Eligibility for Medicaid HCBS Waiver Services

 
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Medicaid Related Assistance
Developmental Disabilities
 
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What you need to know

​​​​​​​​​​​​​​​​​​​​​​To receive services, you must be eligible for a Medicaid Home and Community-Based Services (HCBS) Waiver. Eligibility requirements and the application process depend on which waiver you want. 

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    ​​Medicaid Eligibility ​
    All waivers require you to have Medicaid. If you have not yet applied for Medicaid, you need to do so. People with disabilities who apply for Medicaid should also apply for disability benefits. 

    Medicaid Resources


    ​Aged and Disabled (AD) Waiver

    Eligibility

    To be eligible to receive Aged and Disabled Waiver services, a person must meet the requirements outlined in 480 NAC 5.002:

    • Be eligible for Nebraska Medicaid;
    • Have a disability or be over the age of 65;
    • Meet Nursing Facility Level of Care (as outlined in 471 NAC 12); and
    • Have a need for waiver services.

    For more information on AD eligibility:

    Applying 

    DHHS aims to provide accurate eligibility determinations in a timely manner. Anyone can help a person apply. The person, their guardian, or a legal representative must participate in the eligibility process.

    The AD Waiver requires a paper application be completed and submitted.

    If you need assistance to fill out an application, you may visit your local DHHS office.

    Determination and Level of Care

    When an application is received, DDD checks that the person is eligible for Medicaid. Within 14 days from DDD receiving the application, you should get a call to schedule the Level of Care determination. When the person meets the requirements, they are offered AD Waiver services.

    Level of Care Determination

    Aged and Disabled Level of Care is based on the level of care needed to live in a nursing facility. The Level of Care assessment tool depends on how old the participant is.

    • Nursing Facility Level of Care for Adults (age 18+) looks at activities of daily living, risk factors, medical treatment, cognition factors. The assessment categories are: social support, health status, medications and medical equipment, nutrition, instrumental activities of daily living, and housing.
    • Nursing Facility Level of Care for Children has criteria which may vary depending on the age of the child. It is documented in the Individualized Family Service Plan.​

    Funding

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    Currently there are funds for all people eligible for the AD Waiver. Once eligible, you will receive services. Funding is based on your needs.

     

    Developmental Disabilities (DD) Waivers

    ​​Comprehensive Developmental Disabilities (CDD) Waiver; Developmental Disabilities Adult Day (DDAD) Waiver; and Family Support Waiver (FSW)​

    Eligibility

    To be eligible, you must have a developmental disability, as defined in Neb. Rev. Stat. §83-1205:

    • Have a developmental disability diagnosed by a licensed psychologist or a medical doctor
    • AND substantial limitations in each of the 3 areas:
      • Conceptual skills, such as language, reading, money, time, number concepts, and self-direction;
      • Social skills, such as interpersonal skills, social responsibility, self-esteem, gullibility, wariness, social problem solving, and the ability to follow laws and rules and to avoid being victimized; and
      • Practical skills, such as activities of daily living, personal care, job skills, healthcare, mobility, and the capacity for independent living.

    For more information on developmental disabilities eligibility:

    Applying 

    An application for developmental disabilities services is different from an application for Medicaid, Social Security, Economic Assistance, or Behavioral Health Services. These are separate applications, which you may need to also complete.

    Online Application

    iServe​ is the best way to apply. It has an online application.

    Paper Application

    If you need assistance to fill out an application, you may visit your local DHHS office.

    Determination and Level of Care

    The Process and Needed Documents

    You should get a call a few days after submitting your application. DDD will collect needed documents, which may include:

    When an application and documents are received, a decision is usually made within 30 days. 

    • Being eligible does not mean you will receive services right away. There is limited funding available.
    • Eligibility is reviewed at ages 10 and 18.
    • If Social Security determines that you are not disabled, developmental disabilities eligibility will be reviewed.

    Level of Care Determination

    Once eligible, a level of care assessment is completed.

    • DD Level of Care is based on the level of care needed to live in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID).
    • The Developmental Index is the assessment tool currently used to determine ICF-IID Level of Care.​

    Funding & the Registry

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    DD Registry

    There currently are not enough funds available for all requests for DD waivers.​ When you meet the level of care requirement, if you have Medicaid or are a Medicaid-eligible child, you are placed on the DD Registry to wait for funding. 

    DD Waiver services will be offered when funding is available.

