How to Pay for In-Home Care
How to Pay for Home Care in Hawaii
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
This directory lists Hawaii-specific and federal payment sources that can pay for, reimburse, offset, or help plan for home care. Some are direct payment sources; others are indirect supports that reduce the amount of private home care a family must buy. Hawaii's strongest state-specific pathways include QUEST Integration LTSS and its self-direction option, Kupuna Care with participant direction, Going Home Plus (Money Follows the Person), the I/DD HCBS Waiver, dual-eligible FIDE-SNP coordination, and the county Aging and Disability Resource Center and caregiver-support network, and VA benefits are broken out because they can be one of the strongest payment pathways for eligible Hawaii veterans and surviving spouses.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Hawaii Medicaid / LTSS
QUEST Integration Long-Term Services and Supports (LTSS)
YesHelps pay for: Hawaii Medicaid managed care can authorize institutional and home/community-based LTSS for members who meet the applicable level-of-care and clinical criteria.
Who qualifies: Med-QUEST eligibility plus the required LTSS assessment/level of care; services must be authorized by the QUEST Integration health plan.
How to start: Apply for Med-QUEST, then ask the health plan for an LTSS assessment.
Good to know: Family caregiver payment: Sometimes
Hawaii Medicaid / Self-Direction
QUEST Integration Self-Directed Personal Assistance
YesHelps pay for: Allows eligible members to direct authorized personal-assistance services and use self-directed workers under health-plan/FMS rules.
Who qualifies: Member must qualify for LTSS/personal assistance and choose self-direction; worker enrollment, EVV, payroll and relationship restrictions apply.
How to start: Ask the QUEST health coordinator specifically for the self-directed personal-assistance option.
Good to know: Family caregiver payment: Possible; relationship rules apply
Hawaii Medicaid / Personal Assistance
Personal Assistance Services - Level I
YesHelps pay for: Can cover homemaker/companion/chore-type assistance and support with everyday community living when authorized.
Who qualifies: QUEST LTSS eligibility, assessed need and plan authorization.
How to start: Request PA Level I through the health-plan care coordinator.
Good to know: Family caregiver payment: Possible under self-direction
Hawaii Medicaid / Personal Care
Personal Assistance Services - Level II
YesHelps pay for: Can cover hands-on personal care and attendant assistance with activities of daily living when authorized.
Who qualifies: QUEST LTSS eligibility, assessed hands-on need and plan authorization.
How to start: Request PA Level II through the health-plan care coordinator.
Good to know: Family caregiver payment: Possible under self-direction
Hawaii Medicaid / Respite
QUEST Integration Respite Care
Yes - respiteHelps pay for: Can provide temporary relief for an unpaid caregiver through authorized respite services.
Who qualifies: QUEST LTSS eligibility and respite need documented in the person-centered plan.
How to start: Ask the health coordinator to assess respite needs.
Good to know: Family caregiver payment: No continuous caregiver wage
Hawaii Medicaid / Adult Day
QUEST Integration Adult Day Care
Offsets care cost / day careHelps pay for: Can cover supervised daytime care and personal support, potentially reducing paid in-home supervision hours.
Who qualifies: QUEST LTSS eligibility and service authorization.
How to start: Ask the health plan about adult day care providers and authorization.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Adult Day Health
QUEST Integration Adult Day Health
Offsets care cost / day careHelps pay for: Can cover health-related daytime services, nursing oversight and therapeutic supports when medically necessary.
Who qualifies: QUEST LTSS eligibility and clinical authorization.
How to start: Ask the health coordinator about adult day health.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Nutrition
QUEST Integration Home-Delivered Meals
Offsets care costHelps pay for: Can cover home-delivered meals when included in an authorized LTSS plan.
Who qualifies: QUEST LTSS eligibility and assessed nutrition/support need.
How to start: Ask the health coordinator about meal benefits.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Safety
QUEST Integration Personal Emergency Response System (PERS)
Offsets care costHelps pay for: Can cover an emergency-alert system that supports safe community living and may reduce paid supervision needs.
Who qualifies: QUEST LTSS eligibility and plan authorization.
How to start: Ask the health coordinator about PERS.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Home Modification
QUEST Integration Environmental Accessibility Adaptations
Offsets care costHelps pay for: Can fund approved accessibility modifications that support health, safety and community living.
Who qualifies: QUEST LTSS eligibility; modification must meet medical/functional criteria and be approved before work begins.
