Below are general descriptions of services covered under Nebraska Medicaid. For complete information, refer to Rules and Regulations.
Nebraska Medicaid covers ambulance services for certain conditions. The client's condition must be such that transportation by ambulance is the only medically appropriate option; the service must be required during an emergency (accident, illness, or injury) or required to obtain medical care. There are several ambulance services that Medicaid will not cover.
Nebraska Medicaid covers chiropractic services provided in the office or the client's home. Covered services are limited to X-rays and manual manipulation of the spine. For clients age 21 and older, manual manipulation of the spine is limited to 12 treatments per calendar year. No more than one treatment per client per day is covered.
Nebraska Medicaid covers dental services such as cleaning of teeth, fillings, extractions, X-rays, dental surgery, and dental disease control. Some services require that the dentist obtain approval from Medicaid before providing the service.
Nebraska Medicaid covers certain medical equipment and supplies when they are medically necessary and prescribed by a physician. There are limitations on supplies.
Nebraska Medicaid covers family planning services including consultation and treatment. This may include initial physical examinations and health history, annual and follow-up visits, laboratory services, prescribing and supplying contraceptive supplies and devices, counseling services, and prescribing medications for specific treatment.
Health Check is a service available to all individuals age 20 or younger who are eligible for Medicaid. Health Check provides complete check-ups on a regular basis and provides diagnosis and treatment services for any health problems found at a check-up. Some treatment services provided as a result of a Health Check examination require the provider to obtain approval from Medicaid before providing the service. Services included in Health Check are: health and developmental history; complete physical examination; immunizations; necessary lab tests; health education; hearing checkups; eye examinations; dental examinations; treatment for identified problems; and well-baby, well-child, Head Start, school, and sports physicals.
Nebraska Medicaid covers hearing aids, hearing aid repairs, necessary batteries, and supplies. There are limitations on hearing aid services.
Nebraska Medicaid covers home health agency services when prescribed by a physician and provided wherever they are necessary (besides a hospital or nursing facility). The physician must certify that home health services are medically necessary and appropriate to be provided in the home. Covered services include nursing services, aide services, necessary medical supplies and equipment, and physical, speech, and occupational therapies if there is no other way to receive these services. There are limitations on some services, such as required prior authorizations.
Nebraska Medicaid covers hospice services provided in response to palliative management of a terminal illness. Hospice services include nursing services, physician services, medical social services, counseling services, home health aide/homemaker, medical equipment, medical supplies, drugs and biologicals, physical therapy, occupational therapy, and speech language pathology. Hospice services require prior authorization by Medicaid.
Medicaid covers inpatient, outpatient, and emergency room services, as long as they are medically necessary. Medicaid will not cover items such as private rooms; private-duty nursing while in the hospital; any services not medically necessary; and emergency room services for routine treatment.
Nebraska Medicaid covers Intermediate Care Facilities for Persons with Intellectual Disability (ICF/DD) for individuals with intellectual disabilities or a related condition.
ICF/DD Services are designed to serve individuals who cannot be served in the community through Developmental Disability (DD) Services to assist the individual achieve his/her independence potential. Services include training in all aspects of daily living, social behavior, pre-vocational training, nursing care to the same degree as in a nursing facility, physical, occupational, and speech therapies. Placement in an ICF/DD is never considered permanent as individual needs and alternatives can change over time and other services may become more appropriate.
An IMD is defined as “a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care for persons with mental diseases, including medical attention, nursing care, and related services." Medicaid reimbursement is not available for any people between the ages of 21 and 65 years old who are living in an IMD.
Questions or requests for further information can be sent to DHHS.MedicaidMHSU@nebraska.gov.
Payment may be made for medically necessary diagnostic tests, X-rays, and other procedures that are part of your diagnosis or treatment.
Nebraska Medicaid covers transportation services for trips necessary to obtain medical treatment or medical care when the client has no other means of transportation. Medicaid may cover transportation services for a parent/caretaker/attendant for travel to escort someone to and from medical treatment or medical care when necessary and when there is no other means of transportation. Medicaid may also cover travel to a pharmacy. Medicaid does not cover transportation services for clients residing in nursing facilities. The facility is responsible for providing needed health care for its residents.
