With its breathtaking scenery and comfortable year-round climate, Hawaii is an idyllic retirement destination. Nearly one-fifth of the state’s 1.4 million residents are aged 65 or older. The number of older adults is expected to increase 33% by 2030, which means that demand for assisted living and other age-related supports is on the rise.
Whether you live on Oahu, Maui or one of the lesser-trafficked islands, Hawaii offers retirees a high quality of life and plenty of options for geriatric care, so it’s not surprising that the state ranked fifth in the nation for its overall livability in our 2022 Senior Living Report. Although Hawaii goes by the nickname Paradise of the Pacific, it ranks 18th in the nation for its affordability. Assisted living costs $5,375 per month on average. This is about 20% higher than the national average, but it’s more affordable than many states, including those on the West Coast.
This guide covers everything you need to know about assisted living in the Aloha State, including average long-term care prices, financial assistance programs and assisted living regulations. You’ll also find a number of free resources for seniors that are available at the state and local levels.
The Cost of Assisted Living in Hawaii
If you’re lucky enough to live in the Aloha State, you can expect to pay $5,375 per month for assisted living, according to Genworth Financial’s 2021 Cost of Care Survey. Prices are about $875 higher than the national average, although rates may vary depending on the facility you select. Hawaii’s prices are just $125 higher than California ($5,250) and $330 higher than Oregon ($5,045). Residents save about $625 compared to seniors in Washington where the median is $6,000 a month. Prices in Alaska are $1,455 higher at $6,830.
Hawaii – $5375
The United States – $4500
California – $5250
Washington – $6000
Oregon – $5045
Alaska – $6830
Genworth only tracks long-term care costs in two metropolitan areas in Hawaii, so data is limited. In Honolulu, assisted living fees are on par with the state median at $5,375. Prices in Kahului are about 29 percent lower at $3,825, which is $675 below the national average. The average rate in Honolulu is slightly higher than in Los Angeles, California, where the median is $5,250, and in Portland, Oregon, where the average is $4,975. Hawaii’s major metropolitan areas are much more affordable than mainland cities such as San Francisco, California, and Seattle, Washington, where the average costs of assisted living are $6,319 and $6,750 per month, respectively.
Honolulu – $5375
Kahului – $3825
Seattle, WA – $6750
Portland, OR – $4975
Los Angeles, CA – $5250
San Francisco, CA – $6319
Assisted living is competitively priced compared to other forms of long-term care in Hawaii. Homemaker and home health aide services both cost around $5,720 per month for 44 hours of weekly assistance, and you’re still responsible for the cost of housing. Nursing homes are more than twice as expensive based on a median cost of $12,501 per month for a semiprivate room. If you want private accommodations, you can expect to pay $14,113, which is 2.6 times higher than the rate for assisted living. Adult day health care is a reasonably priced alternative at $1,625. However, it’s most appropriate for seniors who are able to live at home and travel to a local community center.
Homemaker Services – $5720
Home Health Aide – $5720
Adult Day Health Care – $1625
Assisted Living Facility – $5375
Nursing Home (semiprivate room) – $12501
Nursing Home (private room) – $14113
Does Medicaid Cover Assisted Living in Hawaii?
Med-QUEST is Hawaii’s Medicaid program. This acronym stands for quality care, universal access, efficient utilization and stabilizing costs to transform the way health care is provided. Hawaii follows a managed care model that integrates medical care and long-term services and supports, including coverage for assisted living services, personal care, skilled nursing and adult residential care homes.
Beneficiaries are enrolled in health plans administered by one of several commercial insurance providers, and they have the option to change plans once a year and at the time of enrollment. One of the main advantages of this model is that assisted living services are covered directly through Medicaid. This eliminates the waiting lists that typically apply to waiver services in other states, and helps to ensure you get the care you need when you need it.
What Assisted Living Services Are Covered by Medicaid in Hawaii?
In addition to covering primary and emergency medical care, Med-QUEST provides a variety of long-term services and supports that are medically necessary. These include institutional care, such as intermediate or skilled nursing, and home- and community-based alternatives such as assisted living. Here are some of the services that you may be eligible for based on a physician assessment.
- Assisted living services
- Case management
- Move-in assistance
- Residential care homes
- Emergency response systems
- Medical equipment and supplies
- Level I and II personal care
- Non Medical transportation
How to Know if You’re Eligible for Medicaid in Hawaii
To qualify for Med-QUEST, you must meet financial eligibility criteria based on your income and assets. In general, monthly income is capped at $1,235 for regular Medicaid or home- and community-based services. Assets are limited to $2,000 per applicant with exclusions for a primary home, vehicle and household items. Individuals whose income is too high may still be able to qualify by transferring funds to their spouse as a monthly needs allowance or by spending the excess on approved medical expenses. If you’re interested in assisted living or other long-term care benefits, a personal needs assessment is required to determine whether you require a nursing home level of care.