How to start: Discuss home barriers with the health coordinator before purchasing or modifying.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Home Maintenance
QUEST Integration Home Maintenance
Offsets care costHelps pay for: Can cover limited home-maintenance supports when they are part of an approved LTSS plan.
Who qualifies: QUEST LTSS eligibility and authorization; service must fit program rules and assessed need.
How to start: Ask the health coordinator whether the needed maintenance qualifies.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Transition
QUEST Integration Moving Assistance
Offsets care costHelps pay for: Can help with approved moving-related supports when relocation is necessary for community living.
Who qualifies: QUEST LTSS eligibility and plan authorization.
How to start: Ask the health coordinator before incurring moving expenses.
Good to know: Family caregiver payment: No
Going Home Plus (Money Follows the Person)
YesHelps pay for: Helps eligible Medicaid residents move from hospitals, nursing facilities or ICF/IID settings back to the community with services and transition support.
Who qualifies: Medicaid; generally at least 60 continuous days in a qualifying institution; required level of care; choose community transition.
How to start: Ask the facility social worker, health plan or DD case manager for a Going Home Plus referral.
Good to know: Family caregiver payment: No direct caregiver wage
Hawaii Medicaid / Transportation
QUEST Integration Non-Medical Transportation
Offsets care costHelps pay for: Can cover approved non-medical transportation related to LTSS/community participation.
Who qualifies: QUEST LTSS eligibility; trip/service must meet plan rules.
How to start: Request transportation through the health-plan care coordinator.
Good to know: Family caregiver payment: No
Medicaid Non-Emergency Medical Transportation (NEMT)
Offsets care costHelps pay for: Can cover transportation to medically necessary covered care when program requirements are met.
Who qualifies: Med-QUEST eligibility and transportation rules/authorization apply.
How to start: Contact the QUEST health plan for NEMT instructions.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Skilled Care
QUEST Integration Skilled / Private Duty Nursing
Yes - skilled careHelps pay for: Can cover medically necessary skilled or private-duty nursing in the home when authorized.
Who qualifies: Medicaid eligibility, medical necessity and nursing authorization requirements.
How to start: Ask the treating clinician and health plan for nursing assessment/authorization.
Good to know: Family caregiver payment: Generally no
Hawaii Medicaid / Equipment
QUEST Integration Specialized Medical Equipment & Supplies
Offsets care costHelps pay for: Can cover qualifying medical equipment and supplies that support safe care at home.
Who qualifies: Medical necessity and plan coverage/authorization rules apply.
How to start: Ask the clinician/health plan before purchasing equipment.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Care Management
Community Care Management Agency (CCMA) Services
IndirectHelps pay for: Can provide care-management support for eligible LTSS members, including coordination across home and community services.
Who qualifies: QUEST LTSS eligibility and plan assignment/authorization.
How to start: Ask the health plan whether CCMA services apply.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Counseling
QUEST Integration Counseling & Training
Partial / supportHelps pay for: Can cover counseling/training tied to an authorized LTSS plan, including support needed to maintain community living.
Who qualifies: QUEST LTSS eligibility and plan authorization.
How to start: Ask the care coordinator what training/counseling can be included.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Residential Alternative
Community Care Foster Family Home / E-ARCH
Residential alternativeHelps pay for: Medicaid LTSS can cover approved residential alternatives when living fully independently at home is not safe or feasible.
Who qualifies: QUEST LTSS eligibility and licensed/certified setting requirements.
How to start: Ask the health coordinator about community residential alternatives.
Good to know: Family caregiver payment: Potential caregiver/provider payment through licensed setting
Hawaii Medicaid / State Plan
Medicaid Home Health
Yes - skilled careHelps pay for: Can cover medically necessary home-health services such as skilled nursing, therapy and qualifying aide services under Medicaid rules.
Who qualifies: Med-QUEST eligibility, medical necessity and provider/authorization requirements.
How to start: Ask the treating clinician and QUEST plan about home-health coverage.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Financial Eligibility
Medically Needy Spenddown
Indirect - enables MedicaidHelps pay for: Some aged, blind or disabled applicants with income above the standard may qualify after meeting a medical-expense spenddown.
Who qualifies: Income/assets and medically-needy rules apply; documented medical expenses must meet the calculated spenddown.
How to start: Apply for Med-QUEST and request a formal spenddown determination.
Good to know: Family caregiver payment: No
Hawaii Medicaid + Medicare / Integrated Care
FIDE-SNP for Dual-Eligible Members
Coordinates covered careHelps pay for: For 2026, newly enrolling dual-eligible members who choose a D-SNP generally must use the FIDE-SNP offered by the same organization as their QUEST Integration plan, helping coordinate Medicare, Medicaid and LTSS.
