Written by a parent, not a doctor. Nothing here is medical advice.

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Hawaii program

Nursing and personal care at home (QUEST Integration)

Your child’s QUEST plan can cover nursing and personal care at home when the care is medically needed.

What it is

Your child’s QUEST plan can cover nursing and personal care at home when the care is medically needed.

Going home can mean caring for medicines, equipment or symptoms that need trained help. The oncology team describes what your child needs, and the QUEST plan assesses the request. The under-21 child health benefit is the route for this review.

Eligibility rules
  • Your child must be under 21, enrolled in Med-QUEST and need the service under EPSDT, the child health benefit.
  • A diagnosis alone does not establish how many hours of help the plan will approve.
What you get
  • Nursing and personal care hours that the plan approves for your child’s needs.
  • A timely review, with a faster decision when waiting could put your child at risk.
What the help covers
  • The doctor’s request should name the clinical reason and hours of care. The plan decides the medically necessary service.
  • For a child under 21 the plan must look at what your child actually needs, not an adult hour limit. The doctor's request lists each task, how often, and what goes wrong without help.
If you decide to apply
  1. Ask the oncology team and discharge planner to request home care from your child’s QUEST plan.
  2. Describe each task, how long it takes and what cannot be done safely without help. Keep the request date.
  3. Ask for an urgent review if the doctor says waiting would be unsafe.

Your child’s QUEST plan and hospital discharge planner; Med-QUEST appeals: 808-692-8094. · Official page ↗

What happens next
  • An initial QUEST service decision must be as fast as your child’s health requires. The ordinary limit is seven calendar days, or 72 hours for an expedited request. Up to 14 additional calendar days require your request or a documented need for information in your child’s interest.
  • For a denial or a late decision, Med-QUEST’s appeals contact is 808-692-8094.
  • A QUEST health-plan appeal generally must be filed within 60 calendar days of the adverse-benefit notice.
  • The plan ordinarily has 30 calendar days to decide, or 72 hours for an expedited appeal when waiting could seriously harm health or functioning.
  • After the plan appeal, the state fair-hearing request generally is due within 120 calendar days of receiving the appeal decision; a plan’s failure to meet appeal requirements can allow a hearing without waiting for a decision.
  • Your social worker can help identify the right route and the deadline on the notice.
  • For an existing, authorized service that the plan is reducing, suspending or ending, continuing it during appeal has a shorter deadline than filing the appeal itself.
  • To keep hours the plan is cutting, send the appeal within 10 days of the notice and ask in the same letter for the care to continue while it is decided.
  • If the plan still says no, you can ask the state for a hearing within 120 days; asking within 10 days keeps the hours going in the meantime.
  • The state or plan may seek repayment for continued services if the final decision upholds the denial.
Good to know

Children’s nursing goes through QUEST and the under-21 health benefit. Some extraordinary care by a parent can also be reviewed.

Other details
  • The IDD waiver excludes payment to legally responsible parents or guardians of minors. That restriction does not establish a statewide ban on paid parent care.
  • A parent can be paid for personal care that goes well beyond ordinary parenting, up to 40 hours a week, when the plan agrees no other suitable worker is available and the parent completes the training. (merge good[0]–[6] into this one bullet)
  • The plan must approve care beyond ordinary parenting and document that another suitable worker is unavailable.
  • Worker qualifications, training and monitoring apply.
  • The limit is 40 paid hours in any seven-day period.
  • Your QUEST plan confirms whether its payment arrangement is operating and which assessed hours it would approve.
Official sources
Ask your social worker

“Could nursing at home make discharge safe for our child? What help and limits should we expect, and could you help the doctor request the hours we need?”

Why I’m asking: I need to understand what care I can safely do and where trained help is needed.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for the request in writing, keep the date it went in, and appeal if the clock passes.

Your social worker

The oncology team and discharge planner write the request and say why the hours are needed.

The care team

The doctor documents what the child cannot do safely at home without nursing.

Who decides
The child’s QUEST Integration health plan.
Ask your social worker
“Can you send the nursing request to our QUEST plan before discharge, and ask for the expedited 72-hour decision because waiting is not safe?”

How to apply

First step: Ask the discharge planner today to send a nursing request to your QUEST health plan.

  1. Ask the discharge planner to send the nursing request to your QUEST plan before discharge.
  2. Ask for the expedited route when waiting would put the child at risk.
  3. Diary the seventh day, and treat silence as a denial you can appeal.

Where it starts: Ask the oncology team to send a request to the plan naming the hours and the clinical reason. Appeal on 808-692-8094 if it is denied or late.

What to gather

  • The discharge summary
  • the list of what care is needed each day
  • your QUEST plan card

How long: QUEST reviews needed child home care as fast as health requires: ordinarily seven calendar days or 72 hours urgent. A justified extension can add up to 14 days. Approval does not promise immediate staffing.

What a yes looks like

An authorisation naming the hours a week and the agency that will staff them.

What a no looks like, and the next move

Appeal to the plan on 808-692-8094 and ask the ombudsman, Koan Risk Solutions, on 1-888-488-7988 for help.

Watch out

  • Send this to the health plan, not to the waiver: the waiver’s nursing is for age 21 and over.
  • QUEST authority permits certain paid extraordinary parent care; the plan confirms assessed hours, safeguards and implementation. The IDD waiver restriction is separate.
  • The plan can add up to fourteen days, but only on stated grounds.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

QUEST reviews needed child home care as fast as health requires: ordinarily seven calendar days or 72 hours urgent. A justified extension can add up to 14 days. Approval does not promise immediate staffing.

  • $7 — Standard service-authorization decision
  • $72 — Expedited decision when waiting would jeopardise the child
  • $14 — Maximum extension, only on the stated grounds

Covers: Skilled nursing hours at home · Personal care assistance · Equipment and supplies the plan approves

Legal protection: Missing the clock counts as a denial you can appeal · Member appeal line 808-692-8094; the Medicaid ombudsman is Koan Risk Solutions on 1-888-488-7988

What it costs the family: No charge under Med-QUEST.

The eligibility facts, as published

Age
under 21
Coverage
enrolled in Med-QUEST
Medical
medically necessary under the child health benefit
Paid parent
QUEST 1115 permits approved extraordinary personal assistance by a parent or guardian of a minor, with a 40-hour/seven-day cap and safeguards. The plan confirms operation and eligibility; the IDD waiver restriction is separate.

The trap: The waiver’s private-duty nursing is for age 21 and over, and waiver personal care may not be delivered to a child under 21 when the plan should supply it under the child health benefit. So the request goes to the health plan, not to the waiver. The plan can extend the clock by up to fourteen days only on stated grounds, and missing the clock is a denial you can appeal.

Where I read this

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