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 Jul 17, 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 rather than a single standalone waiver program. Home- and community-based services (HCBS) are the supports that let someone who would otherwise need a nursing facility stay in their own home, a family member's home, or a community care setting instead.
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 law lets each state deliver these supports through different authorities, and this is where Hawaii differs from what you may have read about other states.
In many states, HCBS runs through a Section 1915(c) waiver, a capped program with its own slot list. Rather than operating a standalone 1915(c) waiver as the primary vehicle, Hawaii integrates its long-term services and supports into statewide 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 That single change matters for planning: your home-care benefit comes through the managed-care health plan you enroll in, and it is authorized based on medical necessity and clinical criteria rather than handed out from a separate waiver waiting list.
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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 It began in 1994, and in January 2015 the state combined its programs for families and children with the separate program for aged, blind, and disabled residents into one integrated plan.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 The plan is responsible for arranging the home- and community-based services you qualify for, and it uses a care team to assess your needs and set up your services.
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: nursing-facility level of care
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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Your managed-care health plan provides these services to members who meet the appropriate institutional, nursing-facility level of care but who can be served safely in the community rather than in a nursing home.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 In plain terms, you have to need the kind of help a nursing facility provides, while still being able to remain at home with those supports in place.
The financial test: income and assets
Hawaii uses the aged, blind, or disabled (ABD) financial rules for long-term care. A single applicant is limited to $2,000 in countable assets, and a couple to $3,000.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 Countable assets do not include everything you own; your home, a vehicle, and certain other resources are generally treated differently, so it's worth confirming what counts in your situation.
Income works differently in Hawaii than in many states. Rather than setting a hard income ceiling that locks out anyone above it, Hawaii is a medically needy spend-down state.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 If your income is over the limit, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451 One practical upside of this design: Hawaii does not require a Qualified Income Trust, sometimes called a Miller Trust, the way income-cap states do.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 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 Jul 17, 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 managed care rather than a capped waiver, the path in runs through eligibility and level-of-care review rather than a separate program application. First, you become eligible for Medicaid and enroll in a QUEST Integration managed-care health plan. Then, to add long-term services and supports, a physician evaluates the level of care you need, and your plan authorizes services for members who meet the institutional level of care but can be served at home.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
The service package is built by your plan's care team, working from that assessment, and it is reviewed and adjusted as your needs change. Because availability and timelines can shift, 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 Jul 17, 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 must decide an application within 90 calendar days when eligibility is based on disability, and within 45 calendar days for other applicants, except in unusual circumstances outside the agency's control.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf 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
Does Hawaii have a traditional 1915(c) HCBS waiver?
Not as its main home-care pathway. In most states, the aged and disabled home-care benefit runs through a Section 1915(c) waiver, but Hawaii instead integrates its long-term services and supports (LTSS) into statewide managed care through QUEST Integration, a Section 1115(a) demonstration, rather than operating a standalone 1915(c) waiver as the primary vehicle.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 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.
Do I need a Miller Trust to qualify in Hawaii?
No. Because Hawaii handles excess income through a medically needy spend-down rather than a hard income cap, it does not require a Qualified Income Trust, sometimes called a Miller Trust, the way income-cap states do. If your income is over the limit, you instead qualify by meeting the Medically Needy Spenddown once your medical expenses exceed the determined spend-down amount.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
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 Jul 17, 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?
There is no separate waiver application to file. Once you are enrolled in a QUEST Integration managed-care plan, long-term services and supports are added through a level-of-care review: a physician evaluates the level of care you need, and your plan authorizes home- and community-based services for members who meet an institutional, nursing-facility level of care but can be safely served at home.Centers for Medicare & Medicaid Services. (n.d.). Hawaii QUEST Integration — Section 1115 Demonstration record (medicaid.gov). medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/81451
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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.