Get Paid to Care for Your Elderly Parent in Hawaii
Hawaii's Med-QUEST (QUEST Integration) lets long-term-care members self-direct personal assistance and hire relatives, including adult children, as paid caregivers. Note that the Kupuna Caregivers Program (up to $210/week) is a separate state benefit for employed caregivers and is NOT Medicaid.
This guide covers what Hawaii family caregivers need to know: the program structure, pay rates, who can be paid, eligibility, how to apply, and other programs that may supplement your income.
Hawaii pays family caregivers $15–$25 per hour through the QUEST Integration Participant-Directed Personal Assistance option within the Med-QUEST QUEST Integration (1115 demonstration) Home and Community-Based Services. Your parent must meet a nursing-facility level of care but prefer to remain at home.
Hawaii's Main Program: QUEST Integration Participant-Directed Personal Assistance
QUEST Integration Participant-Directed Personal Assistance is a self-directed option within Hawaii's Med-QUEST QUEST Integration (1115 demonstration) Home and Community-Based Services, which provides home and community-based care for seniors and adults with disabilities who meet a nursing-facility level of need. Under self-direction, your parent (or you as their authorized representative) can hire, train, schedule, and supervise the personal-care attendant — and that attendant can be you, an adult child.
What the Program Pays For
Authorized self-directed services typically include:
- Personal care: bathing, grooming, dressing, oral hygiene
- Toileting assistance and incontinence care
- Mobility help: transferring, positioning, ambulation support
- Meal preparation and feeding assistance
- Light housekeeping directly related to health and safety
- Medication reminders (not administration, which requires a nurse)
- Supervision for individuals with cognitive impairment, including dementia
Pay Rates Across Hawaii
| Region | Typical Hourly Rate | Notes |
|---|---|---|
| Honolulu / Oahu | $15–$25/hr | Highest cost of living; participant-directed personal assistance under your QUEST Integration health plan |
| Maui County | $14–$23/hr | Neighbor-island rates vary by plan; FMS handles caregiver payroll and taxes |
| Hawaii Island / Kauai | $13–$22/hr | Rural areas; contact your MCO care coordinator to set up self-direction |
Rates are set within the participant's approved plan-of-care budget and the state's limits; the figures above are typical ranges, not guarantees.
Who Can Be Paid
Under QUEST Integration participant-direction, relatives including adult children may be hired and paid; spouses can be hired in some cases. The separate Kupuna Caregivers Program pays employed caregivers and is NOT Medicaid. Always confirm the current rules with Hawaii Department of Human Services, Med-QUEST Division before you count on a specific arrangement.
Eligibility Requirements
Your Parent Must:
- Be enrolled in full Hawaii Medicaid (not just a savings program)
- Meet the clinical criteria for a nursing-facility level of care
- Be enrolled in the Med-QUEST QUEST Integration (1115 demonstration) Home and Community-Based Services (or its self-directed option)
- Live in Hawaii in a community setting (not a nursing home)
- Be able to direct their own care, or have a legal/authorized representative who can
You (the Caregiver) Must:
- Be 18 years of age or older
- Meet the program's relationship rules (see above)
- Pass a criminal background check and registry search
- Complete any required caregiver orientation and training
- Be legally authorized to work in the United States
- Submit timesheets through a financial management service
How to Apply: Step-by-Step
- Apply for Hawaii Medicaid. Apply online at medquest.hawaii.gov/en/members-applicants/get-started/how-to-apply.html or call 1-800-316-8005. Your parent must meet income and asset limits.
- Request a long-term-services assessment. Contact your local Medicaid or aging office to request a comprehensive functional assessment that determines whether your parent qualifies for the Med-QUEST QUEST Integration (1115 demonstration) Home and Community-Based Services.
- Enroll in the waiver. Once deemed eligible, your parent is enrolled in the Med-QUEST QUEST Integration (1115 demonstration) Home and Community-Based Services and assigned a case manager or care coordinator.
- Request the self-directed (QI) option. During care planning, ask specifically for the consumer/self-directed service model and state that you, the adult child, want to be the hired caregiver.
- Enroll with a financial management service. Complete enrollment paperwork — W-4, I-9, and background authorization — so payroll, tax withholding, and timesheets are handled for you.
- Complete orientation. Finish any state-required caregiver orientation covering personal-care techniques, emergency procedures, and reporting.
- Begin care and submit timesheets. Provide care per the authorized plan and submit electronic timesheets; payroll is processed on a regular cycle with taxes withheld.
