Ethan R. Okura
Hawai‘i Herald Columnist

In last month’s column, I focused on the history of Medicaid and discussed some of the difficulties that arise when dealing with Medicaid’s many laws, rules and policies. I also told you about some of the problems that people have encountered when applying for Medicaid on their own or without proper guidance.

In this column, I’ll go over the steps you will have to take when applying for Long-Term Care Medicaid on your own.


In order to qualify for LTC Medicaid, you must meet the following criteria:

• Be a United States citizen or a “qualified alien” (permanent resident for five years).

• Be a resident of the state of Hawai‘i.

• Have a Social Security number.

• Be age 65 or older, or blind or disabled.

• Require nursing facility level of care.

• Meet asset requirements.

Once you are certain that you meet all of the aforementioned criteria, you can submit your Medicaid application. There are a number of required and optional forms to fill out when applying for LTC Medicaid, starting with the Hawai‘i Department of Human Services’ Form 1100. This is the basic Medicaid assistance application form. When applying for long-term care, you will also have to submit all of the following forms:

• DHS 1100B: Supplemental form for
long-term care services.

• DHS 1167: Statement of intent for applicants in long- term care facilities.

• DHS 1169: Evaluation for placement of liens.

• DHS 8003: Reporting requirements for individuals with annuities.

• Statement regarding assets in trust.

If someone is helping you fill out and submit your application (or if you are helping someone with their application process), you must also submit:

• A copy of any power of attorney or guardianship appointment.

• DHS 1121: Form to designate authorized representative.

• DHS 1123: Authorization to disclose confidential information by the Med-Quest Division.

You must submit your application in your home county. There are two Medicaid offices on O‘ahu, two on Hawai‘i Island, and one each on Kaua‘i, Maui, Moloka‘i and Lana‘i.

To read the rest of 6/15’s article, visit Ethan’s website here or subscribe to The Herald!

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Ethan R. Okura received his doctor of jurisprudence degree from Columbia University in 2002. He specializes in estate planning to protect assets from nursing home costs, probate, estate taxes and creditors.

This written advice was not intended or written to be used, and it cannot be used by any taxpayer, for the purpose of avoiding penalties that may be imposed on the taxpayer. (The foregoing legend has been affixed pursuant to U.S. Treasury Regulations governing tax practice.)

This column is for general information only. The facts of your case may change the advice given. Do not rely on the information in this column without consulting an estate planning specialist.

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Estate Planning – How to Apply for Long-term Care Medicaid