When the time comes, seniors face the challenge of requiring help in their daily living activities at their primary residence.

As seniors age, many prefer to stay home, receiving necessary care in familiar surroundings. However, while Medicaid provides coverage for low-income seniors who require in-home and long-term care, middle- and high-income seniors with significant assets often face challenges in obtaining financial assistance.
The eligibility criteria for Medicaid's long-term care programs typically favor those with lower incomes and limited assets, leaving many seniors who have saved responsibly or own property without coverage. Preparing for this scenario is crucial for seniors who want to protect their financial well-being while ensuring access to quality care.
Why Middle and High-Income Seniors Don't Qualify for Medicaid?
Medicaid, funded by both federal and state governments, is intended as a safety net for individuals who lack the financial resources to cover their medical and care expenses. Therefore, eligibility is limited by income and asset thresholds.
While certain assets, such as a primary residence, are excluded, seniors with savings, investment accounts, retirement funds, or multiple properties may be ineligible for Medicaid. Even when one spouse applies, asset limits often restrict eligibility, as only a modest amount of assets may be allocated to the non-applicant spouse. As a result, middle- and high-income seniors must look to private options to fund their long-term care needs.
In Hawaii, qualifying for Medicaid long-term home health care assistance for seniors typically has specific income and asset limits. For Medicare, eligibility is based primarily on age and disability status rather than income or assets, though there are income-related costs for some parts of the program.
Medicaid Long-Term Care Eligibility:
For Hawaii Medicaid long-term care (including home and community-based services), eligibility criteria for 2024 include the following:
1. Income Limits
Single applicant: The monthly income limit is around $1,442.50 per month if they are single or $2,050 for a married couple where both spouses apply. However, some seniors may qualify for Medicaid by "spending down" their excess income on medical costs.
A married couple (one spouse applying): The non-applicant spouse can retain a certain amount of income without affecting the applicant's eligibility. The non-applicant spouse's income isn't typically counted.
A married couple (both applying): The monthly income limit is about $2,885.
2. Asset (Net Worth) Limits
Single applicant: Can have up to $2,000 in countable assets.
A married couple (one spouse applying): The non-applicant spouse can retain up to $148,620 in assets, and the applicant can keep up to $2,000.
A married couple (both applying): The countable asset limit is $3,000 for the couple.
Certain assets are not considered "countable," such as a primary residence (if the applicant lives in it and its equity value is under a certain amount, typically around $688,000), a single vehicle, and certain personal belongings. (NOTE: Some amount may have changed.)
Verify here https://medquest.hawaii.gov/
Medicare Limitations:
Medicare alone typically does not cover long-term home health care for seniors, except in cases of temporary skilled nursing care or specific therapies. As a result, Medicaid often becomes the primary option for seniors needing extensive, ongoing in-home care support.
Additional Requirements
Functional Needs: Applicants must also meet specific functional needs assessments, indicating that they require a level of care similar to what would be provided in a nursing home.
In 2024, the monthly income limit for Med-QUEST Hawaii is $1,442.50, which is 100% of the Federal Poverty Level (FPL).
However, income eligibility for Medicaid in Hawaii also depends on the applicant's age and family size:
Children: Up to 313% of the FPL
Pregnant women: Up to 196% of the FPL
Parent/Caretaker relatives: Up to 105% of the FPL
Hawaii has a 60-month look-back period for Medicaid applications. During this time, Medicaid reviews all asset transfers to ensure they were not sold or gifted for less than fair market value.
You can apply for Medicaid in Hawaii by calling Med-QUEST Customer Service at (800) 316-8005, or by filling out a PDF application and mailing or faxing it to the nearest Med-QUEST Division Eligibility Office.
Hawaii's eligibility criteria are aligned with federal Medicaid guidelines, but specific figures are subject to change each year. For more accurate information, seniors or their families can contact Hawaii's Med-QUEST Division or a Medicaid planning professional to ensure eligibility and explore spend-down options if necessary.
"Plan Ahead: Secure the Funds for Quality Care When Family Support Isn't Enough"
Overcoming Potential Challenges: Important Information in Preparing for In-Home Assistance in Hawaii.
Planning Options for Middle- and High-Income Seniors
Long-Term Care Insurance
Long-term care insurance (LTCI) can be valuable, covering various services like in-home care, assisted living, and nursing home stays. Purchasing LTCI early (in one's 50s or 60s) often results in lower premiums and fewer health-based exclusions. However, premiums can be high, and seniors should carefully review policies to ensure coverage meets their needs.
Setting Up a Dedicated Savings Fund
Seniors who prefer to self-fund their care might benefit from setting aside a portion of their savings in a high-yield savings account or other conservative investment vehicles. A dedicated account for long-term care can help seniors avoid financial stress later and give them more control over how their funds are used.
Health Savings Accounts (HSAs)
An HSA can be an excellent way for seniors enrolled in a high-deductible health plan before transitioning to Medicare to save for future health-related expenses. Contributions are tax-deductible, grow tax-free, and can be withdrawn tax-free for eligible medical expenses. Although HSAs cannot be used to pay premiums for long-term care insurance, they can cover other qualified healthcare costs, including some in-home care services.
Reverse Mortgages
Seniors who own their homes and need additional income may consider a reverse mortgage. This option allows them to borrow against home equity without monthly payments, though the loan must be repaid when they move out or pass away. It's important to carefully review the terms and seek financial advice, as reverse mortgages can impact inheritance plans for loved ones.
Family Support and Shared Funding
If adult children or other family members are financially stable, they might be willing to contribute to the cost of in-home care for a loved one. Pooling family resources can alleviate some financial burden while the seniors control their care choices. Open discussions with family members can create a collaborative care plan and provide greater peace of mind.
Why Planning Early is Essential
In-home care costs are significant, especially in high-cost areas like Hawaii, where home health aides average around $30 per hour. Without financial assistance, costs can add up quickly, making advance planning essential for middle- and high-income seniors who wish to age in place. By preparing early, seniors can protect their financial stability, ensuring they can enjoy their golden years comfortably in their chosen environment.
Planning for long-term care is a proactive step that empowers seniors to control their futures and maintain their quality of life. Those with substantial assets may face limitations in public assistance, but various strategies—such as long-term care insurance, HSAs, reverse mortgages, and family support—can provide valuable solutions. By exploring these options, middle- and high-income seniors can prepare for the care they deserve without financial uncertainty.
References
Medicaid.gov. Medicaid Long-Term Services and Supports Eligibility. Retrieved from medicaid.gov
IRS. (2024). Health Savings Accounts. Retrieved from irs.gov
Genworth Financial. (2023). Cost of Care Survey: Hawaii. Retrieved from genworth.com
MedQuest Hawaii https://medquest.hawaii.gov/
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