Hawaii Foster Care Clothing Allowance and Difficulty of Care Payments

The monthly board rate is the number most prospective resource caregivers focus on, and for good reason — it is the main financial support for day-to-day care. But two additional payments matter significantly, especially when you are first receiving a child or when a child in your care has serious behavioral or medical needs: the annual clothing allowance and the Difficulty of Care (DOC) supplement.

Both are underutilized, partly because caregivers do not always know they exist or how to access them.

The Annual Clothing Allowance

The listed annual clothing allowance, when applicable to the placement, is paid to the resource caregiver on top of the monthly board rate. The amounts by age:

The allowance reflects reality: children grow quickly, clothing wears out, and children entering foster care frequently arrive without adequate clothing for their current size or the season. The allowance is meant to address this directly without requiring caregivers to absorb that cost out of the standard board payment.

How the Clothing Allowance Is Paid

The clothing allowance is issued annually, not monthly. Payment timing can depend on the specific arrangement and current DHS procedures.

Ask your DHS worker when the first clothing allowance will be available. If a child arrives with minimal clothing, communicate the need early and ask when the allowance or other assistance will be available.

What the Allowance Is For

The clothing allowance is specifically for clothing needs. It is not additional general funds that can be used for other expenses. Keep receipts for clothing purchases made on behalf of a foster child — documentation is occasionally requested, and it protects you if there are questions about how the allowance was used.

The Difficulty of Care Supplement

The Difficulty of Care (DOC) payment is a monthly supplement on top of the base board rate for children with elevated care needs. The maximum DOC payment in Hawaii is $570 per month.

This is not a small amount — for a child ages 12 and older, it represents a 73% increase over the base board rate. For caregivers managing children with serious needs, the DOC supplement can be the difference between a placement being financially sustainable or not.

What Qualifies for Difficulty of Care

DOC payments are tied to the specific child's assessed needs, not to a caregiver's application for extra funds. Qualifying situations typically include:

• Behavioral health challenges: Children with significant trauma histories who exhibit serious behavioral challenges requiring consistent intervention, specialized approaches, and additional supervision
• Medical complexity: Children with ongoing medical conditions requiring regular medical management, in-home care protocols, or specialized equipment
• Developmental needs: Children with developmental disabilities or delays requiring significant additional support and coordination

Children placed in therapeutic foster care (Nā 'Ohana Pulāma / NOP program) may have a different compensation structure that reflects the therapeutic complexity of care. Ask DHS or the relevant contracted program how DOC or other payments are authorized for that placement.

How DOC Payments Are Authorized

A DOC payment does not happen automatically. DHS assesses and authorizes it based on the specific child's documented needs. If you have a child placed with you who you believe may qualify for DOC but the payment has not been discussed, raise it directly with your worker.

Do not assume the worker knows everything about the child's day-to-day challenges. Document specific examples: behavioral incidents, medical appointments, medications, how much additional supervision the child requires versus a child with typical needs. Concrete documentation makes the case for DOC authorization far more effectively than a general statement that the child is "difficult."

DOC and Therapeutic Foster Care

For families specifically interested in caring for children with the highest levels of behavioral or emotional need, therapeutic foster care is the designated pathway. The NOP program provides:

• Additional pre-placement training beyond standard H.A.N.A.I. requirements
• 24/7 support from a supervising agency worker
• Higher monthly compensation structured to reflect the care complexity
• Intensive case coordination

If this is the level of involvement you want, ask DHS which contracted program is currently handling NOP placements and how to apply.

Special Event Funds

A third, smaller pool of funding is the Special Event allocation — up to $125 per year per child for extracurricular activities, school events, or special purchases like prom attire or sports fees. This is separate from both the board rate and clothing allowance.

Additionally, the Victoria S. and Bradley L. Geist Foundation provides up to $500 per year in enhancement grants for Hawaii foster children for enrichment activities — hula lessons, arts programs, sports registration. These are private foundation funds coordinated through DHS and contracted agencies. Ask your worker if a child in your care might qualify.

Putting It Together

For a child ages 12 or older with complex needs placed in your home, the total monthly financial support can look like this:

• Base board rate: $776/month
• Difficulty of Care supplement (if authorized): up to $570/month
• Med-QUEST provides comprehensive medical, dental, and behavioral-health coverage; confirm specific services and provider rules
• Clothing allowance: $1,026/year (roughly $86/month amortized)

The financial package from Hawaii's foster care system is more comprehensive than most people realize when they first start researching. The challenge is knowing what exists and how to access it.

For a complete picture of all financial support available to Hawaii resource caregivers, see the Hawaii Foster Care Licensing Guide.

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