QUEST Integration, Hawaii's Medicaid program, covers home help with chores, bathing and feeding, and its federal terms allow paying a relative or spouse for it only in extraordinary circumstances. A QUEST Integration family caregiver paid under those terms can work no more than 40 hours in a seven-day period, and a member or family may also self-direct care by hiring their own personal assistant.,

What QUEST Integration Covers at Home

The Hawaii Department of Human Services (DHS) Med-QUEST Division runs QUEST Integration under a Section 1115 demonstration approved through December 31, 2029. QUEST Integration delivers home and community-based long-term care through health plans, including personal assistance Level I and Level II.

Med-QUEST describes Level I as chore help and Level II as hands-on help like bathing and feeding, plus a nurse-delegated Level II for nursing tasks. Both levels may be self-directed. Under QUEST Integration's federal terms, self-directing in Hawaii means the member, or the member's parent, guardian, family member or legal representative, employs and supervises a personal assistant "who is certified by the health plan.",

Who Qualifies for QUEST Integration Personal Assistance

Med-QUEST says people who are 65 or older, blind or disabled may qualify with income up to 100% of the federal poverty level and assets up to $2,000 for one person or $3,000 for a household of two. If your relative's income is higher, they may still qualify through Hawaii's Medically Needy Spenddown program, as long as their assets stay under Hawaii's $2,000 or $3,000 limits and their medical expenses exceed the spenddown amount. If their savings sit near that line, check early: your pay can hinge on their coverage.

Long-term care services must also be applied for, and they're available based on a physician's evaluation of the level of care your relative needs; the QUEST health plan provides them to members who meet it. For the full income rules, see Hawaii Medicaid income limits.

Which Family Caregivers QUEST Integration Can Pay

The honest answer is "possibly, under conditions." The source is CMS's Special Terms and Conditions (STCs) for the demonstration, STC 10.5(d), which says Hawaii "may allow payment for family caregivers (i.e., relatives/legal guardians) or legally responsible individuals (LRIs) to render personal assistance Level I and personal assistance Level II services." Legally responsible individuals are people with a duty under state law to care for someone, typically a spouse, or the parent or guardian of a minor child.

Your relationship What STC 10.5(d) allows
Spouse May be paid as an LRI, only in extraordinary circumstances
Parent or guardian of a minor child May be paid as an LRI, only in extraordinary circumstances
Adult child or other relative Covered by "relatives" in the terms (adult children aren't named separately); only in extraordinary circumstances
Legal guardian Named as a family caregiver; only in extraordinary circumstances
Agency or unrelated self-direct worker The terms offer family pay as an alternative to these workers

The terms are a permission, not a promise. QUEST Integration's STCs also say Hawaii must attest to compliance with guardrails before providing these family-pay flexibilities for new services or populations, so ask your health plan whether family pay is available in your relative's case before you count on the income.

The Conditions for Paying a QUEST Integration Family Caregiver

Each of these comes up at assessment. Under STC 10.5(d):

  • Extraordinary circumstances. Hawaii decides the need for a paid QUEST Integration family caregiver during assessment and person-centered planning. The STCs' example: no other qualified, suitable caregiver can be found and kept for when the spouse or other LRI would be away from home, so the family caregiver must stay home to keep the member safe and out of an institution.
  • A 40-hour ceiling. Under QUEST Integration's STC 10.5(d), a paid family caregiver or LRI in Hawaii can give no more than 40 hours of services in a seven-day period, based on the hours authorized.
  • No pay for ordinary household tasks. A QUEST Integration family caregiver in Hawaii can't be paid for things they'd normally do in the household for someone the same age without a disability or chronic illness.
  • Qualifications and a care plan. QUEST Integration family caregivers must meet Hawaii's employment and training standards, and the services must be covered and listed in the member's approved care plan.
  • EVV. QUEST Integration's STC 10.5(d) requires a paid Hawaii family caregiver to log visits in electronic visit verification to receive payment.

How Pay Is Set

Med-QUEST's 2026 fee-for-service reimbursement rate for self-direct personal assistance is $17.40 an hour, and $22.72 an hour when the work includes nurse-delegated tasks, for services from January 1, 2026. Those are provider reimbursement rates, and Med-QUEST says the rates QUEST Integration health plans pay may differ by plan. Before you agree to anything, ask your relative's health plan, in writing, what hourly rate it pays a self-direct personal assistant.

How to Ask About Being Paid, Step by Step

1
Step 1

Apply for Med-QUEST

Med-QUEST takes applications online, by phone, by mail or by fax; call Med-QUEST Customer Service at 1-800-316-8005. See how to apply for Hawaii Medicaid.

2
Step 2

Get the level-of-care evaluation

from your relative's physician.

3
Step 3

Ask the health plan about family pay at assessment,

and describe why no other qualified caregiver is available.

4
Step 4

Set up EVV

QUEST Integration self-direct caregivers in Hawaii must use EVV to be paid for in-home personal assistance; contact your health plan for EVV training and help.

The official program page is Med-QUEST's QUEST Integration overview.

Frequently Asked Questions

Can I be paid if I live with my relative?

The STCs don't name relatives who live with the member as a separate category. Med-QUEST's EVV guidance says Hawaii includes live-in caregivers in EVV, so a live-in caregiver still logs visits.

Does Hawaii have a consumer-directed personal assistance program?

Yes: self-direct personal assistance under QUEST Integration. QUEST Integration's federal terms let Hawaii pay a relative as the assistant only in extraordinary circumstances (see the conditions for paying a QUEST Integration family caregiver).

What if I'm told family members can't be paid?

Ask which condition isn't met, and ask the plan to explain its assessment in writing. See Hawaii Medicaid appeals if you disagree with a decision.

Learn More

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. CaregiverHow to Get Paid to Care for Your Spouse in HawaiiCan you get paid to care for your spouse in Hawaii? Med-QUEST may pay a spouse in extraordinary circumstances, up to 40 hours a week, and the VA pays spouses. MedicaidHawaii Medicaid HCBS WaiversHow Hawaii Medicaid HCBS waivers work in 2026: QUEST Integration home care, who qualifies, covered services, the $2,000 asset limit, and how to apply. MedicaidHow to Apply for Hawaii MedicaidHow to apply for Hawaii Medicaid (Med-QUEST) online, by phone, or by mail or fax, with the documents, decision deadlines, and spend-down rules seniors need. CaregiverCaregiver Programs in HawaiiHawaii caregiver programs for 2026: when Med-QUEST pays a family caregiver, Kupuna Care, respite, VA caregiver benefits, and which agency to call.

Find personalized help getting paid as a family caregiver through QUEST Integration 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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