Overview of Nebraska’s Personal Assistance Services
Nebraska’s State Plan Personal Assistance Services (PAS) is for Nebraskans of all ages who are disabled or have chronic medical conditions, and as a result, require assistance with their day-to-day activities. Intended to assist these persons in continuing to live in their home, program participants receive assistance with a variety of daily activities. These include bathing, dressing, toiletry, mobility, eating, meal preparation, light housework, and grocery shopping.
Program participants can live in their personal home or that of a loved one. PAS are not available to persons residing in adult foster care homes or assisted living residences if they are receiving this type of assistance as part of their residence service package. One exception, however, is if they require personal assistance services to assist with outside employment.
Personal assistance services offered under this program may be provided by licensed agency workers or program participants have the option to self-direct their own care by hiring an independent provider. The independent provider must be enrolled as a Medicaid provider, but the program participant becomes the employer of that individual and responsible for hiring, training, managing, and firing. While friends and relatives, including one’s adult child, can be hired as one’s independent provider, legally responsible persons, such as a spouse, are prohibited from this role. Independent providers are paid by the Nebraska Department of Health and Human Services.
Personal Assistance Services are available through Nebraska’s Regular State Plan Medicaid. Medicaid in Nebraska is also called the Nebraska Medical Assistance Program (NMAP). PAS are an entitlement; meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance. In other words, there is never a waiting list for this benefit.
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.
Benefits of Personal Assistance Services
Program participants can receive up to 40 hours per week of PAS. In some cases, one may be authorized for additional hours. The amount of weekly hours of assistance, and the services for which one can receive assistance, is determined based on an individualized needs assessment. Assistance with the following activities may be provided.
– Accompaniment to Medical Appointments / Treatments
– Bathing / Showering
– Bowel / Bladder Care
– Dressing
– Eating
– Housekeeping Tasks – changing bed linen, laundry, light cleaning, grocery shopping
– Meal Preparation
– Medication Administration
– Mobility
– Nail Care
– Oral Hygiene
– Reminders to Refill Prescriptions
– Shaving
– Specialized Procedures – i.e., oxygen administration, filling insulin syringes, oxygen administration
– Toileting
– Transferring
Eligibility Requirements for Nebraska’s Personal Assistance Services
PAS is for Nebraska residents of any age who are disabled or have a chronic medical condition. Additional eligibility criteria follows and is relevant for seniors and disabled adults.
Financial Criteria: Income, Assets & Home Ownership
Income
In 2024, the individual applicant income limit is $1,255 / month. This figure is 100% of the Federal Poverty Level (FPL) for a household of one. For a married applicant, regardless of if one spouse or both spouses is an applicant, the income limit is $1,703 / month. This figure is 100% of the FPL for a household of two.
Assets
In 2024, the asset limit is $4,000 for a single applicant. For married couples, it is $6,000, regardless of whether one spouse or both are applicants.
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.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is thought it is not applicable for the Personal Assistance Services Program.
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 Nebraska 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.
Learn more about the potential of Medicaid taking the home.
Medical Criteria: Functional Need
While many Medicaid long-term care programs require an applicant to need a Nursing Facility Level of Care (NFLOC), Nebraska’s State Plan Personal Assistance Services does not. It is, however, required that one need assistance with their Activities of Daily Living (ADLs), such as toileting, bathing, dressing, transferring, mobility, and eating. While a diagnosis of Alzheimer’s disease or a related dementia does not mean one will automatically meet the level of care need, it is common for persons with dementia to require assistance with their ADLs.
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, Nebraska Medicaid will pay for Personal Assistance Services.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid Asset Protection Trusts (MAPTs). MAPTS protect assets from both Medicaid and Medicaid’s Estate Recovery Program, but must be implemented long before the need for long-term care arises. Persons can also turn countable assets into an income stream through a Medicaid-Compliant Annuity. There are many other 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. Furthermore, Medicaid’s 60-month Look-Back Rule does not apply for Personal Assistance Services, it does apply to nursing home Medicaid and the Aged and Disabled Waiver Program. As more extensive Medicaid-funded care might be required in the future, it is vital that one not violate the Look-Back Rule. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. 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 Nebraska’s Personal Assistance Services
Before You Apply
Prior to submitting an application for Personal Assistance Services, 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, previous bank statements, and proof of income. A common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
Persons can apply for Personal Assistance Services online via iServe Nebraska, download an Application for Nebraska Medicaid for Aged and Disabled here, or apply via their local DHHS office.
The Nebraska Department of Health and Human Services (DHHS) administers the State Plan Personal Assistance Services. See limited information about Nebraska’s Personal Assistance Services.
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.