Hawaii Medicaid pays for home- and community-based long-term care through QUEST Integration, the state's Section 1115(a) demonstration.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 The program is run by the Department of Human Services (DHS), Med-QUEST Division. What families search for as Hawaii Medicaid HCBS waivers is, in this state, a package of long-term services and supports (LTSS) delivered through your Medicaid managed-care health plan.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Home- and community-based services (HCBS) are the supports that help someone stay in their own home, a family member's home, or a community care setting rather than moving into a nursing facility.
In This Guide
- What Hawaii Medicaid HCBS Waivers Really Are
- QUEST Integration: How Hawaii Delivers Home Care
- Who Qualifies for Hawaii Medicaid HCBS Waivers
- What Hawaii Medicaid HCBS Waivers Cover
- How Enrollment and Level-of-Care Review Work
- How to Apply Through Med-QUEST
What Hawaii Medicaid HCBS Waivers Really Are
Home- and community-based services (HCBS) is the umbrella term for Medicaid long-term care delivered outside an institution, in your own home, a relative's home, an adult day center, or a small community care home. Federal rules let a state offer these supports under its state plan or through waiver programs, and this is where Hawaii differs from what you may have read about other states.U.S. Government Publishing Office. (n.d.). Electronic Code of Federal Regulations (ecfr.gov) - 42 CFR 440.210, required services for the categorically needy. ecfr.gov. Retrieved Sep 4, 2026, from https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?chapter=IV&subchapter=C&part=440§ion=440.210
One such waiver is the Section 1915(c) waiver. Home- and community-based services are an optional Medicaid benefit, and a waiver lets a state offer them only to specific groups and cap enrollment, which is what produces waiting lists.U.S. Government Publishing Office. (n.d.). Electronic Code of Federal Regulations (ecfr.gov) - 42 CFR 440.210, required services for the categorically needy. ecfr.gov. Retrieved Sep 4, 2026, from https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?chapter=IV&subchapter=C&part=440§ion=440.210 Hawaii integrates its long-term services and supports into statewide capitated managed care through QUEST Integration, its Section 1115(a) demonstration.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 That matters for planning: your home-care benefit comes through the managed-care health plan you enroll in, and it is provided based on medical necessity and clinical criteria.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
So when a Hawaii family searches for an "HCBS waiver," the benefit they actually want is the managed LTSS package inside QUEST Integration. That is what the rest of this guide walks through.
QUEST Integration: How Hawaii Delivers Home Care
QUEST Integration is Hawaii's Medicaid managed-care program, administered by the DHS Med-QUEST Division.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 It began in 1994, and in January 2015 QUEST Expanded Access, the program that had served aged, blind, and disabled residents, merged into QUEST Integration, bringing their long-term services and supports with it.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 The federal government has approved the demonstration through December 31, 2029.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
Being "integrated" has a concrete meaning here. Instead of running your regular Medicaid coverage in one place and your long-term care in another, QUEST Integration provides both your standard Medicaid State Plan benefits and your long-term services and supports through the same managed-care health plan.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Med-QUEST states that the health plan provides these services to members who meet the appropriate level of care.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
Who Qualifies for Hawaii Medicaid HCBS Waivers
Qualifying comes down to two separate tests, and you have to meet both: a functional test about the level of care you need, and a financial test about your income and assets.
The functional test: the level of care you need
Long-term services and supports through QUEST Integration must be applied for and are available based on a physician's evaluation of the level of care you require.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Med-QUEST states that your health plan provides these services to members who meet the appropriate level of care.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 That page does not itself spell out which level of care qualifies, so ask Med-QUEST or your health plan what standard the physician's evaluation will be measured against in your case.
The financial test: income and assets
For people who are 65 and over, blind, or disabled, Med-QUEST may determine eligibility using income up to 100% of the federal poverty level and assets up to $2,000 for a single-person household or $3,000 for a household of two.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Not everything you own counts toward that limit: Hawaii's rules exempt equity in your principal home (long-term care applicants face a separate home-equity limit), motor vehicles, and household goods and personal effects, among other items, so it's worth confirming what counts in your situation.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): Hawaii MMMNA floor, and the FEDERAL home-equity minimum/maximum tiers (the CIB does NOT record which tier any individual state elected). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf
Hawaii does not set a hard income cap for long-term care; it uses a medically needy spend-down instead.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): Hawaii MMMNA floor, and the FEDERAL home-equity minimum/maximum tiers (the CIB does NOT record which tier any individual state elected). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf If your income is above 100% of the federal poverty level, you may still qualify for medical assistance under the Medically Needy Spenddown program, provided you have medical expenses greater than the determined spend-down amount.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Being over the income limit is not, by itself, a denial, but spend-down is not a way around the asset test: the same $2,000 and $3,000 limits still apply.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 For the full picture of the figures behind these rules, see our guide to Hawaii Medicaid income and asset limits.
