one that does not touch Medicaid at all.

If your loved one qualifies for Med-QUEST long-term care, respite is a QUEST Integration benefit. It is short-term, comes at hourly, daily, or overnight levels, can be given at home or in an approved care setting, is authorized by their primary care provider as part of their Health Action Plan, and can be self-directed. Ask the health plan how much respite it will authorize.

Outside Medicaid, the National Family Caregiver Support Program (NFCSP), funded by Title III-E of the Older Americans Act, is administered in Hawaii by the Executive Office on Aging through the county-based Area Agencies on Aging. It funds five categories of caregiver help: information, help gaining access to services, counseling, support groups and caregiver training, respite care, and supplemental services on a limited basis.,

Respite and supplemental services carry a condition the first three do not. When you are caring for an older adult, the person you care for must be unable to perform at least two activities of daily living without substantial help, or need substantial supervision because of a cognitive or other mental impairment that makes their behavior a serious health or safety hazard.

To request respite, call the Hawaii Executive Office on Aging at 1-808-586-0100 or use the Eldercare Locator at 1-800-677-1116, and ask to be connected to your county's Area Agency on Aging., Respite can mean temporary relief at home, in an adult day care, or in an institutional setting. Respite is provided by your county Area Agency on Aging or an agency it contracts with, so ask how much respite is available when you call.

For the full respite guide, see Respite Care in Hawaii.

Where to Get Caregiver Support and Training in Hawaii

Each Hawaii county has an Area Agency on Aging, responsible for services to older adults and family caregivers in its area, and they deliver NFCSP services. Services the Executive Office on Aging lists as contracted include chore services, adult day care respite, homemaker help, personal care assistance, home-delivered meals, transportation, case management, and family caregiver services.

Call the Hawaii Executive Office on Aging at 1-808-586-0100 to reach your county's Area Agency on Aging. Reserve the Med-QUEST line at 1-800-316-8005 for Medicaid and paid-caregiver questions.,

VA Caregiver Benefits in Hawaii

If the person you care for served in the military, slow down here. Veterans enrolled in VA health care in Hawaii have access to caregiver support programs that are separate from Medicaid.

VA Program of Comprehensive Assistance for Family Caregivers (PCAFC)

The PCAFC pays a monthly stipend to the Primary Family Caregiver of an eligible veteran. A spouse can be the paid caregiver, and VA has described the stipend as a nontaxable benefit. VA's first screen lists four requirements, and all of them must be true for the veteran: a disability rating of 70 percent or higher, a discharge from the military or a date of medical discharge, a need for in-person personal care for at least six continuous months, and enrollment in VA health care. Those four are necessary but not sufficient, because you and the veteran then apply together and VA's application process decides eligibility. The caregiver must be at least 18 and either a family member or someone who lives full time with the veteran (or is willing to), and the stipend is paid only once the caregiver enrolls in direct deposit through VA's customer engagement portal. In plain terms, the monthly stipend is the federal GS-4, Step 1 annual pay rate for the veteran's locality, divided by 12 and multiplied by 0.625, or by 1.00 if VA determines the veteran is unable to self-sustain in the community. Legacy participants and legacy applicants follow a separate schedule that lapses October 1, 2028; our VA caregiver stipend guide walks through it.

VA Aid and Attendance Pension

Wartime veterans and surviving spouses who get a VA pension, with net worth (assets plus income for VA purposes) under the limit ($163,699 in 2026), may be eligible for the Aid and Attendance pension if they meet at least one of VA's need tests, such as needing another person's help with daily activities like bathing, feeding, and dressing., VA sets these rates as an annual maximum and pays only the difference between a claimant's countable income and that maximum, so someone with income receives less: a veteran with no dependents who qualifies for Aid and Attendance can receive up to $29,093 a year, and a veteran with one dependent up to $34,488 a year. Pension is paid monthly, figured from that annual amount. The pension goes to the veteran, and under VA's rules, care given by a relative or another member of the household does not prevent VA from granting it.

The Hawaii Office of Veterans' Services helps veterans, their dependents, and survivors prepare VA claims and file appeals, with Veterans Services Counselors on Oahu, Kauai, Hawaii island, and Maui; on Oahu, call its Tripler office at (808) 433-0420.

VA Caregiver Support Line: 1-855-260-3274, Monday through Friday, 8 a.m. to 8 p.m. Eastern Time. It is not a crisis line. If you or the veteran are in crisis or having thoughts of suicide, call 988 and press 1, text 838255, or chat at VeteransCrisisLine.net, any hour of any day.

Do Hawaii Caregivers Pay Tax on Caregiver Pay?

IRS Notice 2014-7

If you are paid through a Medicaid Home and Community-Based Services waiver (a section 1915(c) waiver) to care for someone in your own home, where they live under their plan of care, those payments may be excluded from federal gross income under IRS Notice 2014-7. Your home, for this rule, is where you reside and regularly carry out the routines of your private life; the exclusion does not apply if you have a separate home where you reside. Review the guidance on the IRS website and talk to a tax preparer familiar with the rule before filing. Hawaii pays family caregivers through QUEST Integration, a section 1115 demonstration rather than a section 1915(c) waiver, so ask the tax preparer whether the notice's exclusion reaches QUEST Integration self-direct pay.,

Hawaii State Income Tax

Whether Hawaii's income tax follows the federal exclusion for Medicaid waiver pay is a question to put to the Hawaii Department of Taxation or a tax preparer before you file.

