Medicaid Estate Recovery in Hawaii

Medicaid Estate Recovery in Hawaii: key facts

Who is subject

Recipients age 55 or older when the medical assistance was received. A claim is filed only when there is no surviving spouse and no surviving child who is under 21 or blind or disabled (Haw. Rev. Stat. 346-37(a)).

Nursing-facility recipients

Haw. Rev. Stat. 346-37(a) separately directs a claim against the estate of a recipient who was an inpatient in a nursing facility, an intermediate care facility for individuals with intellectual disabilities, or another medical institution, when there is no surviving spouse and no surviving child who is under 21, blind, or disabled.

Recovery deferred

Recovery can be made only after the death of the surviving spouse, if any, and only when there is no surviving child who is under 21 or who is blind or disabled (Haw. Admin. R. 17-1705-56(c)).

Recovery scope

The amount of medical assistance granted, recovered as a claim against the estate of the deceased recipient. Correctly made payments are recoverable only for people who were in a nursing facility, an intermediate care facility, or another medical institution, or for benefits paid on or after October 1, 1993 to a person who was age 55 or older when the services were received (Haw. Admin. R. 17-1705-56(b)).

Hardship waiver

Hawaii waives recovery for the period one of two conditions exists (Haw. Admin. R. 17-1705-56(e)): the estate is the survivors' sole income-producing asset and is a family farm or other family business producing income no greater than 100% of the federal poverty guidelines for the survivors dependent on it; or the estate is a homestead of modest value occupied by survivors who lawfully lived in the home from at least three months before the recipient entered a medical institution and provided care that let the recipient stay home, who own no other real property, and whose income is no greater than 100% of the federal poverty limit. Federal law separately requires a waiver where recovery would work an undue hardship (42 U.S.C. 1396p(b)(3)(A)).

Lien during the recipient's lifetime

Separate from an estate claim, the department may record a lien with the Bureau of Conveyances against the home of a recipient in a medical institution who cannot reasonably be expected to return home (Haw. Admin. R. 17-1705-57). No lien attaches while a spouse, dependent child, or a sibling with an equity interest who lived there for at least a year is living in the home, and the lien dissolves if the recipient is discharged and returns home. The department sends form DHS 1170 first; the recipient has 90 days to request a fair hearing through the Recovery Unit at 1-800-586-1126.

Governing law: Haw. Rev. Stat. 346-37

Steps to take when someone dies

1. Determine whether the deceased received Medicaid medical assistance at age 55 or older.
2. Contact the Med-QUEST Division (1-800-316-8005) or its Recovery Unit (1-800-586-1126) to confirm whether a recovery claim applies and to request the amount.
3. Check the Bureau of Conveyances for a lien recorded during the recipient's lifetime under Haw. Admin. R. 17-1705-57.
4. Address any confirmed claim as a debt of the estate before distributing assets to heirs.
5. Ask the Med-QUEST Division about a hardship waiver under Haw. Admin. R. 17-1705-56(e) if the estate is a family farm or business the survivors depend on, or a homestead of modest value the survivors occupy.

Frequently asked questions