In Hawaii, a family member can get paid to care for a loved one through a few different programs: the state’s Medicaid Home and Community-Based Services (HCBS) waiver, two U.S. Department of Veterans Affairs caregiver programs, and, when the legislature funds it, the Kupuna Caregivers Program. Which one fits depends on who needs care, what condition they have, and your relationship to them.
Medicaid HCBS Waiver: The Main Path
Hawaii’s Med-QUEST Division runs an HCBS waiver for people with intellectual and developmental disabilities. The waiver includes a consumer-directed option, which lets the person receiving care hire their own providers and pay them with Medicaid funds. Family members can be hired through this option.1Hawaii Department of Health. Application for 1915(c) HCBS Waiver
Not every relative qualifies. Spouses cannot be paid to provide waiver services. Parents and legal guardians of minor children are also excluded. For adult care recipients, eligible relatives include parents, siblings, adult children, grandparents, in-laws, and step-family members. Hawaii also recognizes hanai relatives, a Hawaiian tradition of caring for someone without formal adoption.1Hawaii Department of Health. Application for 1915(c) HCBS Waiver
Even eligible relatives face extra scrutiny. The state authorizes family-provided waiver services only when the family member cannot provide care without reimbursement, is the most qualified available provider, or is the only available provider. Family caregivers hired through the consumer-directed model face the same monitoring and supervision requirements as non-relatives.1Hawaii Department of Health. Application for 1915(c) HCBS Waiver
Whether the Care Recipient Qualifies
The person receiving care has to meet both medical and financial rules. Medically, they need a “nursing facility level of care,” meaning they require help with daily tasks like bathing, dressing, or eating, or have cognitive impairments serious enough to require ongoing supervision.2Hawaii Department of Health. Application for 1915(c) HCBS Waiver
Financially, a single individual’s countable assets cannot exceed $2,000 in 2026.3Med-QUEST Division. 2026 MAGI and MAGI-Excepted Income Standards Chart Monthly income cannot exceed $2,982, the federal special income level for 2026.4Medicaid.gov. January 2026 SSI and Spousal Impoverishment Standards Someone whose income exceeds that cap may still qualify by using a Qualified Income Trust. Applications go through the Hawaii Department of Human Services and include a functional assessment.
What the Job Pays
Waiver caregivers typically help with bathing, dressing, meals, and mobility. Hawaii’s minimum wage reached $16.00 per hour on January 1, 2026, which sets the floor.5Hawaii Department of Labor and Industrial Relations. Hawaii Minimum Wage Increases to $16.00 on January 1 Actual rates depend on the service and provider arrangement, but they cannot fall below that. Background checks are standard, and some services require CPR and first aid certification.
VA Programs for Caregivers of Veterans
If the person needing care is a veteran, two VA programs can pay a family caregiver.
Program of Comprehensive Assistance for Family Caregivers
PCAFC pays a monthly stipend to the primary family caregiver. The veteran must have a VA disability rating of 70% or higher, be enrolled in VA health care, and need at least six continuous months of in-person personal care services. The caregiver must be at least 18 and either a family member of the veteran or a full-time housemate.6Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers
The stipend is based on the Office of Personnel Management’s GS-4, Step 1 salary for the veteran’s locality. Level 1 caregivers receive 62.5% of that monthly figure. Level 2, for veterans the VA determines cannot sustain themselves in the community, pays 100%.7U.S. Department of Veterans Affairs. PCAFC Monthly Stipend Fact Sheet Because Hawaii has one of the highest locality pay adjustments in the country, stipends here run larger than in most other states. Primary family caregivers may also get CHAMPVA health coverage, mental health counseling, and respite care.
Veteran-Directed Care
Veteran-Directed Care works differently. The VA gives the veteran a flexible budget to buy their own care services, and the veteran can use it to hire family members at an hourly rate. The veteran (or a representative) manages the budget and schedule.8Department of Veterans Affairs. Veteran-Directed Care Not every VA medical center offers it, so check with the local Hawaii facility first.