VA PCAFC Stipend

In the preamble to its 2020 proposed PCAFC rule, VA described the monthly caregiver stipend as a nontaxable benefit. Confirm how to treat it with a tax preparer.

Your next step Not sure which Hawaii caregiver program fits your family? Chat with Brevy's care navigator for a personalized comparison based on your loved one's Medicaid enrollment, veteran status, and whether you are a spouse or non-spouse caregiver.

Frequently Asked Questions

Can I get paid to care for my spouse in Hawaii?

Only in extraordinary circumstances. Hawaii's approved QUEST Integration terms let Med-QUEST pay a spouse for Personal Assistance Level I or II when Hawaii finds, during assessment, that extraordinary circumstances apply, such as when no other qualified caregiver can be found and kept, and for no more than 40 hours in a seven-day period. Confirm it with your QUEST health plan or Med-QUEST at 1-800-316-8005. If your loved one is a veteran, the VA PCAFC program clearly pays a spouse.,

Does Hawaii still have the Kupuna Caregivers program?

Not as a standalone program in state law. The kupuna caregivers section of Hawaii's aging statute, HRS §349-18, was repealed in 2022. Ask your Area Agency on Aging about Kupuna Care, which pays a service provider or financial management service provider on an invoice, and the separate Community Living Program, which lets older adults hire their own care workers, who may include family or friends.

Is there respite in Hawaii without Medicaid?

Yes. The National Family Caregiver Support Program funds respite through Hawaii's county Area Agencies on Aging under the Older Americans Act, not Medicaid. When you care for an older adult, they must be unable to perform at least two activities of daily living without substantial help, or, because of a cognitive or other mental impairment, need substantial supervision because they behave in a way that poses a serious health or safety hazard. Call the Hawaii Executive Office on Aging at 1-808-586-0100 or the Eldercare Locator at 1-800-677-1116.,,,

How much can my family have and still qualify for Med-QUEST?

For 2026, a single aged, blind, or disabled applicant can have up to $2,000 in countable resources ($3,000 for a couple). Income above the $994 monthly standard for one person does not disqualify them, because Hawaii lets the amount above its $469 medically needy limit be spent down on care each month. Gifts made in the 60 months before applying, and home equity above Hawaii's indexed limit, can also block long-term care coverage, so check the full tests above before acting.

Which VA programs pay family caregivers in Hawaii?

The PCAFC stipend (for veterans who meet all of VA's requirements, starting with a 70 percent or higher disability rating; described by VA as a nontaxable benefit; pays spouses) and the Aid and Attendance pension (for wartime veterans and surviving spouses who get a VA pension, are under the $163,699 net-worth limit, and meet a VA need test), which VA pays to the veteran or surviving spouse, not to the caregiver. Call the VA Caregiver Support Line at 1-855-260-3274, weekdays 8 a.m. to 8 p.m. Eastern Time.,,,,

How do I reach my Area Agency on Aging in Hawaii?

Call the Hawaii Executive Office on Aging at 1-808-586-0100, or use the Eldercare Locator at 1-800-677-1116. Each county has an Area Agency on Aging, and they deliver NFCSP services, including respite and caregiver training.,,,

Where to Get Help in Hawaii

Hawaii Med-QUEST Division Apply for Med-QUEST long-term care and ask about the self-direction option for personal assistance, including whether a family member can be the paid caregiver under the extraordinary-circumstances rule., 1-800-316-8005 medquest.hawaii.gov
Hawaii Executive Office on Aging Reaches your county Area Agency on Aging for NFCSP respite, counseling, support groups, and caregiver training.,, 1-808-586-0100 health.hawaii.gov/eoa
VA Caregiver Support Line Information on support services, counseling and education, and a direct connection to your local VA Caregiver Support Program team. Monday through Friday, 8 a.m. to 8 p.m. Eastern Time; not a crisis line (for a crisis, call 988 and press 1). 1-855-260-3274 www.caregiver.va.gov

Learn More

CaregiverCaregiver Programs: The 50-State GuideA directory of caregiver programs in all 50 states: paid family caregiver pathways, respite, NFCSP grants, and VA benefits. Find your state's complete guide. CaregiverMedicaid Self-Direction and Consumer-Directed ServicesHow Medicaid self-direction lets a family member be your paid caregiver: employer authority, budget authority, the 1915(j) spouse rule, and how to get started. CaregiverThe National Family Caregiver Support Program (NFCSP): A Complete GuideWhat the National Family Caregiver Support Program funds, who is eligible, and how to reach respite and caregiver support through your Area Agency on Aging. CaregiverHow to Get Paid as a Family Caregiver in HawaiiVA Aid and Attendance pays a veteran with one dependent up to $34,488 a year; Hawaii's Med-QUEST has a self-direction option. Compare 5 caregiver pathways. CaregiverRespite Care in HawaiiGet funded respite care in Hawaii: QUEST Integration respite, the Kupuna Care program, NFCSP caregiver support, adult day health, and VA respite options. CaregiverCaregiver Burnout: Signs, Stages, and How to Get SupportHow to recognize caregiver burnout, why it happens, and what actually helps, from respite care to evidence-based programs like REACH II and Powerful Tools. VA BenefitsVA Benefits for Seniors in HawaiiVA Aid and Attendance in Hawaii for 2026: who qualifies, annual rates such as $34,488 for a veteran with a spouse, how to apply, and where Hawaii's OVS helps. MedicaidMedicaid Planning StrategiesSee which assets you keep, how the 5-year look-back works, and the legal moves that qualify you for Medicaid long-term care without losing the house.

Find personalized help with Hawaii caregiver programs 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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