    When you are on the DD Registry:

    • Funding is based on priorities in Nebraska Revised Statute §83-1216 to people who:
      • Are in immediate crisis;
      • Have lived in a Nebraska institutional setting for at least the last 12 months;
      • Are wards of DHHS or under the supervision of the Office of Probation Administration and transitioning out of the system at age 19;
      • Are transitioning from the educational system at age 21 when the school year ends;
      • Are dependents of a member of the armed forces stationed in Nebraska; and
      • Are waiting, by date of application.
    • You are assessed for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care. 
    • You may receive services on a different Medicaid HCBS Waiver, Medicaid non-waiver services, or Lifespan Respite.
    • When you are not on a different Medicaid HCBS Waiver, you may request a Service Coordinator (SC), who will:
      • Work with you to develop a plan based on your natural and local community resources and supports;
      • Help you access resources such as Medicaid, SSI, and SNAP;
      • Help you identify and access community resources based on your needs;
      • Hold meetings annually to help you work toward life goals;
      • Monitor your plan to ensure it adequately addresses your needs;
      • Follow up with your guardian and, as requested, your family;
      • Adjust your plan when changes are needed for success; and
      • Advocate for what you need from your family and community.

    When you are offered funding for a DD waiver:

    For the CDD and DDAD waivers, DDD uses an objective assessment process (OAP) to base your funding on your needs. An assessment determines your Individual Budget Amount (IBA). You use your IBA to purchase services. 


    For the Family Support Waiver (FSW), your annual budget will be $10,000.

     

    Traumatic Brain Injury (TBI) Waiver

    Eligibility

    To be eligible to receive Traumatic Brain Injury services, a person must:

    • Be eligible for Nebraska Medicaid;
    • Be age 18 years or older;
    • Have a diagnosis of traumatic brain injury;*
      • ​Non-degenerative, non-congenital insult to the brain from an external mechanical force;
      • Possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions; and
      • An associated diminished or altered state of consciousness.
    • Meet Nursing Facility Level of Care (as outlined in 471 NAC 12); and
    • Have a need for waiver services.

    *This waiver is not for acquired brain injury caused by strokes, tumors, and other non-traumatic causes. The term TBI does not apply to brain injuries induced or caused by birth trauma.

    For more information on the TBI eligibility:

    Applying 

    ​DDD aims to provide accurate eligibility determinations in a timely manner.

    Anyone can help a person apply. The person, their guardian, or a legal representative must participate in the eligibility process.

    The TBI Waiver requires a paper application be completed.

    • Call our toll-free number (877) 667-6266 to request application be mailed to you. 
    • Fill out the application completely, sign, and submit:

    If you need assistance to fill out an application, you may visit your local DHHS​ office.​​

    Determination and Level of Care

    When an application is received, DDD checks that the person is eligible for Medicaid. Within 14 days from DDD receiving the application, you should get a call to schedule the Level of Care determination.

    • Assessment & Funding - The process used to assess needs and determine TBI services.
    • TBI Waiver is based on the level of care needed to live in a nursing facility.
    • Nursing Facility Adult Level of Care looks at activities of daily living, risk factors, medical treatment, cognition factors. The assessment categories are: social support, health status, medications and medical equipment, nutrition, instrumental activities of daily living, and housing.

    Funding

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    Once eligible, you will receive services. ​Funding is based on your needs.

     

    HCBS Eligibility & Enrollment Team

    When you apply for HCBS Waiver services, the Eligibility and Enrollment (E&E) team reviews your application and makes a decision. They gather information and complete assessments. 

    • E&E Overview - Slides from September 2023 presentation to stakeholders.​


    Notice of Decision

    If you applied for services and received a notice of decision saying you were determined Not Eligible, find out what to do next.

    If you have questions about eligibility or application call (877) 667-6266 or email dhhs.developmentaldisabilities@nebraska.gov.


    FAQs​​

    I earn too much money to qualify for Medicaid, but my child has a disability and could use waiver services. Can you help?​

    There is a process so parent's income is not counted for disabled children who meet waiver eligibility. Contact your local DHHS office to begin the Medicaid application process, and say you want your child assessed for the waiver. ​​

    How many hours a day can I get help?

    Each person's needs are different, so there is not a set number of hours of assistance per day. You and your Service Coordinator will work together on a plan of services to meet your needs and keep you safe at home. ​​

    Do I have to have a waiver for my child to receive Respite?

    Respite is a service on ​the HCBS waivers, as well as being available from other programs. You can only receive Respite from one source. Learn more about possible funding for Respite​.

    How can I get information about eligibility and services in my primary language?

    DDD has a webpage with publications in other languages. 

    The DHHS website can be viewed in other languages by selecting your prefered language from the drop down in the top right corner of any page. 

    For additional translation needs, contact us​.