Kupuna Caregivers Program
Hawaii created the Kupuna Caregivers Program to help working families afford care for older relatives. One thing to know upfront: the program does not pay the family caregiver directly. Under state law, it provides up to $70 per day (up to $210 per week) that goes to contracted service providers for things like adult day care, in-home personal assistance, respite care, and transportation.9Justia. Hawaii Code 349-17 – Kupuna Care Program The idea is to subsidize professional care while the family caregiver is at work, keeping them employed.10Hawaii Executive Office on Aging. State Launches Landmark Kupuna Caregivers Program
The care recipient must be a U.S. citizen or lawful permanent resident, at least 60 years old, and not in a long-term care facility. They cannot already be receiving comparable home and community-based services like Medicaid HCBS. They also need impairments in at least two activities of daily living, two instrumental activities of daily living, one of each, or substantial cognitive impairment requiring supervision.11Justia. Hawaii Code 349-16 – Definitions
The family caregiver applying must be an “employed caregiver,” meaning they work at least 20 hours per week for one or more employers or are self-employed. Living with the care recipient isn’t required, but providing direct care for them is.11Justia. Hawaii Code 349-16 – Definitions
The program depends on annual state funding, and availability has been inconsistent. Before spending time on an application, call the Aging and Disability Resource Center at (808) 643-2372 to confirm the program is currently accepting participants.
Taxes on Caregiver Pay
Getting paid to care for a relative creates tax obligations that catch a lot of people off guard. The IRS generally treats caregivers as household employees of the care recipient, because the care recipient controls what work needs doing and it happens in their home.12Internal Revenue Service. Family Caregivers and Self-Employment Tax
When a family caregiver earns $3,000 or more in cash wages during 2026, the employer (the care recipient or their representative) owes Social Security and Medicare taxes at 6.2% and 1.45% from each side, must withhold the employee’s share from pay, and must report wages on a Form W-2.13Internal Revenue Service. 2026 Publication 926 – Household Employer’s Tax Guide Federal income tax withholding isn’t required unless the caregiver requests it and the employer agrees, but income tax is still owed on the earnings at filing time.14Internal Revenue Service. Tax Situations When Taking Care of a Family Member
Certain relationships change this. If the caregiver is the care recipient’s spouse, a child under 21, or a parent (in some circumstances), the employer may not owe employment taxes, though the wages still get reported on a W-2.12Internal Revenue Service. Family Caregivers and Self-Employment Tax When the caregiver isn’t treated as an employee — say, a family member receiving state payments to care for a relative without being in the caregiving business — the income is still reportable but may not be subject to self-employment tax, and it goes on Schedule 1 of Form 1040 instead of Schedule C. PCAFC stipends have their own rules and are generally excluded from gross income. Talk to a tax professional about your specific situation.
How to Apply
- Medicaid HCBS waiver: apply through the Hawaii Department of Human Services, Med-QUEST Division. The process includes a financial eligibility determination and a functional assessment. If approved, ask about the consumer-directed option so a family member can be the paid provider.
- Kupuna Caregivers Program: call the Aging and Disability Resource Center at (808) 643-2372 to check current availability and apply. The Executive Office on Aging coordinates the program; the ADRC handles eligibility.9Justia. Hawaii Code 349-17 – Kupuna Care Program
- VA caregiver programs: visit caregiver.va.gov or call the VA Caregiver Support Line at 1-855-260-3274 (Monday through Friday, 8:00 a.m. to 8:00 p.m. ET). For PCAFC, the veteran and prospective caregiver apply together, and the VA runs a home care assessment.6Department of Veterans Affairs. Program of Comprehensive Assistance for Family Caregivers
Wait times vary. Medicaid applications can take several weeks, and VA caregiver applications involve clinical evaluations that may add more. Start the paperwork before the situation gets urgent so support is in place when you need it.