Unfortunately it was not the FBX settings and the discussion didn’t really get me anywhere, although it did introduce me to Rigify which is super awesome.
However after generating 7 models from MakeHuman and bringing them in to UE4, I accidentally got it to work but not entirely sure if I was missing this the entire time.
After generating the model and its rig, I had to finalize the model in the addon first, and then up the scale by 100x to fit UE4 scale and CTRL-A, and the model also had to be in T-pose as well. If I scaled the model before finalizing it with the addon, UE would say the bone size is too small. Default FBX export settings worked.