Who qualifies: Must be eligible for both Medicare and Medicaid and meet plan enrollment rules.
How to start: Ask Hawaii SHIP and the QUEST plan about aligned FIDE-SNP options.
Good to know: Family caregiver payment: No direct cash
Hawaii Medicaid / Transition Costs
Going Home Plus Supplemental Transition Supports
Offsets care/transition costHelps pay for: Can help with housing coordination, deposits, utility hookups, essential furniture/household items and moving services for qualifying transitions.
Who qualifies: Must qualify for Going Home Plus and have approved transition needs.
How to start: Coordinate all purchases through the GHP transition team before spending.
Good to know: Family caregiver payment: No
Hawaii Medicaid / I/DD
I/DD 1915(c) HCBS Waiver
YesHelps pay for: Provides HCBS for eligible people with intellectual/developmental disabilities who meet institutional level-of-care criteria and live in qualifying community settings.
Who qualifies: Medicaid, I/DD eligibility and institutional level of care; DD case-management and waiver requirements apply.
How to start: Contact the Hawaii Department of Health Developmental Disabilities Division for intake/case management.
Good to know: Family caregiver payment: Sometimes
Hawaii Medicaid / I/DD / Personal Assistance
I/DD Personal Assistance / Habilitation
YesHelps pay for: Can fund personal assistance and habilitation to support daily living, skill development and community participation.
Who qualifies: I/DD waiver eligibility and person-centered service authorization.
How to start: Request through the DD case manager.
Good to know: Family caregiver payment: Possible; verify worker rules
Hawaii Medicaid / I/DD / Respite
I/DD Waiver Respite
Yes - respiteHelps pay for: Can provide caregiver relief through authorized respite services.
Who qualifies: I/DD waiver eligibility and assessed respite need.
How to start: Ask the DD case manager to include respite.
Good to know: Family caregiver payment: No continuous caregiver wage
Hawaii Medicaid / I/DD / Support
I/DD Assistive Technology & Chore Services
Offsets care costHelps pay for: Can cover qualifying assistive technology and chore supports that help maintain safe community living.
Who qualifies: I/DD waiver eligibility and service authorization.
How to start: Discuss functional barriers with the DD case manager.
Good to know: Family caregiver payment: No
Hawaii Medicaid / I/DD / Accessibility
I/DD Home/Vehicle Modifications, NMT & PERS
Offsets care costHelps pay for: Can cover authorized environmental adaptations, vehicle modifications, non-medical transportation and emergency-response supports.
Who qualifies: I/DD waiver eligibility; items/services must meet waiver criteria and be approved in advance.
How to start: Request through the DD case manager before purchasing.
Good to know: Family caregiver payment: No
Hawaii Medicaid / I/DD / Skilled Care
I/DD Waiver Nursing
Yes - skilled careHelps pay for: Can cover nursing services for eligible waiver participants with assessed clinical needs.
Who qualifies: I/DD waiver eligibility, clinical need and service authorization.
How to start: Ask the DD case manager/clinical team.
Good to know: Family caregiver payment: Generally no
Hawaii Medicaid / I/DD / Community
I/DD Community Learning & Employment Supports
Offsets care costHelps pay for: Community-learning and employment supports can reduce reliance on paid supervision while supporting independence and participation.
Who qualifies: I/DD waiver eligibility and person-centered authorization.
How to start: Ask the DD case manager about community-learning/employment services.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Health-Related Social Needs
Community Integration Services Plus (CIS+) Medical Respite
Temporary supportive careHelps pay for: Beginning in 2026, Hawaii Medicaid is phasing in medical-respite benefits for qualifying members with complex health needs who meet applicable housing/institutional criteria.
Who qualifies: Med-QUEST eligibility plus program-specific clinical/social criteria and referral/authorization.
How to start: Ask the QUEST health plan or hospital discharge team about CIS+ medical respite.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Housing Support
QUEST HRSN Housing Navigation Supports
Offsets housing/care costHelps pay for: Can provide pre-tenancy and tenancy-sustaining services for eligible members with complex health needs who are homeless or at risk of homelessness.
Who qualifies: Med-QUEST eligibility plus clinical and housing-risk criteria.
How to start: Ask the QUEST plan about HRSN housing screening and referral.
