This page provides a plain-English summary of key elder care and estate planning information specific to Hawaii residents. It covers Hawaii Medicaid limits, estate tax rules, advance directive information, and links to important Hawaii agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
Hawaii Medicaid — 2026 Eligibility Limits for Long Term Care
Hawaii’s Medicaid program is called Med-QUEST and is administered by the Hawaii Department of Human Services — DHS — Med-QUEST Division. Hawaii expanded Medicaid under the Affordable Care Act in 2014 providing coverage to adults up to 138 percent of the federal poverty level. Hawaii uses higher Federal Poverty Level thresholds than the mainland United States reflecting the state’s significantly higher cost of living.
Important — Hawaii has the second highest nursing home costs in the country Hawaii has the second highest nursing home costs in the nation at approximately $18,000 per month — exceeded only by Alaska. The high cost of living limited land availability and the expense of importing supplies and staffing drive these exceptional costs. Planning ahead for long term care is especially critical for Hawaii residents given these costs. A six-month stay in a Hawaii nursing home can cost over $100,000.
Income limit — Hawaii nursing home Medicaid uses Share of Cost — no income cap Hawaii is one of the few states that does not impose a hard monthly income cap for nursing home Medicaid eligibility. Instead Hawaii uses a Share of Cost model — meaning nearly all of a resident’s income must be contributed toward nursing home care costs. The resident keeps only a small personal needs allowance plus Medicare premiums and any allowable spousal income allowance. Having higher income does not disqualify a person from Hawaii nursing home Medicaid but does mean contributing more toward care costs.
HCBS income limit — lower threshold Hawaii’s HCBS Waiver uses a lower income limit based on the Hawaii Federal Poverty Level — approximately $1,530 per month for a single applicant in 2026. Hawaii updates its FPL-based income limits on February 1 of each year rather than January 1 like most states.
Asset limit — single applicant A single applicant must have $2,000 or less in countable assets. Exempt assets include the primary residence with equity up to $1,130,000 — Hawaii uses the federal maximum home equity limit reflecting the state’s extraordinarily high real estate values particularly on Oahu and Maui — if the applicant intends to return home, one vehicle, personal belongings and household furnishings, and burial spaces. Note that IRAs are counted as countable assets in Hawaii.
Home and community based care — QUEST Integration HCBS Waiver Hawaii’s primary HCBS program is the QUEST Integration Waiver which provides home and community based services for Hawaiians who need nursing facility level care but want to remain at home. The program also accepts applicants who are at risk of requiring nursing facility care — a slightly broader standard than strict nursing facility level of care. The asset limit is $2,000 for a single applicant.
Hawaii’s QUEST Integration program is distinctive in offering Health Related Social Needs — HRSN — services through managed care plans beginning in 2026 including medically tailored meals food pantry coordination housing navigation and transportation resources — going beyond what standard Medicaid covers in most other states.
Married couples — one spouse applying When only one spouse applies for Hawaii Medicaid through nursing home Medicaid the community spouse — the spouse who remains at home — may retain 50 percent of the couple’s combined countable assets up to a maximum of $162,660. If 50 percent of the couple’s assets is less than $32,532 the community spouse may retain up to $32,532. The applicant spouse retains $2,000.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,643.75 per month in 2026. The maximum is $4,066.50 per month for community spouses with high housing costs. Given Hawaii’s extraordinary cost of living many community spouses in Hawaii will qualify for income closer to the maximum allowance.
Personal needs allowance Hawaii nursing home Medicaid recipients retain a personal needs allowance from their monthly income toward personal discretionary spending after contributing toward care costs. Contact Med-QUEST at 1-800-316-8005 for the current personal needs allowance amount.
Look-back period and divestment penalty Hawaii has a 60-month — five year — look-back period for nursing home Medicaid and HCBS Waiver applications. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. Hawaii’s divestment penalty divisor reflects its average monthly private-pay nursing home cost which is among the highest in the country at approximately $13,000 to $16,000 per month — producing relatively shorter penalty periods for equivalent transfer amounts compared to lower-cost states.
