In Hawaii, the license families see for assisted living is "Assisted Living Facility (ALF)", issued by the Hawaii Department of Health, Office of Health Care Assurance, State Licensing Section. The facility must keep a current physician or primary care provider's report of the resident's physical examination, which includes tuberculosis clearance and confirms the resident is free of other infectious or contagious diseases. A resident must get 14 days' written notice when their behavior is an imminent danger to self or others, the facility cannot meet their needs, or there is a documented pattern of not following agreements.
Key facts
- The median monthly cost of assisted living in Hawaii was $12,096 in CareScout's 2025 Cost of Care Survey, or $145,155 a year, $5,896 above the national median of $6,200 a month. (CareScout, 2026)
- Hawaii's QUEST Integration Medicaid program covers assisted living facility services for members who meet an institutional level of care, and the 2025 to 2029 approval adds people assessed as at risk of needing that care, but payment for room and board is prohibited. (Hawaii Department of Human Services, 2025)
- The resident's physical examination report must include tuberculosis clearance, and all facility staff must follow the Department of Health's current TB clearance procedures. (Haw. Code R. 11-90-9, 2026)
- Medications the facility gives must be prescribed in writing for the resident and reviewed at least every 90 days by a registered nurse or physician. (Haw. Code R. 11-90-8, 2026)
- Hawaii's assisted living rule, chapter 11-90, has no section on memory care or dementia units, so its general rules apply to every resident. (Hawaii Administrative Rules Title 11, chapter 90, 2026)
Hawaii licenses assisted living facilities (ALF) under Hawaii Administrative Rules chapter 11-90, and the state list of April 2026 shows only 17 of them. Adult residential care homes (ARCH), expanded ARCHs and community care foster family homes are separate licenses with their own rules, and the facts below cover the assisted living facility license.
Rules change and communities can set stricter policies. Before you sign, confirm the details with the community and the Hawaii Department of Health, Office of Health Care Assurance, State Licensing Section. This page is general information, not legal advice.
The rules at a glance
| Medical assessment before move-in | The facility must keep a current physician or primary care provider's report of the resident's physical examination, which includes tuberculosis clearance and confirms the resident is free of other infectious or contagious diseases. The rule gives no number of days for how recent the exam must be. [5] More on this |
|---|---|
| TB test | The resident's physical examination report must include tuberculosis clearance, and all facility staff must follow the Department of Health's current TB clearance procedures. The rule does not name a test or say how many days before move-in it must be done. [5][6] More on this |
| Notice before a move-out | A resident must get 14 days' written notice when their behavior is an imminent danger to self or others, the facility cannot meet their needs, or there is a documented pattern of not following agreements. Written notice with no day count applies for license loss or nonpayment, and residents may request an informal conference in writing within 10 days. [7] More on this |
| Who may give medications | Medications the facility gives must be prescribed in writing for the resident and reviewed at least every 90 days by a registered nurse or physician. A registered nurse may delegate routine nursing tasks to unlicensed assistive personnel, and the assisted living rule does not mention insulin injections. [8][9] More on this |
| Memory care and dementia | Hawaii's assisted living rule, chapter 11-90, has no section on memory care or dementia units, so its general rules apply to every resident. These include a service plan based on assessed needs, 24-hour on-site staff and a licensed nurse available seven days a week. [13][8] |
| Long-term care ombudsman | Hawaii's Long-Term Care Ombudsman Program, part of the Executive Office on Aging, investigates and resolves complaints by or for residents of nursing homes, adult residential care homes, assisted living facilities and other long-term care settings and can be reached at 808-586-7268 on Oahu. [10] Official page More on this |
| Medicaid help | Hawaii's QUEST Integration Medicaid program covers assisted living facility services for members who meet an institutional level of care, and the 2025 to 2029 approval adds people assessed as at risk of needing that care, but payment for room and board is prohibited. These services come through QUEST Integration health plans. [11] Official page More on this |
What assisted living costs in Hawaii
The median monthly cost of assisted living in Hawaii was $12,096 in CareScout's 2025 Cost of Care Survey, or $145,155 a year, $5,896 above the national median of $6,200 a month. [14]
A median is the middle of the rates communities reported, so many charge more or less. Rates differ between regions and by the care a resident needs, so ask each community for its full fee list in writing. More: assisted living costs in every state, a monthly budget and the costs that aren't in the base rate.
How to check a community in Hawaii
The Office of Health Care Assurance posts state inspection reports for assisted living facilities, with violations and plans of correction, on its Healthcare Facilities Inspection Reports page. Since August 1, 2026, complaints go through the office's online Kahua Ike portal, and its info line is 808-586-4400. Search Hawaii's records. [2][3]
The licensing agency: Hawaii Department of Health, Office of Health Care Assurance, State Licensing Section. [1] Our guide on how to read an inspection report explains what to look for.