Good to know: Family caregiver payment: No
Hawaii Medicaid / Palliative Care
Community Palliative Care Benefit
Yes - clinical supportHelps pay for: Hawaii Medicaid has implemented a community palliative-care benefit that can support serious-illness care outside the hospital when criteria are met.
Who qualifies: Med-QUEST eligibility, serious-illness/clinical criteria and plan authorization.
How to start: Ask the treating clinician and QUEST plan for palliative-care referral.
Good to know: Family caregiver payment: No
Hawaii Aging / State Funded
Kupuna Care Program
Yes / subsidizedHelps pay for: State/federal aging funds can provide LTSS and caregiver supports to help older adults age in place and avoid institutionalization.
Who qualifies: Eligibility is determined by the county Area Agency on Aging/ADRC using intake, assessment and a person-centered plan; funding is limited.
How to start: Contact the county Office on Aging/ADRC for Kupuna Care screening.
Good to know: Family caregiver payment: Sometimes through participant direction
Hawaii Aging / Self-Direction
Kupuna Care Participant-Directed Services and Supports
Yes / subsidizedHelps pay for: Eligible participants can have decision-making authority over a budget to purchase and manage needed services/supports under a person-centered plan.
Who qualifies: Must qualify for Kupuna Care; AAA authorizes/allots services; FMS/provider and worker rules apply.
How to start: Tell the county AAA/ADRC you want the participant-directed option.
Good to know: Family caregiver payment: Possible; verify local worker rules
Hawaii Aging / Personal Care
Kupuna Care Personal Care & Attendant Care
Yes / subsidizedHelps pay for: Can provide help with bathing, eating, dressing, toileting, transfers, supervision and other personal assistance for eligible older adults.
Who qualifies: Generally age 60+ aging-network eligibility, assessed need and local funding/authorization.
How to start: Request an in-home assessment through the county Office on Aging.
Good to know: Family caregiver payment: Possible under participant direction
Hawaii Aging / Homemaker
Kupuna Care Homemaker & Chore Services
Yes / subsidizedHelps pay for: Can help with meal preparation, shopping, housework, medication routines and heavier household/yard tasks.
Who qualifies: Aging-network eligibility, assessed need and local funding.
How to start: Ask the county Office on Aging about homemaker/chore services.
Good to know: Family caregiver payment: Possible under participant direction
Hawaii Aging / Respite
Kupuna Care / Aging-Network Respite
Yes - respiteHelps pay for: Can provide temporary caregiver relief and may be combined with other caregiver-support services when funding is available.
Who qualifies: Caregiver/care-recipient assessment and local program availability.
How to start: Contact the county Office on Aging/ADRC.
Good to know: Family caregiver payment: No continuous caregiver wage
Hawaii Aging / Adult Day
Kupuna Care Adult Day Care / Adult Day Health
Offsets care cost / day careHelps pay for: Can subsidize supervised daytime care and health-related day services, reducing in-home supervision needs.
Who qualifies: Aging-network eligibility, assessment and local provider/funding availability.
How to start: Ask the county Office on Aging for adult-day options.
Good to know: Family caregiver payment: No
Hawaii Aging / Nutrition
Home-Delivered & Congregate Meals
Offsets care costHelps pay for: Meals can reduce food spending and caregiver meal-preparation time while providing nutrition and social/safety support.
Who qualifies: Program-specific age, need and local availability criteria.
How to start: Contact the county Office on Aging/ADRC or nutrition provider.
Good to know: Family caregiver payment: No
Hawaii Aging / Transportation
Assisted Transportation & Transportation Services
Offsets care costHelps pay for: Can subsidize door-to-door/escort or other transportation for older adults, reducing caregiver driving time and transportation expense.
Who qualifies: Aging-network eligibility and local service/funding availability.
How to start: Contact the county Office on Aging/ADRC.
Good to know: Family caregiver payment: No
Hawaii Aging / Caregiver Support
National Family Caregiver Support Program / Hawaii Aging Network
Partial / respiteHelps pay for: Provides caregiver information, assistance, counseling, training, respite and limited supplemental services through county aging agencies.
Who qualifies: Older Americans Act caregiver eligibility and local funding/priorities apply.
How to start: Contact the county Office on Aging/ADRC for caregiver assessment.
Good to know: Family caregiver payment: No continuous caregiver wage
Hawaii Aging / Navigation
Aging & Disability Resource Centers / County Offices on Aging
IndirectHelps pay for: One-stop navigation for long-term-care options, aging services, caregiver support, meals, transportation and local providers.
Who qualifies: Available statewide; service eligibility varies by referred program.
