Key takeaway
Hawaii pays family caregivers primarily through Med-QUEST’s QUEST Integration managed care program and its Community Care Services (CCS) benefit. The Kupuna Caregivers Program offers up to $210/week to help working caregivers. Spouses generally cannot be paid under Medicaid; VA Veteran Directed Care can pay spouses.
- QUEST Integration: Hawaii’s Medicaid managed care program covers long-term services and supports (LTSS), including in-home care.
- Community Care Services (CCS): pays for personal care, homemaker, and respite — family caregivers can be hired through self-direction.
- Going Home Plus: Money Follows the Person initiative that helps people transition out of facilities into community care.
- Kupuna Caregivers Program: state benefit of up to $210/week for working family caregivers of older adults.
- Veterans: Aid & Attendance and Veteran Directed Care can fund family caregiving (VDC can pay spouses).
Overview
Hawaii combines Medicaid (Med-QUEST), state funds, and federal VA benefits to support family caregivers. The Department of Human Services’ Med-QUEST Division administers QUEST Integration — a Medicaid managed care program that covers acute care and long-term services and supports under one plan, delivered through health plans such as AlohaCare, HMSA, Kaiser, ‘Ohana Health Plan, and UnitedHealthcare Community Plan.
For working family caregivers, Hawaii is unusual in offering the Kupuna Caregivers Program — a state-funded benefit that pays up to $210 per week toward caregiving services so that an employed family caregiver can keep working. Spouses and legal guardians cannot generally be paid as caregivers under Hawaii Medicaid, but the VA’s Veteran Directed Care program allows spouses.
Programs that pay family caregivers in Hawaii
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| QUEST Integration LTSS (Medicaid managed care) | Age 65+ or adults 18+ with a disability; meets nursing-facility level of care; Medicaid financial limits apply. | Health plans authorize personal care, homemaker, adult day, respite, and home modifications. Family caregivers can be hired through Community Care Services with self-direction (not spouses or legal guardians). |
| Community Care Services (CCS) (QUEST Integration HCBS benefit) | QUEST Integration enrollees meeting nursing-facility level of care. | Funds personal care, homemaker, respite, and case management. Self-direction allows hiring family caregivers (other than spouses and legal guardians). |
| Going Home Plus (Money Follows the Person) (Medicaid transition program) | Medicaid recipients moving from a nursing facility back into the community after 60+ days of facility care. | Funds transition services and enhanced in-home supports; family caregivers may be hired through CCS once transitioned. |
| Kupuna Caregivers Program (State-funded benefit) | Working family caregivers (30+ hours/week of employment) caring for a kupuna (older adult) age 60+ who is not on Medicaid. | Provides up to $210/week toward adult day, homemaker, personal care, or respite services. Does not pay the family caregiver directly, but offsets paid services so the caregiver can keep working. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse with limited income/assets and documented ADL need. | Increases monthly pension to help cover care costs. Veteran can pay an adult child or relative; spouses cannot be paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veteran enrolled in VA health care who meets nursing-home level of care; lives in an area served by a participating VAMC. | Monthly care budget the veteran manages to hire any caregiver, including a spouse. VA Pacific Islands Health Care System participates in VDC. |
Hawaii Medicaid programs
Hawaii Medicaid (Med-QUEST) delivers long-term services and supports through QUEST Integration. Within QUEST Integration, the Community Care Services (CCS) benefit is the primary path for family caregivers to be paid. The Going Home Plus initiative helps people leave facilities and access in-home care. Spouses and legal guardians cannot be paid caregivers under any QUEST option.
QUEST Integration Long-Term Services and Supports
QUEST Integration unifies Hawaii’s Medicaid programs under managed care. Enrollees who meet a nursing-facility level of care receive LTSS through their chosen health plan, with services authorized by a care coordinator.
- Age 65+ or adults 18+ with a qualifying disability.
- Must meet nursing-facility level of care.
- Income limit generally at or below 100% of the federal poverty level for the Medicaid LTSS pathway (with some special rules for institutionalized eligibility).
- No general waitlist — eligible enrollees receive services through their MCO.
- Family caregivers can be hired via CCS self-direction (excluding spouses and legal guardians).
Community Care Services (CCS)
CCS is the HCBS benefit within QUEST Integration. It pays for personal care, homemaker, respite, and case management for people who would otherwise need a nursing facility.
- Authorized by the QUEST Integration MCO after a care coordinator assessment.
- Self-direction is available — the participant selects, hires, and supervises their caregiver.
- Common hires include adult children, siblings, friends, and other relatives.
- Spouses, legal guardians, and parents of minor children cannot be paid.
Going Home Plus (Money Follows the Person)
Going Home Plus is Hawaii’s Money Follows the Person demonstration. It helps Medicaid recipients move from nursing facilities back to community settings with enhanced in-home services for the first year.
- Must have lived in a Medicaid-funded facility for at least 60 days.
- Provides transition coordination, home set-up, and bridge funding for community services.
- After transition, the individual accesses ongoing services through QUEST Integration CCS.
Kupuna Caregivers Program and Hawaii ADRC
Hawaii offers a distinctive set of state-funded supports beyond Medicaid, including the Kupuna Caregivers Program and Kupuna Care, coordinated by the Executive Office on Aging and the four county Area Agencies on Aging.
