Hawaii Medicaid Income Limits 2024

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Medical assistance is medical coverage provided for eligible low-income Hawaii residents. Hawaii has two medical assistance programs called Hawaii QUEST and Medicaid Fee-For-Service. Generally, for eligible individuals who are age 65 and over, or certified blind or disabled, coverage is provided under Hawaii’s Medicaid Fee-For-Service Program where providers are paid directly for covered services.

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Hawaii Medicaid Income Limits 2023

For all other eligible individuals, coverage is provided under a managed care program called Hawaii QUEST. The income standard used to determine your eligibility would depend on your coverage group. When applying for Medicaid, the Department will determine your coverage group and use the income standard of that group to determine your eligibility.

Who is eligible for Hawaii Medicaid Fee-For-Service Program?

To be eligible for Hawaii Medicaid Fee-for-Service, you must be a resident of the state of Hawaii, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:

  • Pregnant, or
  • Be responsible for a child 18 years of age or younger, or
  • Blind, or
  • Have a disability or a family member in your household with a disability.
  • Be 65 years of age or older.

Hawaii Medicaid Income Limits 2023 2024

Household Size* Maximum Income Level (Per Year)
1 $22,305
2 $30,165
3 $38,025
4 $45,885
5 $53,746
6 $61,606
7 $69,466
8 $77,327

*For households with more than eight people, add $7,861 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

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How can I contact someone?

Contact the nearest office of the Med-QUEST Division’s Eligibility Branch to request an application form. The Med-QUEST Division accepts applications at eligibility offices located throughout Hawaii. (Most hospitals and certain health centers have also made arrangements to forward your medical application to us.) If you are currently receiving food stamps, your caseworker can process your medical application.

For more information, please visit the Med-QUEST Division’s website. Complete the application form and return it to the Med-QUEST office. They may contact you to schedule an appointment to establish your eligibility. You may be required at that time to provide verification of your date of birth, citizenship, Social Security Number, income, and assets.

If you are unable to represent yourself, you may appoint someone to represent you. This could be your spouse, adult child, sibling, other relatives, a friend, or anyone else who knows of your situation. Go to the Hawaii My Medical Benefits website to access applications and further information.

Hawaii Medicaid Income & Asset Limits for Eligibility

March 2023 – February 2024 Hawaii Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid No hard income limit* $2,000 Nursing Home No hard income limit* $3,000 Nursing Home No hard income limit* $2,000 for applicant & $148,620 for non-applicant Nursing Home
Home and Community Based Services $1,398 / month† $2,000 Nursing Home $1,398 / month per spouse if living at home† $3,000 Nursing Home $1,398 / month for applicant if living at home† $2,000 for applicant & $148,620 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind, and Disabled $1,398 / month $2,000 Help with ADLs $1,890 / month $3,000 Help with ADLs $1,890 / month $2,000 Help with ADLs

*With the exception of a Personal Needs Allowance of $50 / month, Medicare premiums, and potentially a Spousal Income Allowance for a non-applicant spouse, all a beneficiary’s monthly income must go towards nursing home costs.

  • The income limit varies based on the location in which the senior lives.
  • While the income limit for a senior living at home is $1,398 / month, any income that exceeds that amount must go towards one’s care costs.
  • For a senior SSI recipient seeking home and community based services in an adult foster care home / community care foster family home (CCFFH), the entire SSI amount ($1,565.90 / month), with the exception of $50 – $70 / month for a Personal Needs Allowance (PNA), must go towards their care costs.
  • To avoid confusion, SSI payments for persons residing in CCFFH’s are higher than for persons residing at home or in assisted living.
  • If a senior has income that exceeds the SSI amount, $419 / month must be paid towards the cost of room and board.
  • The remaining funds, with the exception of a PNA between $50 and $70 / month, must go to the foster home caregiver.

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Hawaii Medicaid Long-Term Care Definition

Medicaid, or Med-QUEST in HI, is a health insurance program for low-income individuals of all ages. While this program provides coverage for various groups of Hawaii residents, the focus of this page is long-term care Medicaid eligibility for elders, aged 65 and over. In addition to providing care in nursing homes, community care foster family homes, expanded adult residential care homes, and assisted living residences, Med-QUEST pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of long-term care programs for which HI seniors may be eligible.

Institutional / Nursing Home Medicaid – This is an entitlement program; anyone who meets the eligibility requirements will receive benefits. Assistance is only provided in nursing home facilities.

Home and Community Based Services (HCBS) – Hawaii used to offer HCBS Medicaid Waivers for the elderly, but no longer does. Instead, long-term care services are provided at home, adult day care, community care foster family homes, expanded adult residential care homes, or in assisted living residences via a managed care system. This allows program participants to receive all needed services via one administering agency. There may be an enrollment cap for HCBS, and therefore, there may be a waiting list to receive services.