How to start: Call the county Office on Aging serving the resident.
Good to know: Family caregiver payment: No
Hawaii Aging / Dementia
Hanai Memory Network Program
Indirect / care navigationHelps pay for: New 2026 statewide dementia initiative designed to improve screening, diagnosis, navigation, coordinated care and caregiver support, including specialists in each county.
Who qualifies: Program implementation and local service availability will determine access; aimed at people with dementia and caregivers.
How to start: Ask the Executive Office on Aging/county aging office about Hanai Memory Network availability.
Good to know: Family caregiver payment: No direct wage
Medicare Counseling
Hawaii SHIP
Offsets insurance/medical costHelps pay for: Free unbiased counseling on Medicare, Medicare Advantage, Part D, Medigap and programs that reduce Medicare costs.
Who qualifies: Medicare beneficiaries, caregivers and people approaching Medicare eligibility.
How to start: Call Hawaii SHIP for one-to-one counseling.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - skilled/limited aideHelps pay for: Can cover intermittent skilled nursing, therapy and limited home-health-aide services when Medicare eligibility rules are met.
Who qualifies: Medicare; homebound and skilled-care requirements generally apply; custodial care alone is not covered.
How to start: Ask the treating clinician for a Medicare-certified home-health referral.
Good to know: Family caregiver payment: No
Medicare / Caregiver Support
Medicare Caregiver Training Services
Offsets caregiver training costHelps pay for: Medicare can cover certain training for caregivers when needed to help a patient carry out a treatment plan safely.
Who qualifies: Must meet Medicare coverage requirements and be part of the patient care plan.
How to start: Ask the clinician whether caregiver training can be billed to Medicare.
Good to know: Family caregiver payment: No
Medicare / Dementia
GUIDE Dementia Care Model
Partial / respiteHelps pay for: Participating GUIDE organizations can provide dementia care coordination, caregiver education/support and respite benefits for eligible beneficiaries.
Who qualifies: Traditional Medicare beneficiary with dementia; must meet model and participant-provider requirements.
How to start: Use the CMS GUIDE participant list or ask Medicare/clinician about participating organizations.
Good to know: Family caregiver payment: No continuous caregiver wage
Medicare Cost Reduction
Medicare Savings Programs (MSP)
Offsets household/medical costHelps pay for: Medicaid-administered programs can pay Medicare premiums and, for some beneficiaries, other Medicare cost sharing, freeing income for care.
Who qualifies: Income/resource and Medicare eligibility rules vary by MSP category.
How to start: Apply through Med-QUEST and ask Hawaii SHIP for screening help.
Good to know: Family caregiver payment: No
Prescription Cost Reduction
Extra Help / Part D Low-Income Subsidy
Offsets prescription costHelps pay for: Reduces Medicare Part D premiums, deductibles and prescription copays for qualifying beneficiaries.
Who qualifies: Medicare Part D and income/resource or automatic-eligibility rules.
How to start: Apply through Social Security or ask Hawaii SHIP.
Good to know: Family caregiver payment: No
Food Cost Reduction
SNAP
Offsets household costHelps pay for: Monthly food benefits can reduce grocery spending, preserving household income for care.
Who qualifies: Household income and program rules; households with elderly/disabled members use special net-income rules.
How to start: Apply through Hawaii DHS Benefit, Employment & Support Services.
Good to know: Family caregiver payment: No
Energy Cost Reduction
Hawaii Home Energy Assistance Program (H-HEAP / LIHEAP)
Offsets household costHelps pay for: Can provide eligible households a one-time payment toward electric or gas bills, including crisis assistance when service is threatened.
Who qualifies: Income, household and program-year rules; crisis slots/funding can be limited.
How to start: Apply through the contracted community action agency for the county.
Good to know: Family caregiver payment: No
Home Energy / Cost Reduction
Weatherization Assistance Program
Offsets household costHelps pay for: Provides free qualifying energy-efficiency measures for eligible low-income households, reducing ongoing utility costs.
Who qualifies: Generally within 200% of the federal poverty guideline; priority includes older adults and people with disabilities.
How to start: Contact the community action agency serving the county.
Good to know: Family caregiver payment: No
Energy Rebates / Cost Reduction
Hawaii Energy & Utility Efficiency Rebates
Offsets household costHelps pay for: Rebates and efficiency programs can reduce appliance, water-heating, cooling and other home-energy costs; availability differs by county/utility.
Who qualifies: Program, technology, county and utility rules vary; some incentives are income-qualified.