2022 Medicaid Income Limits for Seniors in Hawaii
ANNUAL INCOME LIMITS
ANNUAL INCOME LIMIT – $14,820
ASSET LIMIT – $2,000
(One Spouse Applying)
ANNUAL INCOME LIMIT – $14,820 for applicant
ASSET LIMIT – $2,000 for applicant
$137,400 for non applicant
(Both Spouses Applying)
ANNUAL INCOME LIMIT – $29,640
ASSET LIMIT – $2,000
Med-QUEST long-term services and supports are available to applicants who also meet citizenship, residency and age/functional requirements. You will be asked to show that you’re:
- Aged 65 or older or permanently disabled
- A permanent resident of Hawaii
- A U.S. citizen or legal resident
How to Apply for Medicaid in Hawaii
The fastest and easiest way to apply for Med-QUEST is by completing an online application using the Kolea portal at Medical.MyBenefits.Hawaii.gov. You can also apply over the phone by calling (877) 628-5076. Alternatively, paper applications may be mailed or faxed to your local Med-QUEST Division Eligibility office. If you need help completing your application, a DHS community navigator can provide free assistance.
Information You Will Need
- Personal information, including name and address
- Social Security number
- Date of birth and proof of age
- Proof of citizenship or legal residency
- Information about your tax filing status and any dependents
- Details about any insurance coverage
- Information about income and assets
How to Get Help Applying for Medicaid
Hawaii provides numerous resources to help you complete your application, enroll in a qualifying health plan and access your benefits. Services may be provided by government agencies and community service organizations.
The Department of Human Services provides a list of authorized community partners who are qualified to help residents with applications for Medicaid and Marketplace coverage. In-person assistance is available at various locations in Maui County and on the islands of Oahu, Hawaii and Kauai.
(808) 524– 3370 (Oahu)
(800) 316-8005 (other islands)
For general assistance or to check your application status, contact your local eligibility office or the state’s Customer Services Call Center. Representatives can help you complete routine tasks, such as changing your address, updating your income or personal information and signing up for a health plan.
Eligible beneficiaries are automatically assigned to a health plan once approved for Med-QUEST. If you have questions or would like to change plans during the initial or annual enrollment period, this Med-QUEST department can help.
(808) 746-3324 (Oahu)
If you have questions or concerns about your Med-QUEST benefits or need help with the application process, contact the Medicaid Ombudsman at the number provided. Beneficiaries are encouraged to contact their health plan to resolve coverage-related issues before calling.
Does Medicare Cover Assisted Living in Hawaii?
The short answer is that no, Medicare does not cover the cost of assisted living in Hawaii. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.
For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Hawaii.
Other Financial Assistance Options for Assisted Living in Hawaii
Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.
HOW TO APPLY
HOW IT WORKS
Aid and Attendance
Learn more and apply online at va.gov.
Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.
Learn more about your options and how to apply at ftc.gov
If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home’s equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
Long-Term Care (LTC) Insurance
Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.
Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.
Free and Low-Cost Resources for Seniors in Hawaii
Seniors who are considering assisted living have a variety of resources at their disposal. The following state agencies and nonprofits can provide personalized advice to help you determine which programs or services best meet your needs.
The Executive Office on Aging oversees four Area Agencies on Aging serving Honolulu, Maui, Kauai and Hawaii counties. AAAs administer a variety of state and federal benefits available to adults aged 60 and older. They can help with assisted living placement, personal needs assessments, accessible transportation and home- and community-based services to help you age in the setting of your choice.
Hawaii’s Aging & Disability Resource Center provides information, referrals and direct services to seniors, caregivers and individuals with disabilities. The center focuses on issues related to long-term services and supports, including assisted living. You can also contact the ADRC for help with Medicare enrollment, plan comparisons and billing issues. The Hawaii Healthy Aging initiative provides evidence-based programs to help residents stay active, prevent falls and manage chronic conditions.
Hawaii’s Long-Term Care Ombudsman advises residents on assisted living facilities, nursing homes and other alternatives. The agency focuses on educating seniors and families about resident rights, and it investigates general and specific complaints about providers to protect seniors’ health and well-being, including issues with meals, personal care, privacy and dignity. All services are free and confidential.
(808) 536-0011 (Oahu)
(888) 536-0011 (other islands)
Sponsored by the Legal Aid Society of Hawaii, Kupuna Legal Aid Services provides free legal assistance to seniors aged 60 and older. It focuses on health care and advance planning, including wills, advance directives, property rights and powers of attorney for health care and financial decision-making. Advocacy services are also available to those who have experienced abuse or exploitation.
The Social Security Administration provides a variety of benefits that support retirees and disabled adults. Local offices handle applications and appeals as well as Medicare enrollment, or you can manage your benefits online. Social Security representatives can refer you to other community-based organizations for help with government benefits and legal concerns. Individuals who receive Supplemental Security Income may be eligible for an additional payment to help with the cost of assisted living room and board.