Estate recovery Hawaii requires Medicaid estate recovery. After a Med-QUEST recipient dies the state seeks reimbursement from the estate for long term care costs paid. Planning with an elder law attorney is especially important in Hawaii given the high value of real estate and the significant cost of care.
How to apply for Hawaii Med-QUEST Medicaid Applications can be submitted online through the Hawaii KOLEA portal at kolea.hawaii.gov, by phone at 1-800-316-8005, or in person at your local Med-QUEST district office.
Hawaii Medicaid administering agency Hawaii Department of Human Services Med-QUEST Division — medquest.hawaii.gov
Hawaii Estate Tax — 2026
Hawaii is one of 12 states that imposes its own state estate tax. Hawaii’s estate tax exemption of $5.49 million is significantly lower than the federal exemption making Hawaii estate planning more complex and more important than in most states.
Hawaii state estate tax — $5.49 million exemption Hawaii imposes a state estate tax on estates exceeding $5,490,000 per individual in 2026. Hawaii’s estate tax rates are progressive ranging from 10 percent to 20 percent on amounts above the exemption. The tax is paid by the estate before assets are distributed to beneficiaries.
Hawaii estate tax portability — beneficial for married couples Hawaii’s estate tax exemption is portable between spouses — meaning when the first spouse dies the surviving spouse can use the deceased spouse’s unused $5.49 million exemption in addition to their own. This portability election must be made by filing a Hawaii estate tax return even if no tax is owed at the first spouse’s death. For a married couple this means up to $10.98 million can be protected from Hawaii estate tax with proper planning.
Hawaii estate tax compared to federal exemption Because Hawaii’s $5.49 million exemption is far below the federal $15 million exemption many Hawaii estates owe state estate tax but no federal estate tax. Given Hawaii’s high real estate values — particularly on Oahu — many Hawaii homeowners with modest financial assets may find their estate exceeds the state exemption simply due to real estate appreciation. This makes Hawaii-specific estate planning essential for homeowners with significant property.
No Hawaii inheritance tax Hawaii does not impose an inheritance tax. Once assets are distributed to beneficiaries Hawaii does not impose a separate tax on the inheritance received.
Federal estate tax Hawaii residents may also be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The federal exemption is also portable between spouses.
No Hawaii gift tax Hawaii does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
Hawaii income tax — among the highest in the country Hawaii has a progressive income tax with 12 brackets and a top rate of 11 percent on income over $200,000 for single filers — one of the highest state income tax rates in the country. Social Security benefits are not taxed in Hawaii. State and county government pensions are exempt from Hawaii income tax. Military retirement pay is fully exempt. Private pensions and IRA distributions are generally taxable in Hawaii. Capital gains are taxed as ordinary income at Hawaii income tax rates with no preferential long-term capital gains rate at the state level.
General Excise Tax — not a traditional sales tax Hawaii does not have a traditional sales tax. Instead Hawaii imposes a General Excise Tax — GET — at a rate of 4 percent statewide with Honolulu on Oahu adding a 0.5 percent surcharge for a combined 4.5 percent. The GET is applied at the gross receipts level on businesses and is effectively slightly higher than a comparable sales tax rate due to pyramiding.
Hawaii property taxes — low rates but high values Hawaii has very low nominal property tax rates — approximately 0.35 percent for owner-occupied residential property in Honolulu — among the lowest in the country. However Hawaii’s extraordinarily high home values mean that actual property tax bills can be substantial despite the low rate. A $1 million home in Honolulu at 0.35 percent generates a $3,500 annual property tax bill.
Hawaii Advance Directives
Hawaii law recognizes the following advance directive documents:
Hawaii Advance Health Care Directive Hawaii uses a combined Advance Health Care Directive that includes both the appointment of a healthcare agent and treatment instructions. Must be signed and witnessed by two adults or notarized.