Regular Medicaid / Aged, Blind, and Disabled – This is an entitlement program; anyone who is eligible will receive assistance. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

In Hawaii, the Medicaid program is called Med-QUEST. While this is a state and federally funded program, the state administers the program under federally set parameters. The Hawaii Department of Human Services is the administering agency.

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hawaii med-quest income eligibility

The Hawaii QUEST Program (QUEST) is a Medicaid managed care program where the State pays health plans to provide coverage of medical and mental health services. Dental Services are provided on a fee-for-service basis.

QUEST Eligibility Requirements

  • Be a Hawaii resident
  • Be a U.S. citizen or legal immigrant
  • Provide proof of their citizenship status
  • Provide proof of their identity
  • Provide a Social Security Number
  • Not reside in a public institution
  • Be under age 65
  • Not blind or disabled
  • Not be eligible for to receive health insurance from their employer (except for individuals covered under Section 1931 of the Social Security Act, the General Assistance Program, or the Transitional Medical Assistance Program)
  • Meet an asset test (except for pregnant women and individuals under age 19)
  • Meet an income test

QUEST Financial Responsibility for Support

Spouses and parents of minor children living together are responsible to support the family. Adult children are not responsible to support their parents, even if they live together.

Assets

Individuals subject to the asset test are not eligible if their countable assets exceed the asset standard. Pregnant women and children under age 19 are not subject to the asset test. Countable assets include cash, bank accounts, stocks, bonds, real property and other personal property. Exempt assets include the home property, motor vehicles, clothing and household furnishing and appliances. The asset standard is $2,000 for a household of one, $3000 for two, and $250 for each additional family member.

hawaii med-quest income eligibility

Individuals must have countable income within the appropriate income standard. Countable income includes wages, earning from self employment, retirement pensions, unemployment insurance benefits, Social Security benefits, annuities, interest, royalties, etc. Exempt income includes SSI benefits, welfare payments, food stamps, and loans.

Adults must not have countable family income that is more than 100% of the current Federal Poverty Level (FPL). Children under age 19 must not have countable family income that is more than 200% FPL. Pregnant women must not have countable family income that is more than 185% FPL (her household size includes the unborn child(ren). Individuals should contact the Med-QUEST Division to obtain the current income standards.

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QUEST Enrollment Cap

An enrollment cap will be in effect when QUEST enrollment exceeds 125,000 individuals. Under the cap, single childless adults cannot be enrolled in QUEST, even if they meet all other requirements. The cap is lifted when enrollment is below 125,000 individuals on the last day of the year.

QUEST Covered Services

The QUEST health plans pay contracted health care providers for medical services received by enrollees. Dental services for QUEST recipients are covered by on a fee-for-service basis. The QUEST covered services include, but are not limited to:

  • Inpatient and outpatient hospital and clinical services (including X-ray and laboratory examinations)
  • Physicians’ services
  • Nursing facility and home health services
  • Drugs
  • Biological and medical supplies (medical equipment and appliances)
  • Podiatry (foot care)
  • Whole blood
  • Eye examinations, refraction and eyeglasses
  • Dental services (individuals age 21 and older have an annual payment limit for non-emergency services.)
  • Family planning services
  • Psychiatric/psychological services
  • Diagnostic, screening, preventive and rehabilitative services
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services
  • Prosthetic devices, (including hearing aids)
  • Transportation to, from, and between medical facilities, (including inter-island or out-of-state air transportation, food, and lodging as necessary)
  • Respiratory care services
  • Hospice care services

Individuals under age 21 also receive Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) health services. These services include:

  • Complete medical and dental exams;
  • Hearing and vision tests, laboratory tests;
  • Immunizations and skin tests for tuberculosis (TB);
  • Assistance with necessary scheduling and transportation upon request.
  • Unlimited mental health benefits.

QUEST Enrollment

  • QUEST recipients can choose a health plan that provides services on the island they live. The Department will assign recipients who fail to choose a plan within 10 days to a plan.
  • The health plan will mail a handbook and health plan card to new enrollees. The handbook will explain plan benefits, providers, service procedures, and important phone numbers.
  • The health plan will ask each enrollee to choose a doctor from their plan network to provide or arrange for heath care. This doctor is called a PCP (Primary Care Provider). Enrollees who fail to select a PCP will be assigned one by the plan.