What Hawaii Medicaid HCBS Waivers Cover
The home- and community-based services available through QUEST Integration cover the practical supports that keep daily life manageable at home.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 The covered services include:
- Adult day care and adult day health
- Assisted living services
- Community Care Management Agency (CCMA) services, which coordinate a member's care
- Counseling and training
- Environmental accessibility (home) adaptations, such as ramps and grab bars
- Home-delivered meals
- Home maintenance and moving assistance
- Non-medical transportation
- Personal assistance services, at Level I and Level II
- Personal Emergency Response Systems (PERS), the wearable call buttons for emergencies
- Residential care, including Expanded Adult Residential Care Homes (E-ARCH) and Community Care Foster Family Homes (CCFFH)
- Respite care, which gives family caregivers a break
- Skilled, or private-duty, nursing
- Specialized medical equipment and supplies
That range is what lets QUEST Integration serve people across a wide span of need, from someone who mainly needs help with bathing, meals, and a personal care aide, to someone who needs skilled nursing and lives in a small community care home. If a nursing home would otherwise be the only option, these are the services meant to make staying in the community workable. For a comparison with facility-based care, see our guide to Hawaii Medicaid and nursing home care.
How Enrollment and Level-of-Care Review Work
Because Hawaii delivers HCBS through QUEST Integration's managed care, the path in runs through Medicaid eligibility and a level-of-care review.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 You need Medicaid coverage through a QUEST Integration managed-care health plan, and long-term services and supports must then be applied for: a physician evaluates the level of care you need, and the health plan provides the services to members who meet the appropriate level of care.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
Availability and timelines can shift, so confirm the current process and any wait for services directly with Med-QUEST or your assigned health plan before you count on a specific start date.
How to Apply Through Med-QUEST
You apply for Hawaii Medicaid, including the coverage that leads to long-term services and supports, through Med-QUEST. The state's online application system is KOLEA, reached through the Med-QUEST benefits portal at medical.mybenefits.hawaii.gov.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 You can also apply through other channels the state offers, and once you have Medicaid, you work with your managed-care health plan and a physician to request the level-of-care evaluation for long-term services.
Federal rules put an outer limit on how long the decision can take. Under 42 CFR 435.912, a state Medicaid agency generally has no more than 90 days for applicants who apply for Medicaid on the basis of disability, and no more than 45 days for all other applicants.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The regulation excuses those limits in unusual circumstances, for example when the applicant or an examining physician delays a required step, or during an administrative or other emergency beyond the agency's control.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 Where the agency is late, it must document why in your case record, and it may not use the time limits as a waiting period or as a reason to deny you.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The 45- and 90-day limits are ceilings on the agency, not a promise of when your answer comes, and the one that applies turns on the basis you applied under rather than on whether a disability question arises in your case: an older adult applying on the basis of age falls under the 45-day ceiling even when the file includes a level-of-care evaluation. If you are close to a care crisis, apply as early as you can, and keep copies of everything you submit. Our step-by-step walkthrough of the process is in how to apply for Hawaii Medicaid.
Frequently Asked Questions
How does Hawaii deliver Medicaid home care?
Through QUEST Integration. Hawaii integrates its long-term services and supports (LTSS), including home- and community-based services, into statewide capitated managed care through QUEST Integration, a Section 1115(a) demonstration administered by the Med-QUEST Division.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 The benefit families are looking for is the managed LTSS package inside QUEST Integration.
My mother's income is above the limit. Is she shut out of home care?
Not necessarily. Hawaii handles excess income through a medically needy spend-down rather than a hard income cap.Centers for Medicare & Medicaid Services. (2026). CMS CMCS Informational Bulletin — Updated 2026 SSI and Spousal Impoverishment Standards (April 27, 2026): Hawaii MMMNA floor, and the FEDERAL home-equity minimum/maximum tiers (the CIB does NOT record which tier any individual state elected). medicaid.gov. Retrieved Jul 10, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib04272026.pdf An applicant with income above 100% of the federal poverty level may still be eligible for medical assistance under the Medically Needy Spenddown program, provided she has medical expenses greater than the determined spend-down amount and her assets stay within the same $2,000 limit for a single-person household.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Ask Med-QUEST what her spend-down amount would be before you assume the answer is no.
Does QUEST Integration only cover care in my own home?
No. Alongside in-home supports such as personal assistance and skilled nursing, the covered services include residential settings in the community, including assisted living services, Expanded Adult Residential Care Homes (E-ARCH), and Community Care Foster Family Homes (CCFFH).Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 That means "home and community-based" can mean your own home or a small community care home, depending on the level of care you need.
I already have Hawaii Medicaid. How do I add home-care services?
Long-term services and supports must be applied for, and they are available based on a physician's evaluation of the level of care you need; Med-QUEST states that the health plan provides them to members who meet the appropriate level of care.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Aug 1, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Ask your QUEST Integration health plan how to start that evaluation.
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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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