A state-funded benefit of up to $210 per week toward caregiving services for employed family caregivers (working 30+ hours/week) of a non-Medicaid kupuna (older adult). The money funds purchased services so the caregiver can keep working.
Hawaii’s state-funded in-home and community services program for non-Medicaid older adults age 60+, including personal care, homemaker, adult day, transportation, and home-delivered meals.
Aging and Disability Resource Center coordinated through the four county AAAs. Call 643-ADRC (2372) for help navigating long-term care options on Oahu, Maui, Kauai, or Hawaii Island.
Who qualifies
- Kupuna Caregivers Program: working family caregivers caring for a kupuna (60+) who is not on Medicaid.
- Kupuna Care: older adults 60+ who are not Medicaid-eligible; cost-sharing may apply.
- Family Caregiver Support Program: caregivers of adults 60+ or of any age with Alzheimer’s/related dementia.
Veterans’ programs
Hawaii is home to roughly 110,000 veterans. The main VA pathways for paid family caregiving are Aid & Attendance, Veteran Directed Care, and PCAFC, coordinated through the VA Pacific Islands Health Care System.
Aid & Attendance Pension
A&A boosts a wartime veteran’s or surviving spouse’s VA pension to help cover care costs. The veteran can use the increased pension to pay a family member providing care.
- Qualifying wartime service, limited income/assets, and documented ADL need.
- Adult children and other relatives may be paid; spouses cannot be paid directly.
Veteran Directed Care (VDC)
VDC provides a monthly care budget the veteran manages to hire caregivers — including a spouse. The VA Pacific Islands Health Care System participates.
- Veteran must meet nursing-home level of care.
- Spouses may be paid under VDC.
- Financial management service handles payroll.
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
PCAFC provides a monthly stipend, training, and other supports to the primary family caregiver of an eligible veteran with serious injury or illness.
- Stipend tier depends on the veteran’s assessed needs.
- Apply through the VA Caregiver Support Program.
Long-term care insurance
If the care recipient owns a long-term care insurance policy, benefits may be used to pay a family caregiver, subject to policy terms.
What to check in the policy
- Coverage includes in-home personal care, not just facility care.
- Benefits pay the policyholder directly (cash/indemnity model), enabling payment to a chosen family caregiver.
If the policy reimburses only licensed agencies, the family caregiver may need to work through a Hawaii-licensed home care agency that bills the policy.
How to apply in Hawaii (step-by-step)
- Identify your most likely path: QUEST Integration with CCS self-direction, Kupuna Caregivers Program, Going Home Plus, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security card, proof of Hawaii residency, income/asset documentation, medical records, current medications list, and (for veterans) DD-214.
- Start with the right agency:
- QUEST Integration LTSS / CCS: apply through Med-QUEST online (medical.mybenefits.hawaii.gov) or call Med-QUEST at 1-800-316-8005.
- Kupuna Caregivers Program / Kupuna Care: contact your county Area Agency on Aging via the Hawaii ADRC at 643-ADRC (2372).
- Going Home Plus: ask the nursing facility social worker or Med-QUEST about transition options.
- VA paths: contact the VA Caregiver Support Line at 1-855-260-3274 or VA Pacific Islands Health Care System.
- LTC insurance: call the insurer to confirm caregiver payment rules.
- Complete the functional level-of-care assessment and Med-QUEST financial eligibility review (or AAA assessment for Kupuna programs).
- Choose a QUEST Integration health plan, designate your family caregiver under CCS self-direction, and enroll with the fiscal intermediary.
- Begin services. Submit timesheets, keep care logs, and prepare for annual reassessment.
Hawaii paid caregiver FAQs
Can a spouse be paid as a caregiver in Hawaii?
Not under Hawaii Medicaid — QUEST Integration and Community Care Services both exclude spouses and legal guardians as paid caregivers. Spouses can be paid through the VA’s Veteran Directed Care program if the veteran qualifies and lives in an area served by the VA Pacific Islands Health Care System.
How much do caregivers get paid in Hawaii?
Self-directed caregivers under CCS within QUEST Integration typically earn $16 to $22+ per hour, depending on the MCO and care plan. The Kupuna Caregivers Program does not pay the family caregiver directly — instead it provides up to $210/week toward purchased services so an employed caregiver can keep working.
Can I be paid to care for my parent in Hawaii?
Yes. Adult children are routinely hired through QUEST Integration CCS self-direction and VA programs such as Aid & Attendance and Veteran Directed Care. If your kupuna is not on Medicaid, the Kupuna Caregivers Program can offset paid services so you can stay employed.
What is Hawaii’s Kupuna Caregivers Program?
Kupuna Caregivers is a state-funded benefit that pays up to $210 per week toward adult day, homemaker, personal care, or respite services for the older adult — letting working family caregivers (30+ hours/week of employment) keep their jobs while caring for a kupuna age 60+ who is not on Medicaid. It does not pay the family caregiver directly; it funds purchased services.
What is QUEST Integration?
QUEST Integration is Hawaii’s Medicaid managed care program. It combines acute medical care and long-term services and supports under one health plan, delivered through contracted managed care organizations. Family caregivers are typically paid through the program’s Community Care Services (CCS) benefit with the self-direction option.
