Medicaid Home and Community-Based Programs

 
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Medicaid Related Assistance
Medicaid & Long-Term Care
 
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What would you like to do?

What you need to know

What's a program?

A program is a group of services intended to meet an individual's or family's needs. Home and community-based services provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than isolated settings. Many of these services are provided via waivers, which provide additional services to those regularly covered by Medicaid

First, a person must qualify for the program. Each program has its own requirements. People who are eligible for a program are called participants.

Once eligible, participants will partner with a services coordinator or a social services worker to get the services they need.


 

Aged and Disabled Waiver

What is the Aged and Disabled Waiver?

This is a program that offers an array of services to support people in their homes.

Who may need this program?

Individuals of all ages who:

  • Are eligible for Medicaid and have needs at nursing facility level of care
  • Want to live at home rather than a nursing facility
  • Can be served safely at home

What services may be available through the Aged and Disabled Waiver?

Please visit the services page for more information.

What is done to ensure the safety and well-being of individuals served by this program?

The Nebraska Medicaid and Long-Term Care Home and Community-Based Services (HCBS) Waivers Unit utilizes a quality improvement system to ensure the health and well-being of participants through continuous, participant-focused monitoring and improvement.

  • The quality improvement system is guided by key principles and defined roles and functions.
  • A quality council advises the HCBS Waivers Unit on strategies to improve all aspects of the quality improvement system and reviews progress on strategies.
  • Processes are used to measure compliance, CMS assurances, participant outcomes and utilization.
  • Survey results and reports are compiled from data obtained through the quality improvement system processes.

Learn more about Aged and Disabled Waiver roles, functions, processes and the Quality Council.

Contact someone who can answer your questions about the following services in the Aged and Disabled Waiver:

What does it mean for me to be eligible for the waiver?

To be eligible, you must:

  • Be financially eligible for Medicaid
  • Have physical and health needs which require services similar to those provided by a nursing facility (see the next question)
  • Have an individualized plan of services and supports that will keep you safe in your home

What does it mean to “meet nursing facility level of care"?

Nursing facility level of care means you have needs which require you to receive services similar to those provided to individuals who live in a nursing home. For example, you may need assistance with every day tasks such as getting dressed, taking a bath or shower, eating or walking safely. A few examples of other areas considered are how much help you need to take medications, any memory problems or health conditions you may have and how they are managed. Persons who apply for Medicaid waivers are assessed to see if their needs are the same as those of people who live in a nursing home.

I earn too much money to qualify for Medicaid, but my child has a physical disability and we could really use the services of the waiver. Can this help?

There is a process to follow so that a 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 be sure to say you want your child assessed to determine if they qualify for the waiver.

How many hours in the day can I have help?

Each person's needs are different; there is not a set number of hours of assistance per day from the waiver. You and your services coordinator will work together on a plan of services that will meet your needs and keep you safe at home.

I am an adult living in my own apartment. If I qualify for the waiver, who will I get to help me in my home? Who comes in to clean and do laundry? Who comes and helps me while I take a bath?

First, an assessment is completed to determine what kind of help you need to stay safely in your home. Next, staff from the waiver program will be able to connect you with a choice of providers to help you in your home. You choose who provides services for you and when they work for you. Some providers are agencies. Other providers are self-employed and do not work for an agency. If you know someone that you want to work for you as your provider, refer the person to the waiver staff.

Where can I read the DHHS regulations about the Aged and Disabled Waiver?

More information is available in Title 480 NAC Chapter 5.

Where can I read more about the Children's Level of Care Assessment?

More information is available on the Secretary of State's website.

Katie Beckett Program

What is the Katie Beckett program?

This program provides Medicaid eligibility to children who otherwise would be hospitalized because of their high level of health care needs.


Who may need this program?

Families with a child or children under 19 years of age who have one or more of the following:

  • A ventilator to breathe
  • A tracheostomy
  • A Need for intravenous therapy involving central lines for daily fluids or nutrition
  • Need for frequent and complex medical care that requires use of equipment to prevent life-threatening situations

What services may be available through the Katie Beckett program?