Hawaii Medicaid Eligibility and Enrollment

Access to quality healthcare is a fundamental right, and in Hawaii, the Medicaid program plays a crucial role in ensuring that low-income individuals and families have access to essential medical services. The eligibility criteria for Medicaid in Hawaii, as in many other states, are determined based on household size and income. In 2023, the Hawaii Medicaid Income Limits continue to evolve to provide assistance to those who need it most. This article will break down the income limits according to household size, helping you understand if you qualify for Medicaid in the beautiful islands of Hawaii.

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Hawaii Medicaid Eligibility

Medicaid is a joint federal and state program designed to provide health coverage to eligible low-income individuals and families. In Hawaii, the program is known as “Med-QUEST,” and it is administered by the Department of Human Services (DHS). To be eligible for Medicaid, you must meet certain income and household size requirements, which can change from year to year.

Hawaii Medicaid Income Limits for 2023

The Hawaii Medicaid Income Limits for 2023 are primarily determined by your household size and total annual income. These limits ensure that those with limited financial means can access vital healthcare services. Let’s take a closer look at the income limits for different household sizes:

  • Household Size: 1
    • Maximum Income Per Year: $22,305
  • Household Size: 2
    • Maximum Income Per Year: $30,165
  • Household Size: 3
    • Maximum Income Per Year: $38,025
  • Household Size: 4
    • Maximum Income Per Year: $45,885
  • Household Size: 5
    • Maximum Income Per Year: $53,746
  • Household Size: 6
    • Maximum Income Per Year: $61,606
  • Household Size: 7
    • Maximum Income Per Year: $69,466
  • Household Size: 8
    • Maximum Income Per Year: $77,327

Hawaii Medicaid Eligibility Criteria

To qualify for Medicaid in Hawaii, you must meet the income limits corresponding to your household size. Your household size includes all individuals living together who share financial resources. This typically includes family members and sometimes even non-relatives living in the same household.

It’s important to note that these income limits are subject to change and can vary depending on specific circumstances and programs within Medicaid. Additionally, certain individuals may qualify for Medicaid even if their income exceeds these limits, such as pregnant women, children, and individuals with disabilities.

Hawaii Medicaid Application Process

To apply for Medicaid in Hawaii, you can use the online portal provided by the Department of Human Services or seek assistance from their offices across the state. You’ll need to provide information about your household size, income, and other relevant details.

FAQ’s-Hawaii Medicaid Income Limits 2023 2024

Q: What are the Hawaii Medicaid Income Limits for 2023 based on household size and income?

Ans: The Hawaii Medicaid Income Limits for 2023 vary according to the number of household members and their total annual income. Here are the income limits:

  • Household Size: 1
    • Maximum Income Per Year: $22,305
  • Household Size: 2
    • Maximum Income Per Year: $30,165
  • Household Size: 3
    • Maximum Income Per Year: $38,025
  • Household Size: 4
    • Maximum Income Per Year: $45,885
  • Household Size: 5
    • Maximum Income Per Year: $53,746
  • Household Size: 6
    • Maximum Income Per Year: $61,606
  • Household Size: 7
    • Maximum Income Per Year: $69,466
  • Household Size: 8
    • Maximum Income Per Year: $77,327

Q: Who administers the Medicaid program in Hawaii?

Ans: The Medicaid program in Hawaii, known as “Med-QUEST,” is administered by the Department of Human Services (DHS).

Q: Can I qualify for Medicaid in Hawaii if my household income exceeds the maximum income limit for my household size?

Ans: In some cases, yes. Certain individuals, such as pregnant women, children, and individuals with disabilities, may qualify for Medicaid even if their household income exceeds the stated maximum income limits. Eligibility criteria can vary based on specific circumstances and programs within Medicaid.

Q: How can I apply for Medicaid in Hawaii?

Ans: You can apply for Medicaid in Hawaii by using the online portal provided by the Department of Human Services or by seeking assistance from their offices located throughout the state. During the application process, you’ll need to provide information about your household size, income, and other relevant details.

Q: Are the Hawaii Medicaid Income Limits for 2023 subject to change?

Ans: Yes, the income limits for Medicaid in Hawaii can change from year to year. It’s essential to check the most current income limits to determine your eligibility accurately.

Q: What is considered the household size when applying for Medicaid?

Ans: Your household size includes all individuals living together who share financial resources. This typically includes family members and sometimes even non-relatives living in the same household. When determining Medicaid eligibility, the income limits are based on this household size.

Conclusion – Hawaii Medicaid Income Limits 2023 2024

Access to healthcare is a fundamental right, and the Hawaii Medicaid program helps ensure that low-income individuals and families can receive essential medical services. The income limits for Medicaid in Hawaii for 2023 vary according to household size, and it’s crucial to check the eligibility criteria and apply if you meet the requirements. These income limits can provide a lifeline to individuals and families in need of medical care, making a positive impact on the health and well-being of Hawaii’s residents.

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