The review and admission process
The provider manual describes Form 1147 as required for admissions, transfers, changes in level of care, and certain changes to Medicaid-primary coverage. It states that the attending physician recommends admission, a DHS consultant or representative approves it, and MQD staff or a representative performs the medical or independent professional review (Med-QUEST Form 1147 process).
The manual says a medical authorization for admission expires 30 days after approval, and approval of a level of care does not itself establish Medicaid financial eligibility or authorize payment. Financial eligibility, a covered service, and an appropriately certified provider must still be present when services are rendered (Med-QUEST admission authorization rules).
Patient liability and the published allowance
For a medically needy institutionalized person, Hawaii calculates cost share by applying income and the rule’s deductions. Hawaii’s income regulation identifies a $50 personal-needs allowance for a person residing in a nursing facility or medical facility receiving nursing-facility-level care (Hawaii institutional cost-share rule).
An older DHS consumer document likewise describes Act 96 as establishing a $50 monthly personal-needs allowance for Social Security recipients living in listed long-term-care settings, including nursing facilities. Because personal-needs and patient-liability rules can change, confirm the amount used in the actual eligibility and cost-share budget rather than relying on a facility estimate (Hawaii DHS personal-needs allowance document).
When a nursing-facility application is urgent, do not delay the functional review while collecting financial records. The Form 1147 process, financial application, transfer review, and cost-share calculation are related but distinct steps.
For certain applicants with serious mental illness, intellectual disability, or developmental disability, the manual also describes preadmission screening and resident-review procedures. Those reviews are distinct from the financial application and can affect whether nursing-facility placement and specialized services are appropriate (Med-QUEST Long Term Care provider manual).
Not mutually exclusive. Most families combine two or three funding pillars — this one rarely stands alone.
The
Journey Assessment ranks all ten pillars against your specific situation and
recommends the top three.