All Medicaid services based on medical need, including (but not limited to):

  • Nursing care in the home
  • Hospital stays
  • Medicine, medical supplies and equipment
  • Physician fees

We earn too much money for Medicaid, but our child has many health problems and has been in the hospital since birth. Can the Katie Beckett program help?

Only the child's income is considered for the Medicaid eligibility process for children served by the Katie Beckett program. Contact your local DHHS office to begin the Medicaid application process, and be sure to say you want your child assessed to determine if he or she qualifies for Katie Beckett. 

Does a private health insurance policy affect eligibility?

No, your child can still be eligible for the program if your family has private health insurance through a job or another group. The private insurance must be used first and Medicaid pays after your other health insurance has paid.
 

Program of All-Inclusive Care for the Elderly (PACE)

What is the PACE?

PACE provides comprehensive, coordinated health care and long-term services and supports for voluntarily-enrolled individuals. PACE provides another alternative along the continuum of available long-term care services and supports. It enables participants to continue to live in their homes and communities.

Who may need this program?

Individuals aged 55 years and older who:

  • Meet nursing facility level of care criteria
  • Live within the service area of an approved PACE provider
  • Are able to safely live in a community setting with PACE services at the time of enrollment

What services may be available through PACE?

The benefits package for PACE includes all Medicare and Medicaid-covered items and services. It covers other services as determined necessary by the PACE provider's interdisciplinary team. All services must be received solely through the PACE provider and its subcontractors.

Who is an approved PACE provider, and what is their service area?

Immanuel Pathways is currently the only approved PACE provider in Nebraska. Their service area is all of Douglas and Sarpy counties and portions of Cass, Dodge, Saunders, and Washington counties. 

Who can enroll in PACE?

Medicaid and Medicare-eligible individuals may pursue enrollment in PACE, as well as private pay individuals.

What does it mean to meet nursing facility level of care criteria?

Nursing facility level of care means you have needs which require you to receive services similar to those provided to individuals who live in a nursing home.  For example, you may need assistance from another person with daily tasks such as getting dressed, taking a bath or shower, eating or walking safely. Other areas considered are how much help you need to take medications, any memory problems or health conditions you may have, and how they are managed. Nursing facility level of care criteria are located in DHHS regulations at 471 NAC 12.

Where can I read the DHHS regulations about PACE?

The DHHS regulations for PACE services are available at Title 471 NAC Chapter 37.

For more information, email DHHS.Pace@nebraska.gov.

Traumatic Brain Injury (TBI) Waiver

What is the Traumatic Brain Injury (TBI) Waiver?

This program funds specialized assisted living services for persons with traumatic brain injury.

Who may need this program?

Individuals with traumatic brain injury who:

  • Qualify for nursing-facility level of care
  • Are ages 18 through 64
  • Want to live in assisted living

Who may be eligible for this program?

Adults who:

  • Live in Nebraska
  • Are eligible for Medicaid
  • Are ages 18 through 64
  • Have a diagnosis of traumatic brain injury* (such as a blow to the head) and meet nursing facility level of care
  • Have a need for specialized assisted living

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

What services may be available through the TBI Waiver?

Specialized assisted living which offers services that include assistance with personal care activities and activities of daily living, such as:

  • Escort services (an escort is a person who will accompany the individual with TBI to a medical appointment if he or she is unable to go alone)
  • Essential shopping
  • Health maintenance activities
  • Housekeeping services
  • Laundry services
  • Provision of medications
  • Personal care services
  • Transportation services

What types of facilities do the Keys Amendment affect and where can I find a copy of the compliance document?

List of facilities and Keys Amendment compliance

Where can I find information on public services and other resources for individuals with traumatic brain injury (TBI) and training related to the causes, symptoms, and treatment of TBI?

Nebraska Traumatic Brain Injury Online Training