Eligibility for Medicaid HCBS Waiver Services

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.

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

Referrals are made to local Service Coordination offices:

• Birth to age three: Early Development Network
• Ages three through 17: DHHS Local Offices
• Ages 18 and older: Area Agencies on Aging or League of Human Dignity

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

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.

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:

• DD Services Eligibility Brochure (En Español) - Eligibility requirements and how to get started.
• Tips for Teachers (en Español) - Information for teachers about DD eligibility, services, funding, resources for students and a timeline.

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.

• Applying for Developmental Disabilities Services gives step by step instructions to complete the 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:
• Mail to DD Eligibility, PO Box 98947, Lincoln NE 68509-8947
• OR scan and email to DHHS.DDEligibility@nebraska.gov
• OR fax to (402) 742-8384
  

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

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:

• Assessments completed by a licensed psychologist:
• Information for school psychologist (En Español)
• Information for diagnosing psychologist (En Español)
• Diagnosis of disability given before age 22, which affects your ability to complete activities of daily living skills
• School reports:
• All Multi-Disciplinary Team (MDT) reports
• Most recent Individual Education Plan (IEP)

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.

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.

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.