How to start: Check Hawaii State Energy Office and local utility/Hawaii Energy programs before purchase.
Good to know: Family caregiver payment: No
Private Insurance
Long-Term Care Insurance
Yes / reimbursementHelps pay for: Existing LTC insurance may reimburse covered home care, personal care, respite or other long-term-care services according to the policy.
Who qualifies: Policy benefit triggers, elimination periods, daily/monthly limits and covered-provider rules apply.
How to start: Review the policy and request a written benefit eligibility determination from the insurer.
Good to know: Family caregiver payment: Sometimes indirectly
Home Equity
Reverse Mortgage / HECM
Cash / indirectHelps pay for: Eligible homeowners age 62+ may convert home equity to cash that can be used for care, but the loan has significant costs and obligations.
Who qualifies: Age, home, occupancy, equity and counseling requirements apply; taxes/insurance/maintenance remain borrower obligations.
How to start: Speak with a HUD-approved HECM counselor before applying.
Good to know: Family caregiver payment: Yes, indirectly
Life Insurance
Life Insurance Cash Value / Accelerated Benefit / Life Settlement
Cash / indirectHelps pay for: Depending on policy terms, cash value, an accelerated death benefit or a life settlement may provide funds that can be used for home care.
Who qualifies: Policy-specific; tax, Medicaid and estate consequences can be significant.
How to start: Ask the insurer for an in-force illustration/options and review with a qualified adviser.
Good to know: Family caregiver payment: Yes, indirectly
Retirement / Savings
Retirement Income, Annuity or Savings Drawdown
Cash / private payHelps pay for: Retirement accounts, annuities and savings can be budgeted to pay privately for home care when public benefits do not cover all needed hours.
Who qualifies: Account, tax, required-distribution and liquidity rules vary.
How to start: Build a care budget with a fiduciary financial/tax adviser.
Good to know: Family caregiver payment: Yes, indirectly
Private Pay / Family Arrangement
Personal Care Agreement / Private Family Payment
Yes - private payHelps pay for: A written personal-care agreement can formalize payment to a relative for legitimate caregiving services and document duties, hours and reasonable compensation.
Who qualifies: Must be bona fide, prospective and properly documented; Medicaid transfer-of-asset and tax/employment rules can apply.
How to start: Use an elder-law attorney/CPA before beginning payments if Medicaid eligibility may matter.
Good to know: Family caregiver payment: Yes
Workers Compensation
Workers Compensation Medical / Home Care
SometimesHelps pay for: For a compensable work-related injury, workers compensation can pay medical care and may cover medically necessary home services when authorized.
Who qualifies: Must arise from a covered work injury and be authorized under Hawaii workers-compensation rules.
How to start: Ask the carrier/claims adjuster and treating clinician about home-care coverage.
Good to know: Family caregiver payment: Sometimes, case-specific
Auto / Liability
Liability or Accident Settlement
Cash / indirectHelps pay for: Settlement proceeds from an accident or injury can be reserved or structured to pay future home-care expenses.
Who qualifies: Depends on claim, settlement terms, liens, benefit eligibility and tax/legal issues.
How to start: Coordinate with attorney and financial adviser before spending settlement funds.
Good to know: Family caregiver payment: Yes, indirectly
VA Benefits
VA Homemaker & Home Health Aide
YesHelps pay for: VA may pay an authorized community aide to help an eligible Veteran with ADLs and selected daily tasks.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local availability; copay may apply.
How to start: Ask the VA primary-care team/social worker for assessment and authorization.
Good to know: Family caregiver payment: No
Veteran-Directed Care (VDC)
YesHelps pay for: Provides a flexible self-directed budget for eligible Veterans needing personal care; workers may include family or neighbors subject to local program rules.
Who qualifies: Enrolled Veteran; community-care eligibility; clinical criteria and local VDC availability.
How to start: Ask the VA social worker whether VDC is available locally.
Good to know: Family caregiver payment: Yes
VA Aid & Attendance Pension Add-On
Cash / indirectHelps pay for: Additional monthly pension amount for qualifying Veterans/survivors who need help with daily activities or meet other criteria; cash can be used toward care.
Who qualifies: Must first qualify for VA pension plus Aid & Attendance medical/financial criteria.
How to start: Apply through VA or an accredited representative.
Good to know: Family caregiver payment: Yes, indirectly
VA Homemaker & Home Health Aide
YesHelps pay for: VA may pay an authorized community aide to help an eligible Veteran with ADLs and selected daily tasks.
