Nursing-facility Medicaid in Hawaii runs through Med-QUEST and its QUEST Integration managed-care structure. The state's coverage recognizes several distinct facility levels: skilled nursing facility or nursing facility Level C, intermediate care facility or nursing facility Level A, and ICF/ID Level B care. According to the Med-QUEST Long Term Care provider manual, home- and community-based services are delivered through QUEST Integration health plans, while the manual separately lays out how each nursing-facility level and its admission process work for providers.
The clinical gatekeeper for this whole process is DHS Form 1147, officially the Level of Care and At Risk Evaluation. The Department of Human Services treats meeting an institutional level of care as the baseline functional requirement for accessing long-term-care services, and once approved, a Form 1147 determination is valid for no more than 12 months before it needs to be revisited.