Home Care Medicaid Rates in Hawaii: Med-QUEST HCBS Reimbursement (2026)

Home care Medicaid rates in Hawaii are best read through two ranked services: adult day health and companion care. Hawaii Med-QUEST pays $63.06 a day for adult day health on S5105, which ranks 8th of 12 states with a comparable daily rate and sits 8.2% below the national median of $68.67. Companion care ranks near the bottom at $16.00 an hour.

Hawaii has no comparable hourly agency personal care rate in our national service ranking, but its published fee-for-service rates for hands-on care are high: $53.12 an hour for personal care on T1019. What makes Hawaii distinctive is the gap between those published rates and how agencies are actually paid, because QUEST Integration plans negotiate their own home care rates.

Adult day health is the closer of the two to the national middle. Maine leads at $124.44 a day, while the lowest states pay $42.00 to $42.43. The rate has been in effect since January 1, 2025.

Companion care is a different story. Hawaii pays $4.00 per 15 minutes on S5135 with the U1 modifier, effective January 1, 2026, which is $16.00 an hour. That places Hawaii 17th of 20 states. Vermont pays $51.92 on the same code.

The full dataset holds all 17,383 current Hawaii Medicaid rates, each linked to its source on the Hawaii Medicaid rates hub.

Hawaii's published HCBS fee-for-service rates for hands-on care sit far above its companion care rate. Med-QUEST pays $13.28 per 15 minutes on T1019, or $53.12 an hour, effective since January 1, 2024. Among 39 states that publish a T1019 rate, Hawaii ranks 4th.

That figure matters more as a negotiating anchor than as a guaranteed payment. Because QUEST Integration plans set their own home care rates, an in-network agency is paid what its contract says. The published rate is what the plan pays out of network, which makes it the natural starting point for any contract discussion.

The spread between companion care and personal care is also a scheduling signal. Where a client's needs genuinely include hands-on help, the service should be authorized and billed as personal care rather than companion care, since the two are priced on very different scales.

Adult day health at $63.06 a day is the Hawaii home care rate closest to the national middle, and it has been stable since January 1, 2025.

Adult day economics differ from in-home care. A center pays for a building, transport, meals, activity staff and nurse oversight, and spreads those costs across daily attendance. The rate per participant matters, but the daily census matters more: a center running near capacity can work at a below-median rate, while one with empty seats cannot.

For families, adult day is often the service that keeps a caregiver employed, which makes it a steady source of referrals. For providers, the four prior authorization rules on S5105 mean that enrollment paperwork has to be complete before a participant's first day, or that day may not be paid.

Hawaii's labor market is more expensive than the national figures. The state median wage for home health and personal care aides was $18.32 an hour in May 2025, against a US median of $17.21. Registered nurses had a state median of $65.54, well above the US median of $46.90.

Against the companion care rate, the arithmetic does not work. The median aide wage equals 162.8% of the $16.00 hourly companion rate, and after a loaded wage the margin is $-10.04 an hour.

In practice, companion care in Hawaii cannot be staffed at the median wage on the published rate alone. An agency offering it needs a broader service mix, or better negotiated plan rates, to carry the cost.

Nurse costs

Hawaii's RN wage is among the highest relative to the national median. Programs that require nurse assessments or supervision of aides carry a heavier cost here than almost anywhere else, so agencies should price nurse time explicitly into each client's plan of care.

Hawaii is one of the more authorization-heavy states for home care:

• 4 rules each on S5105 (adult day health), S5125 (attendant care) and S5130 (homemaker).
• 3 rules each on S5135 (companion), S5161 and T1019 (personal care).

None of these codes carries a published unit limit, so the authorization itself is the main control on volume. For billing teams, that shifts the work from tracking unit caps to keeping authorizations current before each service period. With several plans each running their own authorization process, agencies should track authorizations by plan as well as by client.

Hawaii delivers much of its Medicaid coverage through QUEST Integration plans; 9 plans are in our home care data. They include AlohaCare, Hawaii Medical Service Association (HMSA), Kaiser Foundation Health Plan, UnitedHealthcare Community Plan and 'Ohana Health Plan, along with plans serving the Community Care Services program.

For home and community-based services and personal care, the state's rule is that plans negotiate their own rates, and the published rate applies out of network. The Med-QUEST rate is therefore a reference point rather than a guaranteed floor for in-network agencies. The Hawaii managed care page lays out how each service line is handled.

Negotiating with QUEST Integration plans

Bring three things to a plan negotiation: the published Med-QUEST rate for each service, your actual cost per hour including nurse time and inter-island or rural travel, and your capacity in the areas the plan struggles to cover. Plans need network adequacy across islands, and an agency that can reliably staff a hard-to-serve area has leverage beyond the rate itself.

Geography shapes Hawaii home care costs in ways that rate tables do not show. Agencies serving more than one island, or rural parts of a single island, face travel time that cannot be billed, smaller pools of available aides and less ability to fill a cancelled visit with another nearby client.

Three practices help. First, build local teams on each island rather than flying or driving staff in, so that travel stays within a community. Second, schedule longer visits where the plan of care allows, since a single four-hour visit carries far less travel overhead per hour than several short ones. Third, raise geography directly in plan negotiations: QUEST Integration plans must maintain networks across the state, and an agency that covers an underserved area can reasonably ask for a rate that reflects the cost of serving it.

Hawaii updates HCBS policy through numbered QI memos, and several were issued in 2026:

• QI-2604, published February 6, 2026, carried a 4.32% rate change effective January 1, 2026, the same date the current companion care rate took effect. QI-2604A followed on July 17, 2026.
• QI-2601: CIS+ implementation / medical respite, effective January 2, 2026, followed by QI-2601A, effective July 1, 2026.
• QI-2617: Nutrition Supports implementation guidelines, effective September 1, 2026, and QI-2617A, effective October 1, 2026.
• QI-2430: Community palliative care benefit implementation, effective January 1, 2025.

What to watch

The CIS+ and medical respite memos extend the range of services QUEST Integration can pay for beyond traditional personal care. Agencies already delivering in-home supports may be well placed to add these services. Because rates move by memo, check for updates mid-year; the QI-2604A follow-up shows the state revisiting a rate memo months after it took effect.

Nationally, home care rates are compressed around a personal care median of $30.52 an hour, with Utah the outlier at $84.84 and Texas lowest at $18.28. On the lines where Hawaii ranks, it sits in the lower half: just below the median for adult day and near the bottom for companion care. Its published personal care and attendant care rates, by contrast, are among the highest of any state publishing those codes.

For a Pacific comparison, see Alaska home care rates, and compare every state on the home care Medicaid rates by state page.

• Contracting. Use the published Med-QUEST rate as your anchor with every QUEST Integration plan.
• Service classification. Authorize and bill hands-on care as personal care, not companion care.
• Budgeting. Build nurse time into cost per hour at Hawaii wage levels.
• Monitoring. Track QI memos; rates and covered services change through them.

Rates are compiled from official Hawaii Medicaid publications, including the Med-QUEST HCBS fee-for-service rates in QI memos such as QI-2604A and the Medicaid fee-for-service fee schedule. Each rate links to its source document. Rankings compare the rate for the same service across states that publish one, using the per-hour figure where a service is billed in time units. Wages are May 2025 medians. Rankings follow our methodology; access to the full dataset is described on our pricing page.