Who qualifies: VA enrollment/community-care eligibility, clinical need and local availability; copay may apply. Ask VA primary care/social work for assessment and authorization.
How to start: Ask the VA social worker or care team about VA Homemaker & Home Health Aide.
Good to know: Family caregiver payment: No
Veteran-Directed Care (VDC)
YesHelps pay for: Provides a flexible self-directed budget for eligible Veterans who need personal care and help with daily activities; workers may include family or neighbors under local program rules.
Who qualifies: Enrolled Veteran; community-care eligibility; clinical need and local VDC availability. Ask the VA social worker whether VDC is available through the local VA/AAA partnership.
How to start: Ask the VA social worker or care team about Veteran-Directed Care (VDC).
Good to know: Family caregiver payment: Yes
VA Skilled Home Health
Yes - skilled careHelps pay for: VA may purchase skilled nursing, therapy and related home-health services from community providers for eligible Veterans.
Who qualifies: Clinical need, VA eligibility and authorization/local availability. Ask the VA care team for skilled home-health assessment/referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No
VA Respite Care
Yes - respiteHelps pay for: VA may arrange in-home, adult-day or nursing-home respite to give eligible caregivers a break.
Who qualifies: Clinical need, enrollment and local availability; community-care authorization may apply. Ask the VA caregiver support coordinator/social worker.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No
VA Aid & Attendance
Cash / indirectHelps pay for: Extra pension amount for a qualifying Veteran/survivor who needs help with ADLs, is bedridden, has severe vision impairment or meets other criteria.
Who qualifies: Must qualify for VA pension and Aid & Attendance medical/financial criteria. Apply through VA or an accredited representative.
How to start: Ask the VA social worker or care team about VA Aid & Attendance.
Good to know: Family caregiver payment: Yes, indirectly
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Direct caregiver stipendHelps pay for: Monthly stipend and additional supports for an approved primary family caregiver of an eligible Veteran.
Who qualifies: Veteran and caregiver must meet PCAFC eligibility and complete VA assessment/enrollment. Apply jointly through VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes
VA Community Care Network - Region 4
Pays authorized providerHelps pay for: VA-authorized community care can include home health and other approved services. Hawaii is in CCN Region 4, administered by TriWest.
Who qualifies: VA referral/authorization and community-care eligibility generally apply. Do not assume reimbursement after privately hiring care. Obtain VA authorization before routine community care; use emergency/urgent-care rules when applicable.
How to start: Ask the VA social worker or care team about VA Community Care Network - Region 4.
Good to know: Family caregiver payment: No
VA Pension
Cash / indirectHelps pay for: Needs-based monthly cash benefit for qualifying wartime Veterans or survivors; can be used toward living and care expenses.
Who qualifies: Wartime service plus age/disability and net-worth/income rules. Apply through VA or an accredited representative.
How to start: Ask the VA social worker or care team about VA Pension.
Good to know: Family caregiver payment: Yes, indirectly
Housebound Pension Add-On
Cash / indirectHelps pay for: Additional pension amount for some pension-eligible Veterans substantially confined to the home because of permanent disability.
Who qualifies: Must qualify for pension plus housebound criteria; cannot generally receive both A&A and housebound add-ons. Apply with pension/A&A-housebound forms and medical evidence.
How to start: Ask the VA social worker or care team about Housebound Pension Add-On.
Good to know: Family caregiver payment: Yes, indirectly
Home Improvements and Structural Alterations (HISA)
Offsets care costHelps pay for: Grant for medically necessary home improvements/structural alterations such as accessibility changes.
Who qualifies: Veteran must meet HISA clinical/eligibility rules; prescribed improvement and approval required. Ask VA prosthetics/rehabilitation or care team before starting work.
How to start: Ask the VA social worker or care team about Home Improvements and Structural Alterations (HISA).
Good to know: Family caregiver payment: No
VA Adult Day Health Care
Offsets care cost / day careHelps pay for: Therapeutic daytime health, rehabilitation and social services can reduce in-home supervision needs for eligible Veterans.
Who qualifies: Clinical need, enrollment/eligibility and local availability. Ask the VA social worker about adult day health care.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No
VA Hospice Care
Yes - hospiceHelps pay for: VA can arrange hospice/palliative services, often including home-based support, for eligible Veterans with advanced illness.
Who qualifies: Clinical eligibility and VA/hospice authorization requirements. Ask VA care team for hospice/palliative consultation.
How to start: Ask the VA social worker or care team about VA Hospice Care.