Put Hawaii's paperwork on a date
Parent Move Plan counts every task back from the move-in day, including the medical assessment and TB screening the community will ask for, so nothing lands in the last week.
Get your first 3 days freeFrequently asked questions
How much does assisted living cost in Hawaii?
The median monthly cost of assisted living in Hawaii was $12,096 in CareScout's 2025 Cost of Care Survey, or $145,155 a year, $5,896 above the national median of $6,200 a month. A median is the middle of the rates communities reported, so many charge more or less, and rates differ between regions and by the care a resident needs.
What medical assessment does Hawaii require before moving into assisted living?
The facility must keep a current physician or primary care provider's report of the resident's physical examination, which includes tuberculosis clearance and confirms the resident is free of other infectious or contagious diseases. The rule gives no number of days for how recent the exam must be.
Does Hawaii require a TB test for assisted living?
The resident's physical examination report must include tuberculosis clearance, and all facility staff must follow the Department of Health's current TB clearance procedures. The rule does not name a test or say how many days before move-in it must be done.
How much notice must an assisted living community in Hawaii give before a move-out?
A resident must get 14 days' written notice when their behavior is an imminent danger to self or others, the facility cannot meet their needs, or there is a documented pattern of not following agreements. Written notice with no day count applies for license loss or nonpayment, and residents may request an informal conference in writing within 10 days.
Who can give medications in assisted living in Hawaii?
Medications the facility gives must be prescribed in writing for the resident and reviewed at least every 90 days by a registered nurse or physician. A registered nurse may delegate routine nursing tasks to unlicensed assistive personnel, and the assisted living rule does not mention insulin injections.
Who can help with a complaint about assisted living in Hawaii?
Hawaii's Long-Term Care Ombudsman Program, part of the Executive Office on Aging, investigates and resolves complaints by or for residents of nursing homes, adult residential care homes, assisted living facilities and other long-term care settings and can be reached at 808-586-7268 on Oahu.
Does Medicaid pay for assisted living in Hawaii?
Hawaii's QUEST Integration Medicaid program covers assisted living facility services for members who meet an institutional level of care, and the 2025 to 2029 approval adds people assessed as at risk of needing that care, but payment for room and board is prohibited. These services come through QUEST Integration health plans.
Sources
- Hawaii Department of Health, Office of Health Care Assurance: State Licensing Section (2026) (checked October 22, 2026)
- Hawaii Department of Health, Office of Health Care Assurance: Healthcare Facilities Inspection Reports (2026) (checked October 22, 2026)
- Hawaii Department of Health, Office of Health Care Assurance: Home page, Complaints notice (2026) (checked October 22, 2026)
- Hawaii Department of Health, Office of Health Care Assurance: Type of Hawaii State Licensed and/or Federal Certified Facilities or Agencies (2026) (checked October 22, 2026)
- Haw. Code R. 11-90-9, Record and reports system (via Cornell LII; effective 1999, no later amendments listed), 2026 (checked October 22, 2026)
- Haw. Code R. 11-90-6, General policies, practices, and administration (via Cornell LII; effective 1999, no later amendments listed), 2026 (checked October 22, 2026)
- Haw. Code R. 11-90-10, Admission and discharge (via Cornell LII; effective 1999, no later amendments listed), 2026 (checked October 22, 2026)
- Haw. Code R. 11-90-8, Range of services (via Cornell LII; effective 1999, no later amendments listed), 2026 (checked October 22, 2026)
- Haw. Code R. 16-89-100, Delegation, Purpose (via Cornell LII), 2018 (checked October 22, 2026)
- Hawaii Department of Health, Executive Office on Aging: Long-Term Care Ombudsman Program (2026) (checked October 22, 2026)
- Hawaii Department of Human Services, Med-QUEST: QUEST Integration Section 1115 Demonstration, CMS Special Terms and Conditions, Jan. 8, 2025 to Dec. 31, 2029 (via Internet Archive), 2025 (checked October 22, 2026)
- Hawaii Department of Health, Office of Health Care Assurance: Assisted Living Facility list, updated April 2026 (checked October 22, 2026)
- Hawaii Administrative Rules Title 11, chapter 90, Assisted Living Facility, full chapter (Department of Health official PDF; effective 1999), 2026 (checked October 22, 2026)
- CareScout: Cost of Care Survey 2025, Ranked Median Costs by State (2026) (checked October 22, 2026)