Nebraska Medicaid Program
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This information represents a general description of services covered under the Nebraska Medicaid Program. For complete information, refer to Rules and Regulations.
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.
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 keratonomy; and Weight control programs.
Services that have special requirements, limitations, and/or require approval from the Medicaid program include:
- Medical transplants
- Cosmetic surgery
- Sterilizations and hysterectomies
Laboratory and Radiology (X-ray) Services
Payment may be made for medically necessary diagnostic tests, x-rays, and other procedures that are part of your diagnosis or treatment.
Nurse Midwife Services
Medicaid pays for the following nurse midwife activities:
- Attending cases of normal childbirth
- Providing prenatal, intrapartum, and postpartum care
- Providing normal obstetrical and gynecological services for women;
- Providing care for the newborn immediately following birth
Nurse Practitioner Services
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.
Services Provided by Clinics
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.
Family Planning Services
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 Services (EPSDT)
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 check-ups; eye examinations; dental examinations; treatment for identified problems; and well-baby, well-child, Head Start, school, and sport physicals.
Home Health Agency Services
Nebraska Medicaid covers home health agency service when prescribed by a physician and provided in your place of residence (this does not include a hospital or nursing facility). The physician must certify that you are homebound and that staying home is necessary for your care. 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.
Personal Assistance Services
Medicaid covers personal assistance services to persons with disabilities and chronic conditions of all ages to enable them to accomplish tasks that they would normally do for themselves if they did not have a disability. Personal assistance services are intended to help a client remain in the home rather than be in 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 or ‘health maintenance activities’ such as giving of injections, administration of oxygen and insertion and care of catheters. The client’s physician or registered nurse determines the specialized procedures can safely be performed in the home and community by an approved personal assistance service provider. There are limitations to personal assistance services.
Private-Duty Nursing Services
Nebraska Medicaid covers private-duty nursing series 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.
Program of All-Inclusive Care for the Elderly (PACE)
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. For more information about PACE, including who may need this program and what services may be available, please access the following link: http://dhhs.ne.gov/Pages/PACE.aspx
Medical Transportation Services
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 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 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. Please Contact Medicaid for more information.
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 pre 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.
Durable Medical Equipment, Orthotics, Prosthetics, and Medical Supplies
Nebraska Medicaid covers certain medical equipment and supplies when they are medically necessary and prescribed by a physician. There are limitations on supplies. Please Contact Medicaid for more information.
Nebraska Medicaid covers most drugs prescribed by the client's physician. Some over-the counter drugs may be covered is prescribed by the physician and approved by Medicaid. There are several drugs Medicaid does not cover. Please Contact Medicaid for more information.
Hearing Aid Services
Nebraska Medicaid covers hearing aids, hearing aid repairs, necessary batteries, and supplies. There are limitations on hearing aid services. Please see http://www.dhhs.ne.gov/Pages/reg_t471.aspx Chapter 8, hearing aids, for more information.
Therapies: Physical, Occupational, Speech Pathology & Audiology
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.
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.
Psychiatric Services for Individuals Age 21 and Older
Nebraska Medicaid covers medically necessary psychiatric services for medically necessary primary psychiatric diagnoses for individuals age 21 and older in the following categories:
- Outpatient Services -- this includes psychiatric evaluation, psychological evaluation, psychological testing, individual psychotherapy, group psychotherapy, family psychotherapy, family assessment, medication checks, and electroconvulsive therapy;
- Day Treatment -- an active treatment program that provides a package of services to clients who are capable of functioning in the community, but still require significant contact with mental health professionals. The program includes individual, family, and group therapy in addition to other services.
- Adult inpatient hospital psychiatric services.
- Inpatient hospital services for clients age 65 or older in institutions for mental disease (IMDs).
Mental Health and Substance Abuse Services for Children and Adolescents (ages 0-20)
Nebraska Medicaid covers mental health and substance abuse services for children and adolescents in the following categories:
- Outpatient Services: This includes evaluation by a psychiatrist psychologist; individual, group, and family psychotherapy; individual, group, and family substance abuse counseling; family assessment; conferences with family or other responsible persons; mileage for home- based family therapy; community treatment aid services; intensive family preservation services; medication checks; treatment crisis intervention services.
- Middle Intensity Services: These services are designed to prevent hospitalization or to help a hospitalized client learn to function within the community with less frequent contact with the mental health or substance abuse provider. Services include:
- Treatment foster care services
- Treatment group home services
- Residential treatment services
- Inpatient mental health services
- Inpatient mental health services in institutions for mental disease (IMDs)
Visual Care Services
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. Medicaid for clients 21 years and older.
Screening Services (Mammograms)
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.
Nursing Facility Services
Nebraska Medicaid covers services provided in nursing facilities, intermediate care facilities for person with mental retardation, and certain other long-term care living arrangements. Services that a nursing facility must provide include:
- regular room
- nursing services
- social services when required
- most medical supplies and equipment
- other routine services
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, speech language pathology, volunteer services and pastoral care services offered on the individual’s needs and choice for terminally ill patients and their families. Hospice services require authorization by Medicaid.
Nebraska Medicaid covers Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) for individuals with mental retardation, or a related condition.
ICF/MR 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. Training in all aspects of daily living, social behavior, pre-vocational training, nursing care to the same degree as in a Nursing Home, physical, occupational, and speech therapies. Placement in an ICF/MR is never considered permanent as individuals needs and alternatives can change over time; other services may be more appropriate.
Case Management Services for Adults with Mental Retardation
See Older Adults and Adults with Disabilities.