Good to know: Family caregiver payment: No
Where Hawaii Families Can Start
Not sure where to begin? Match your situation to a contact below.
Medicaid applications, eligibility, plan enrollment and general Med-QUEST questions
Med-QUEST Customer Services
LTSS assessment, personal assistance, self-direction, respite, meals, PERS, home modifications, nursing and transportation
QUEST Integration Health Plan
Statewide aging/caregiver programs, county aging network and policy information
Executive Office on Aging
Kupuna Care, caregiver supports, meals, transportation and aging services on Oahu
Honolulu Elderly Affairs Division / ADRC
Kupuna Care, caregiver supports, meals, transportation and aging services on Hawaii Island
Hawaii County Office of Aging / ADRC
Kupuna Care, caregiver supports and aging services for Maui, Molokai and Lanai
Maui County Office on Aging / ADRC
Kupuna Care, caregiver supports, meals, transportation and aging services on Kauai
Kauai Agency on Elderly Affairs / ADRC
Free Medicare, Medicare Advantage, Part D, Medigap and Medicare cost-assistance counseling
Hawaii SHIP
LIHEAP electric/gas bill assistance and crisis help
Hawaii Home Energy Assistance Program
Free qualifying energy-efficiency measures for eligible households
Weatherization Assistance Program
Medicare home health, caregiver training, GUIDE and coverage questions
Medicare
VA health benefits, caregiver/home-care programs and general VA assistance
U.S. Department of Veterans Affairs
Before You Rely on Any Payment Source
Planning Point
Why It Matters
QUEST Integration is the main Medicaid LTSS pathway
For older adults and adults with disabilities who meet the required level of care, QUEST Integration can authorize a broad HCBS package including personal assistance, respite, meals, PERS, modifications, transportation and nursing.
Self-directed personal assistance can create a paid-worker pathway
Hawaii Medicaid has a self-directed personal-assistance program. A proposed family worker should be cleared with the QUEST health plan/FMS before work begins because enrollment, relationship, EVV and payroll rules apply.
Kupuna Care is broader than the old Kupuna Caregivers program
Hawaii repealed the separate Kupuna Caregivers statute and consolidated caregiver/employed-caregiver support into Kupuna Care. Current law provides both traditional delivery and participant-directed services/supports.
County ADRCs are essential because aging services are locally administered
Honolulu, Hawaii, Maui and Kauai aging agencies authorize and coordinate Kupuna Care and Older Americans Act services; available providers and funding can differ significantly by island.
Going Home Plus can cover more than direct care
For qualifying institutional transitions, Going Home Plus can combine HCBS with deposits, utility hookups, essential household items, housing coordination and moving support.
I/DD waiver services use a separate DD case-management system
People with intellectual/developmental disabilities generally access waiver services through the Department of Health Developmental Disabilities Division rather than the standard older-adult aging network.
2026 dual-eligible enrollment rules changed
Starting January 1, 2026, new dual-eligible people who enroll in a D-SNP generally use the FIDE-SNP offered by the same organization as their QUEST Integration Medicaid plan. Hawaii SHIP can help compare options.
Medical respite and HRSN housing supports are newer Medicaid benefits
The 2025-2029 QUEST demonstration extension is phasing in medical respite and housing-related social-needs benefits. Eligibility is narrower than ordinary LTSS and should be confirmed with the health plan.
The Hanai Memory Network is navigation/support, not a caregiver salary
The 2026 dementia initiative is designed to improve screening, diagnosis, coordinated care and caregiver support statewide. It should be paired with Medicaid/Kupuna Care/VA benefits when direct care funding is needed.
Medicare is not a general custodial home-care benefit
Medicare home health depends on skilled/intermittent and other coverage requirements. GUIDE and caregiver training add targeted supports but do not replace ongoing Medicaid, VA, LTC insurance or private-pay custodial care.
Island availability matters more in Hawaii than statewide lists suggest
A benefit can be authorized yet difficult to staff on a particular island. Families should confirm provider capacity, waitlists and travel/service-area limits before building a care plan around a program.
Hawaii home-care costs are high and vary by island
CareScout reports a 2025 statewide median of $93,808 for 44 hours/week of non-medical caregiving. Oahu, Maui, Hawaii Island, Kauai and smaller islands may differ substantially, so local quotes are important.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Hawaii to help you navigate the application process.
← Back to How to Pay for In-Home CareHome Care Providers in Hawaii
These providers serve families in Hawaii and can help you apply what you've learned above to your specific situation.