The Department of Veterans Affairs provides health care, pensions and a variety of other financial benefits and social services to current and former service members as well as their spouses and dependents. Individuals who receive a VA pension and require personal care or assisted living may be eligible for an additional monthly payment through the Aid & Attendance or Housebound program. The VA operates an extensive network of medical facilities, vet centers and benefits offices throughout the islands.
COVID-19 Rules for Assisted Living in Hawaii
The following information is based on research done on several government websites, including health.hawaii.gov and cdc.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 3/22/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.
RULES FOR HAWAII COMMUNITIES
Are loved ones allowed to visit to provide emotional support?Yes (Conditions Apply)
Are relatives allowed to visit for end-of-life care?Yes
Are residents required to quarantine after visiting with a loved one?No
Are visitors required to wear PPE (including masks) in order to visit residents?Yes
Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?No
Are visitors checked for elevated temperatures?Yes
Are visitors required to answer questions about health, travel, and potential virus contact?Yes
Outings & Social Activities
RULES FOR HAWAII COMMUNITIES
Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?Yes
Are residents who leave required to quarantine when they return?No (Conditions Apply)
Are senior living communities required to cancel all group outings?No
Are residents allowed to eat meals together in a common area?Yes (Conditions Apply)
Are residents allowed to gather in common areas for group activites?Yes (Conditions Apply)
COVID-19 Safety Measures for Staff and Residents
RULES FOR HAWAII COMMUNITIES
Are staff members regularly required to do a temperature check?Yes
Are staff members regularly tested for COVID-19?Yes
Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?Yes
Are residents regularly screened for COVID-19 symptoms?Yes
Are residents regularly checked for elevated temperatures?Yes
Assisted Living Laws and Regulations in Hawaii
Assisted living facilities and adult residential care homes in Hawaii are licensed by the State Licensing Section at the Department of Health, Office of Health Care Assurance. This agency is responsible for enforcing a variety of standards related to health, safety and staffing.
HAWAII LAWS AND REGULATIONS
Assisted Living Service Plan Requirements
Assisted living facilities must develop a personalized plan of care for each resident based on a comprehensive needs assessment. The plan must address all aspects of care as well as the individual’s personal preferences. Service plans must be developed at or before the time of admission and reassessed after 30 days. Designated staff members are responsible for periodically reviewing each service plan.
Assisted Living Admission Requirements
Facilities may not deny residents admission based on their race, national origin, sexual orientation or other protected status. New residents must be advised of their rights and the facility’s policies and procedures. If the facility is unable to provide adequate care or needs to discharge a resident for any reason, they must provide at least 14 days notice in writing.
Assisted Living Scope of Care
Assisted living facilities must provide a comprehensive range of personal care services, including 24-hour staffing, help with daily activities, health monitoring, household services, social activities and three daily meals. They must also provide social services, transportation, bill pay assistance and ancillary services, such as hair care, physical therapy and podiatry, either in-house or through contracted providers.
Assisted Living Medicaid Policy
Personal care and assisted living services are covered by Hawaii’s Med-QUEST managed care system when they are medically necessary. Applicants must meet financial eligibility requirements.
Assisted Living Facility Requirements
Each resident must have access to a mobility-friendly apartment-style unit with a bathroom and cooking facilities, if medically appropriate, including a refrigerator and sink. Each unit must have at least 220 square feet of living space, excluding the bathroom. Residents must also have access to a 24-hour call system, private mailbox and connections for telephone and TV. Facilities must also provide common areas, including recreation spaces, lounges, dining facilities and laundry equipment.
Medication Management Regulations
Facilities may be responsible for administering prescription and nonprescription medications unless the resident has received permission to self-administer from a registered nurse or physician. Facilities must maintain adequate records, and medication protocols must be reviewed at least once every 90 days by a licensed medical professional.
Facilities must employ a qualified administrator or director and provide 24-hour direct-care staffing. A licensed nurse must be available 7 days a week to oversee resident care and monitoring. The administrator is responsible for providing adequate training and ensuring that the facility complies with relevant regulations.
Staff Training Requirements
Assisted living facilities must provide sufficient training to help workers complete their job duties. All staff members must be trained in CPR and first aid, and the state requires at least 6 hours of annual in-service training for direct-care workers as well as orientation for new employees. Nurse aides in Hawaii must complete a 100-hour training program, including 70 hours of clinical experience, which exceeds federal minimums.
Background Checks for Assisted Living
The state requires background checks for all direct-care workers and volunteers who work in health care facilities. License applications may be denied if an applicant has a criminal conviction or a history of abuse, neglect or misappropriation of property.
Requirements for Reporting Abuse
Instances of suspected abuse, exploitation or neglect should be reported to Adult Protective Services by calling one of the regional hotlines: (808) 832-5115 (Oahu), (808) 933-8820 (East Hawaii), (808) 327-6280 (West Hawaii), 808-241-3337 (Kauai) or (808) 243-5151 (Maui and others). Reporting is mandatory for designated health care workers. Reports can also be made anonymously.