Eligibility for Medicaid HCBS Waiver Services

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

• Apply online with iServe.​
  
• iServe Application Tip Sheet
• Open or print an application (DD-10) in your preferred language.
  
• English (DD-10) 
• Other languages here.
• Call our toll-free number (877) 667-6266 to request an application be mailed to you. 
  
• Fill out the application completely, sign, and submit:
• Mail to HCBS Waiver Eligibility, PO Box 98947, Lincoln NE 68509-8947;
  
• Email to DHHS.HCBSWaiverApp@nebraska.gov; or​
  
• Fax to (402) 328-6257.
  

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

When an application is received, the Division checks that the person is eligible for Medicaid. Within 14 days from receiving the application, you should get a call to schedule the Level of Care determination. When the person meets the requirements, they are offered AD Waiver services.

• ​AD Assessment Brochure - The process used to assess needs and determine AD 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 - Eligibility requirements and how to get started. 
  

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.

• Apply online with iServe.
  

• iServe Application Tip Sheet​

• Open or print an application (DD-10) in your preferred language:

• English (DD-10)  
• Other languages here.​
• ​Call our toll-free number (877) 667-6266 to request an application be mailed to you. 
  
• Fill out the application completely, sign, and submit:
• Mail to HCBS Waiver Eligibility, PO Box 98947, Lincoln NE 68509-8947;
  
• Email to DHHS.HCBSWaiverapp@nebraska.gov; or
  
• Fax to (402) 328-6257.
  

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. The Division will collect needed documents, which may include:

• Assessments completed by a licensed psychologist:
• Information for school psychologist
  
• Information for diagnosing psychologist
  
• 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)
• ​Tips for Teachers - Information for teachers about eligibility, services, and assessments the school can complete.​

When an application and documents are received, a decision is usually made within 90 days. 

• Eligibility is reviewed at ages 10 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 Intellectual Disabilities (ICF-IID).
• The interRAI is the assessment tool used to determine ICF-IID Level of Care and funding. 
• DD Services Assessment Brochure - Explains the process used to assess needs for DD services.​

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

• Be eligible for Nebraska Medicaid;
• Be age 18 years or older;
• Have a diagnosis of traumatic brain injury;*
  
• ​Non-degenerative, non-congenital insult to the brain from an external mechanical force;
  
• Possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions; and
  
• An associated diminished or altered state of consciousness.
  
• Meet Nursing Facility Level of Care (as outlined in 471 NAC 12); and
• Have a need for waiver services.

*This waiver is not for acquired brain injury caused by strokes, tumors, and other non-traumatic causes. The term TBI does not apply to brain injuries induced or caused by birth trauma.

For more information on the TBI eligibility:

• Services & Eligibility - Available services, eligibility requirements, and how to apply.
  

There is a process so 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 say you want your child assessed for the waiver. ​​

Each person's needs are different, so there is not a set number of hours of assistance per day. You and your Service Coordinator will work together on a plan of services to meet your needs and keep you safe at home. ​​

The Division has a webpage with publications in other languages. 

The DHHS website can be viewed in other languages by selecting your preferred​ language from the drop down in the top right corner of any page. 

For additional translation needs, contact us​.