Nebraska Medicaid covers mental health and substance abuse services for children and adolescents in the following categories:
For more information, see Medicaid Behavioral Health Services.
Medicaid pays for the following nurse midwife activities:
Nebraska Medicaid covers nursing assessments as nurse practitioner services. The services must be medically necessary. The initial medical diagnosis and institution of a plan of therapy or referral may also be covered. Nebraska Medicaid also covers the services of certified pediatric nurse practitioners and certified family nurse practitioners, as required by federal law.
Nebraska Medicaid covers services provided in nursing facilities, intermediate care facilities for people with intellectual disabilities, and certain other long-term care living arrangements. Services that a nursing facility must provide include:
Medicaid covers medical and surgical services performed at the physician's office, your home, clinic, hospital, or other locations. Payment may also be made for diagnostic tests, X-rays, and other procedures that are part of your diagnosis or treatment. Medicaid will not cover services such as: routine physical exams for adults; acupuncture treatment; reversal of sterilization; sex change surgery; radial keratotomy; and weight control programs.
Services that have special requirements, limitations, and/or require approval from the Medicaid program include:
Medicaid covers personal assistance services to persons with disabilities and chronic conditions of all ages to enable them to accomplish routine tasks they would be able to do without a disability. Personal assistance services are intended to help a client remain in the home rather than an institution. Personal assistance services means tasks, directed by the individual which provide the client's self-care activities and other supportive services such as dressing and grooming, bathing and personal hygiene, mobility and transferring, and housekeeping activities. Also included are specialized procedures such as giving of injections, administration of oxygen, and insertion and care of catheters. The client's physician or registered nurse determines if the specialized procedures can safely be performed in the home or community by an approved personal assistance service provider. There are limitations to personal assistance services.
Nebraska Medicaid covers medical and surgical services provided by a podiatrist, in the podiatrist's office, the client's home, a clinic, hospital, or other location. Medicaid may also cover diagnostic tests, X-rays, and other procedures that are part of the treatment.
Nebraska Medicaid covers most drugs prescribed by the client's physician. Some over-the-counter drugs may be covered if prescribed by the physician and approved by Medicaid. There are several drugs Medicaid does not cover.
Nebraska Medicaid covers private-duty nursing services when ordered by the client's physician and when medically necessary. Private-duty nursing services may be provided in the client's home or some other living arrangement outside of a hospital or nursing facility. Prior authorization is required for these services.
The Program of All-Inclusive Care for the Elderly (PACE) is a Nebraska Medicaid service that 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 to enable participants to continue to live in their homes and communities.
Nebraska Medicaid covers medically necessary psychiatric and substance use disorder services for medically necessary primary psychiatric and/or substance use disorder diagnoses for individuals age 21 and older in the following categories:
Nebraska Medicaid covers mammograms when provided based on a medically necessary diagnosis. In the absence of a diagnosis, Nebraska Medicaid covers mammograms according to the American Cancer Society's periodicity schedule.
Nebraska Medicaid covers services provided by clinics, including rural health clinics, federally qualified health centers, community mental health centers, and Indian Health Services clinics if they participate in the Medicaid Program. Covered services may include physician services, nurse practitioner services, and other services that are usually covered by the Medicaid program.
Nebraska Medicaid covers speech, physical, and occupational therapies in the office, in the client's home, hospital, nursing facilities, or other facilities. The services must be prescribed by a physician. Therapy is limited to restoration of lost function due to illness or injury if you are age 20 and older. Medicaid will cover up to 60 combined visits per year.
Medicaid covers eye examinations to determine the need for glasses, the purchase of glasses, and necessary repairs. Eye exams for adults 21 years and older are limited to one every 24 months. Medicaid covers eyeglasses, including lenses and frames, when required for the following medical reasons: the client's first pair of prescription eyeglasses; size change needed due to growth; or a prescribed lens change only if new lenses cannot be accommodated by the current frame.