Eligibility for Medicaid HCBS Waiver Services

 
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Medicaid Related Assistance
Developmental Disabilities
 
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No

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    To receive services from DDD, you must be eligible for a Medicaid Home and Community-Based Services (HCBS) Waiver. Eligibility requirements and the application process depend on which waiver you want. All waivers require you to have Medicaid.


    Aged and Disabled (AD) Waiver

    Aged and Disabled (AD) Eligibility

    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.

    For more information on AD eligibility:

    Applying for AD 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.

    For an application:

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

    AD Eligibility Determination and Level of Care

    When an application is received, DDD checks that the person is eligible for Medicaid. Within 14 days from DDD 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.

    • ​InterRAI Level of Care Presentation​ - Information on the interRAI assessment tool and timeline for transitioning to the interRAI for Level of Care. PowerPoint used December 14, 2021.

    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.​

    AD Waiver Funding

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    Currently there are funds for all people eligible for the AD Waiver. Once eligible, you will receive services. Funding is based on your needs.

     

    Comprehensive Developmental Disabilities (CDD) and Developmental Disabilities Adult Day (DDAD) Waivers

    Developmental Disabilities (DD) Eligibility

    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:

    Applying for DD Waiver Services

    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.

    Online Application

    iServe​ is the best way to apply. It has an online application.

    Paper Application

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

    DD Eligibility Determination and Level of Care

    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:

    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 Intellectual Disabilities (ICF-IID).
    • The Developmental Index is the assessment tool currently used to determine ICF-IID Level of Care.

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    DD Waiver Funding & the Registry

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    DD Registry

    There currently are not enough funds available for all requests for DD waivers.​ When you meet the level of care requirement, if you have Medicaid or are a Medicaid-eligible child, you are placed on the DD Registry to wait for funding. 

    DD Waiver services will be offered when funding is available.

    When you are on the DD Registry:

    • Funding is based on priorities in Nebraska Revised Statute §83-1216 to people:
      • In immediate crisis;
      • Who have lived in a Nebraska institutional setting for at least the last 12 months;
      • Who are wards of DHHS or under the supervision of the Office of Probation Administration and transitioning out of the system at age 19;
      • Transitioning from the educational system at age 21;
      • Who are dependents of a member of the armed forces stationed in Nebraska; and
      • Who are waiting, by date of application.
    • You will be assessed for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care. Assessment happens once determined eligible, and yearly.
    • You may receive services on a different Medicaid HCBS Waiver, Medicaid non-waiver services, or Lifespan Respite.
    • If you are not on a different Medicaid HCBS Waiver, you may request a Service Coordinator (SC), who will:
      • Work with you to develop a plan based on your natural and local community resources and supports;
      • Help you access resources such as Medicaid, SSI, and SNAP;
      • Help you identify and access community resources based on your needs;
      • Hold meetings annually to help you work toward life goals;
      • Monitor your plan to ensure it adequately addresses your needs;
      • Follow up with your guardian and, as requested, your family;
      • Adjust your plan when changes are needed for success; and
      • Advocate for what you need from your family and community.

    When you are offered funding for a DD waiver:

    DDD uses an objective assessment process (OAP) to base your funding on your needs. An assessment determines your Individual Budget Amount (IBA). You use your IBA to purchase services. 

     

    Traumatic Brain Injury (TBI) Waiver

    Traumatic Brain Injury (TBI) Eligibility

    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;*
      • ​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 needs requiring the type of care necessary to treat the conditions and criteria identified in the definition of Specialized Assisted Living (SAL).

    *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.

    Applying for TBI Waiver Services, Eligibility Determination, and Level of Care

    ​DDD 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.

    For an Application

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

    Eligibility Determination and Level of Care

    ​When an application is received, DDD checks that the person is eligible for Medicaid. Within 14 days from DDD receiving the application, you should get a call to schedule the Level of Care determination and discuss if needs would be best met from TBI Waiver or AD Waiver.

    • 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.​

    TBI Waiver Funding

    Medicaid HCBS waivers allow federal Medicaid funds and state funds, which would otherwise be used to provide services in institutional settings, to be used to pay for home and community-based services. A person must receive Medicaid and be on a waiver to receive services.

    Currently there are funds for all people eligible for the TBI Waiver. Once eligible, you will receive funding, which is based on your needs. Your funding can be used to purchase services from the TBI waiver provider, when their services are determined to meet your needs and they have a spot available. ​

     

    Notice of Decision

    If you applied for a Medicaid HCBS Waiver services and received a notice of decision saying you were determined Not Eligible, find out what to do next.

    If you have questions about eligibility or application call (877) 667-6266 or email dhhs.developmentaldisabilities@nebraska.gov.


    FAQs

    I earn too much money to qualify for Medicaid, but my child has a disability and could use waiver services. Can you help?

    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. ​​

    How many hours a day can I get help?

    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. ​