Updated August 27, 2026. Quick answer: Hawaii’s rule defines the arithmetic and then fixes the sequence. “An individual’s excess income is the countable income which exceeds the medically needy income standard for the household of applicable size.” Then: “Medical expenses incurred by an individual or financially responsible relative not subject to payment by a third party shall be deducted from the excess income in the following order:” — and premiums, deductibles and coinsurance come first.
What Hawaii requires
| What the state sets out | What it says |
|---|---|
| Hawaii’s name for it | spenddown (HAR Title 17, Chapter 1730.1) |
| What the chapter covers | This chapter describes the spenddown of excess income for children under age nineteen years, pregnant women, and aged, blind or disabled (ABD) individuals with incurred medical expenses to qualify for medical assistance |
| How excess income is defined | “An individual’s excess income is the countable income which exceeds the medically needy income standard for the household of applicable size.” |
| Deduction sequence | “Medical expenses incurred by an individual or financially responsible relative not subject to payment by a third party shall be deducted from the excess income in the following order:” |
| First in the order | “Expenses for Medicare and other health insurance premiums, deductibles or co-insurance charges including enrollment fees and co-payments.” |
| Proof | “Evidence of medical services received shall be required to determine eligibility for a given month.” |
How it works in practice
- Order matters when the expenses do not cover the whole excess. Insurance premiums, deductibles, coinsurance, enrollment fees and copayments are applied before anything else, which usually means Medicare costs absorb the first slice every month.
- Someone else’s money does not count as yours. The chapter excludes an employer’s contribution to a health plan and any premium “voluntarily paid in whole or in part” by another person from the deduction.
- Evidence is required per month, not per period: “Evidence of medical services received shall be required to determine eligibility for a given month.” A spenddown is a documentation exercise as much as a financial one.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for Hawaii.
What this page does not settle
- The chapter covers children under nineteen, pregnant women, and aged, blind or disabled individuals. It is the pathway for people ineligible under a categorically needy group, not a substitute for one.
- This page reads one source: Hawaii Administrative Rules, Title 17 Chapter 1730.1, Medically Needy Spenddown. It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
Spending down to the income limit is only half of what Hawaii Medicaid can do for a household that is already providing the care itself, and getting paid as a family caregiver in Hawaii names the Hawaii program that pays one and answers the family-member and the spouse question separately.
Before the excess-income rule applies, there is the eligibility test itself: Hawaii’s Medicaid nursing-home income test sets out the figure or the mechanism the state actually uses, with its primary-source citation.