Overview of the Nebraska Aged and Disabled Waiver
Nebraska’s Aged and Disabled Waiver (AD Waiver) is a statewide Medicaid program for Nebraskans who are elderly or disabled and at risk of institutionalization (nursing home admission). Intended to assist these persons in continuing to live at home and in their community, a variety of long-term services and supports (LTSS) are available. These include adult day health care, meal delivery, personal emergency response systems, personal care assistance, and respite care. Also available are community transition services, which assist persons currently living in a nursing home to transition back home.
AD Waiver participants can reside in one’s home, the home of a loved one, or an assisted living residence and receive program benefits.
Many long-term care Medicaid programs allow program participants the option of self-directing their own care, specifically hiring the caregiver of their choosing. In the traditional sense, this is not an option through the AD Waiver. Program participants, however, have the choice of receiving their services via an agency provider or an independent provider, both of which must be approved Medicaid providers. A program participant who opts for an independent provider becomes the employee, responsible for hiring and managing that individual. Payment is made by the Nebraska Department of Health and Human Services. While friends and relatives, including one’s adult child, can be one’s independent provider, a spouse is prohibited from this role.
Nebraska’s Aged and Disabled Waiver, formally called the HCBS Waiver for Aged and Adults and Children with Disabilities, is a 1915(c) Home and Community Based Services (HCBS) Medicaid Waiver. It is not an entitlement program; meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the number of participant enrollment slots are limited, and when they are full, a waiting list for program participation forms.
The Nebraska Medicaid program is also called the Nebraska Medical Assistance Program (NMAP).
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. Meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.
Benefits of the Nebraska Aged and Disabled Waiver
Follows is a list of long-term services and supports available via the AD Waiver. Any benefit relevant only to children is not included on this page. While all program participants receive service coordination, one’s unique needs and existing supports are assessed to determine which other benefits they will receive.
– Adult Day Health
– Assisted Living Services – i.e., personal care, light housekeeping, laundry, essential shopping
– Assistive Technology – to improve or maintain one’s level of functioning
– Chore Activities – i.e., snow removal, raking leaves, mowing lawn, minor repairs of screens
– Companion Services – i.e., supervision, light housekeeping, meal preparation, essential shopping
– Community Transition Services / Home Again – assists Medicaid-funded nursing home residents in moving to a private home
– Home Modifications – i.e., grab bars, ramps, bathroom modifications to allow wheelchair access
– Home Delivered Meals
– Independence Skills Building – daily living activities and home management skills training
– Non-Medical Transportation
– Personal Care Assistance – may include nursing care and administration of medications
– Personal Emergency Response Systems
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Vehicle Modifications – to assist persons with special needs
While assisted living services is an available benefit via the AD Waiver, the cost of room and board is not paid for by this program.
Eligibility Requirements for the Nebraska Aged and Disabled Waiver
The AD Waiver is for Nebraska residents who are seniors (65+ years old), or any age, if physically disabled. Additional eligibility criteria follows and is relevant for seniors and adults who are disabled.
Financial Criteria: Income, Assets & Home Ownership
Income
The applicant income limit is equivalent to 100% of the Federal Poverty Rate (FPR). This figure increases each January, and in 2024, is $1,255 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $1,255 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,255 / month. Furthermore, the non-applicant spouse may be entitled to a Spousal Income Allowance, called a Monthly Maintenance Needs Allowance (MMNA), from their applicant spouse.
In Nebraska, there is a minimum income allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. There is also a maximum income allowance, which in 2024, is $3,854 / month. While this potentially allows a non-applicant spouse a higher income allowance, the exact amount one can receive is dependent on their shelter and utility costs. However, a Spousal Income Allowance can never push a non-applicant’s total monthly income over $3,854.
Assets
In 2024, the asset limit is $4,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $8,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse is allowed up to $4,000 in assets and the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment. The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $30,828 the non-applicant spouse can keep all of the couple’s assets, up to this amount.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. Medicaid has a Look-Back Rule and violating it results in a Penalty Period of Medicaid ineligibility.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. For eligibility purposes, Medicaid in NE considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $713,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a minor child (aged 17 or younger) living in the home.
– The applicant has a permanently disabled or blind child (of any age) living in the home.
While the home is likely exempt while one is receiving Medicaid benefits, it may not be safe from Medicaid’s Estate Recovery Program. Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the AD Waiver, functional need is assessed through utilization of the interRAI Home Care (interRAI-HC) tool. There are several areas of assessment. The first of which is one’s limitations in independently completing their Activities of Daily Living (ADLs), such as toileting, continence, bathing, dressing, transferring, mobility, and eating. Medical conditions / treatments, like those that require continuing medical or nursing care or are potentially unstable, are considered. Risk factors, such as behavior, safety, and frailty, are also considered, as well as cognitive deficits, which are commonly seen in persons with Alzheimer’s disease or a related dementia. While persons with dementia commonly meet the NFLOC, a diagnosis of dementia in and of itself does not mean one will automatically meet it.
For a Nursing Home Level of Care determination, one of the following statements must be true for the applicant:
– Has limited functioning with at least 3 ADLs and has at least 1 risk factor.
– Has limited functioning with at least 3 ADLs and has at least 1 medical condition / treatment.
– Has limited functioning with at least 3 ADLs and has at least 1 area of limited cognition.
– Has limited functioning with at least 1 ADL, has at least 1 risk factor, and has at least 1 area of limited cognition.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for NE Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Nebraska has a Medically Needy Program for Medicaid applicants who have high medical expenses relative to their income. Also known as a spend-down program, applicants spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s medically needy income limit. The monthly amount that must be “spent down” each month is called a share of cost, but can be thought of as a deductible. Once one’s “deductible” has been met for the month, the Aged and Disabled Waiver will pay for care services and supports.
When persons have assets over the limits, trusts are an option. Irrevocable Funeral Trusts (IFTs) are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Medicaid Asset Protection Trusts (MAPTs), which must be implemented well in advance of the need for care, are trusts that protect assets from Medicaid and Medicaid’s Estate Recovery Program. Another option, although rarely utilized anymore and limited to couples with a significant amount of “excess” assets, is a Medicaid Divorce. There are many other Medicaid planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Nebraska to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of these strategies violate Medicaid’s 60-month Look-Back Rule, and therefore, should only be implemented with careful planning. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
How to Apply for the Nebraska Aged and Disabled Waiver
Before You Apply
Prior to submitting an application for the AD Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. A common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Since the Aged and Disabled Waiver is not an entitlement program, there may be a waiting list for program participation. This waiver is approved for a maximum of approximately 9,000 beneficiaries per year. In the case of a waiting list, priority is given to persons whose health and / or safety is jeopardized without waiver services. This means that in some cases, persons who submitted an application at a later date than other applicants will be awarded a participant slot first.
Application Process
Persons can apply for the Aged and Disabled Waiver online at iServe Nebraska. Alternatively, one can download the Application for Home and Community Based Services (HCBS) Waiver or call 877-667-6266 to request a mailed application. Information on where to submit the completed application can be found on the application. Persons who require application assistance, or have questions regarding the program, can call 877-667-6266 or contact their local DHHS office.
Learn more about the AD Waiver here and here.
The Division of Developmental Disabilities (DDD) within the Nebraska Department of Health and Human Services (DHHS) administers the Aged and Disabled Waiver.
Approval Process & Timing
The Nebraska Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waiting list may exist, approved applicants may spend many months waiting to receive benefits.