Hawaii Physician Orders for Life-Sustaining Treatment — POLST Hawaii uses a POLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician or advanced practice registered nurse.
Hawaii Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. Hawaii has standardized out-of-hospital DNR protocols.
Hawaii Advance Directive Registry Hawaii does not maintain a statewide advance directive registry. Copies of your advance directive should be given to your healthcare agent physician and any hospital or care facility where you receive care.
Free Hawaii advance directive forms Free Hawaii-specific advance directive forms are available at caringinfo.org and from the Hawaii Medical Association at hmaonline.net.
Hawaii Key Agencies and Resources
Hawaii Department of Human Services Med-QUEST Division Administers Med-QUEST — Hawaii Medicaid — including long term care programs. Website: medquest.hawaii.gov KOLEA Portal: kolea.hawaii.gov Phone: 1-800-316-8005
Hawaii Executive Office on Aging — EOA Coordinates programs and services for older Hawaiians including home care nutrition programs caregiver support and the Hawaii SAGE PLUS program for free Medicare counseling. Website: health.hawaii.gov/eoa Phone: 1-808-586-0100 Hawaii SAGE PLUS — free Medicare counseling: 1-888-875-9229
Hawaii Area Agencies on Aging Hawaii is served by 4 Area Agencies on Aging — one for each county — that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
Hawaii Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: health.hawaii.gov/eoa/long-term-care-ombudsman Phone: 1-808-586-0100
Hawaii State Bar Association Lawyer Referral and Information Service Connects Hawaiians with attorneys including those who specialize in elder law and estate planning. Website: hsba.org Phone: 1-808-537-9140
Legal Aid Society of Hawaii Provides free civil legal services to low income Hawaiians including seniors on issues related to Medicaid benefits housing and elder law. Website: legalaidhawaii.org Phone: 1-808-536-4302
Hawaii Veterans Resources
Hawaii Office of Veterans Services — OVS Provides services and benefits to Hawaii veterans and their families including free VA claims assistance and connections to Hawaii veterans resources. Website: dod.hawaii.gov/ovs Phone: 1-808-433-0420
Hawaii State Veterans Home Hawaii operates a state veterans home providing long term care to eligible veterans and their spouses located in Hilo on the Big Island. Website: dod.hawaii.gov/ovs/veterans-home
Hawaii Senior Property Tax Benefits
Home Exemption for Owner-Occupants Hawaii homeowners who occupy their home as their primary residence qualify for a home exemption that reduces the assessed value of the home for property tax purposes. The exemption amount varies by county and increases for homeowners aged 65 and older. Contact your county real property tax division for current exemption amounts.
Honolulu County Senior Exemption Honolulu County homeowners aged 65 and older who occupy their home as their primary residence qualify for an enhanced home exemption that provides additional property tax relief beyond the standard owner-occupant exemption. Contact the City and County of Honolulu Real Property Assessment Division for details.
Disabled Veteran Property Tax Exemption Hawaii veterans who are totally and permanently disabled due to a service-connected disability may qualify for a property tax exemption on their primary residence. Contact your county real property tax division for details.
Finding Elder Law and Estate Planning Attorneys in Hawaii
The following resources can help you find a qualified elder law or estate planning attorney in Hawaii:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- Hawaii State Bar Association Lawyer Referral and Information Service — hsba.org — 1-808-537-9140
- Hawaii Chapter of NAELA — Hawaii has an active NAELA chapter with members throughout the state
- Legal Aid Society of Hawaii — legalaidhawaii.org — free legal assistance for income-qualifying seniors — 1-808-536-4302
The information on this page is for general informational purposes only and does not constitute legal or financial advice. Hawaii Med-QUEST Medicaid rules estate tax rates and other figures change frequently. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: May 2026