Check Your Parent's Eligibility
Our free Benefits Checker helps identify whether your parent qualifies for Hawaii's caregiver-pay programs and other benefits.
Check Eligibility NowOther Programs That May Pay Hawaii Family Caregivers
VA Veteran-Directed Care & PCAFC
If your parent is a veteran enrolled in VA healthcare, the Veteran-Directed Care program provides a monthly budget that can pay family caregivers, and the Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers a monthly stipend for eligible primary caregivers. Contact the caregiver support coordinator at your parent's VA medical center or call 1-855-260-3274.
Personal Care Agreement (Private Pay)
If your parent does not qualify for Medicaid, a formal written Personal Care Agreement lets them pay you from their own funds at fair-market rates. Drafted with an elder-law attorney, it must be prospective and reasonable — and it keeps payments from being treated as "gifts" during the Medicaid 5-year look-back.
State Respite & Caregiver Support
Through the National Family Caregiver Support Program, Hawaii's Area Agencies on Aging fund respite, training, and counseling. These rarely pay ongoing wages but reduce your out-of-pocket costs. Find your local agency through the Eldercare Locator (1-800-677-1116) or 808-643-2372.
Tax Implications for Family Caregivers
- W-2 wages: The financial management agency issues you a W-2; federal income tax, Social Security, and Medicare are withheld.
- IRS Notice 2014-7: If you live in the same home as your parent (the Medicaid waiver participant), your self-directed wages may be excludable from federal gross income. Consult a CPA before filing — see IRS guidance on Medicaid waiver payments.
- Earned Income Tax Credit: These wages count as earned income and may qualify you for the EITC.
Maintain daily logs of services provided — date, time in, time out, and a brief description. Medicaid audits self-directed arrangements, and accurate records protect both you and your parent.
What Hawaii Caregivers Are Actually Earning
At 30 hours per week and about $20 per hour, you would earn roughly $2,600 per month. At 40 hours per week and $25 per hour, earnings reach about $4,333 per month — around $52,000 per year before taxes.
For comparison, a nursing home costs far more per year, and agency home care runs roughly $30–$40 per hour. A self-directed arrangement lets your parent receive care from someone they trust, while you earn income that partially replaces what you may have given up to provide care.
Contact Information
- Hawaii Department of Human Services, Med-QUEST Division: medquest.hawaii.gov | 1-800-316-8005
- Apply for Medicaid: medquest.hawaii.gov/en/members-applicants/get-started/how-to-apply.html
- State aging services: health.hawaii.gov/eoa | 808-643-2372
- Eldercare Locator (find local help): eldercare.acl.gov | 1-800-677-1116
- Medicaid (federal): medicaid.gov
Frequently Asked Questions
Pay under Hawaii's QUEST Integration participant-directed personal assistance typically runs about $15 to $25 per hour, reflecting the state's high cost of living. The exact rate is set by your Medicaid managed-care plan and the financial management service that processes payroll. Separately, the Kupuna Caregivers Program can contribute up to $210 per week.
QUEST Integration (QI) is Hawaii's Medicaid managed-care program run by the Med-QUEST Division, combining medical, behavioral, and long-term services and supports. Within QI, eligible members can self-direct personal assistance services and choose their own caregiver.
Under QUEST Integration self-direction, relatives including adult children can be hired and paid as caregivers, and in some cases spouses may also be hired. Rules vary by managed-care plan, so confirm with your QI health plan's care coordinator.
Hawaii delivers long-term care through its 1115 QUEST Integration demonstration rather than a standalone 1915(c) waiver. The participant-directed personal assistance benefit within QUEST Integration is what allows a family member to be hired and paid.
Apply for Med-QUEST online, by phone, by mail, or by fax; Med-QUEST customer service is 1-800-316-8005. Once enrolled with long-term-care eligibility, ask your managed-care plan's care coordinator to set up participant-directed services. The statewide ADRC line is 808-643-2372.
Yes. A parent with dementia who qualifies for QUEST Integration long-term care can self-direct personal assistance and hire an adult child as the paid caregiver. A financial management service handles payroll and tax withholding.
Related Guides
- How to Get Paid to Care for Your Parent (National Overview)
- How to Apply for Medicaid for an Elderly Parent
- Caregiver Tax Deductions 2026
- VA Benefits for Elderly Parents
- Power of Attorney for an Elderly Parent
- Medicaid Spend-Down Rules
This guide is general information, not legal or financial advice. Program names, pay rates, and eligibility rules change and vary by county — confirm details with Hawaii Department of Human Services, Med-QUEST Division. Sources: medquest.hawaii.gov · health.hawaii.gov.