Eligibility for Medicaid HCBS Waiver Services

 
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Disabilities Assistance
Developmental Disabilities
 
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    To receive services from DDD, 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. All waivers require you to have Medicaid.

    Aged and Disabled (AD) Waiver

    Aged and Disabled (AD) 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.

    Applying for AD Waiver Services

    DHHS aims to provide accurate eligibility determinations in a timely manner.

    Referrals are made to local Service Coordination offices:

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

    AD Eligibility Determination and Level of Care

    When Service Coordination receives a referral, a Service Coordinator (SC) is assigned and checks that the person is eligible for Medicaid. Within 14 days from receiving the referral, the SC reaches out to the person 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.

     

    Comprehensive Developmental Disabilities (CDD) and Developmental Disabilities Adult Day (DDAD) Waivers

    Developmental Disabilities (DD) 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 for DD Waiver Services

    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.

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

    For a paper application:

    • You can print in English or en Español, or call our toll-free number (877) 667-6266 to request one be mailed to you. You also need to complete a release of information.
    • Fill out the application completely, print, sign, and submit:

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

    DD Eligibility 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 9 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 Developmental Disabilities (ICF/DD).
    • The Developmental Index is the assessment tool currently used to determine Level of Care.

    DD Wait List

    When you meet the level of care requirement, if you have Medicaid or are a Medicaid-eligible child, you are placed on the wait list. For more information on the DD Wait List, see the Funding section on the main Participant page.


     

    Traumatic Brain Injury (TBI) Waiver

    Traumatic Brain Injury (TBI) Eligibility

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

    • Be eligible for Nebraska Medicaid;
    • Be age 18 through 64;
    • Have a diagnosis of traumatic brain injury* (such as a blow to the head);
    • Meet Nursing Facility Level of Care (as outlined in 471 NAC 12); and
    • Have needs requiring the type of care necessary to treat the conditions and criteria identified in the definition of Specialized Assisted Living (SAL).

    *This program is not for acquired brain injury caused by strokes, tumors, and other non-traumatic causes.

    Applying for TBI Waiver Services, Eligibility Determination, and Level of Care

    A person seeking services from the TBI Waiver should contact the League of Human Dignity, Lincoln Office. The person should also contact the TBI provider to see if they have the ability to support the person's needs.

    • The Service Coordinator will discuss if needs would be best met from TBI Waiver or AD Waiver.
    • The SC will determine the person meets eligibility requirements, including Level of Care.
      • 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.


     

    Notice of Decision

    If you applied for any Medicaid HCBS Waiver services and received a notice of decision, find out what your next steps can be:

    I was determined Eligible

    I was determined Not Eligible

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