No
Public Comment Period - Ended January 5, 2026
Pursuant to 42 C.F.R. §441.304(f), the Nebraska Department of Health and Human Services (DHHS) is required to give public notice related to the state's plan to renew the 1915(c) Medicaid Home and Community Based Services (HCBS) Aged and Adult and Children with Disabilities (NE.0187) waiver and amend the Traumatic Brain Injury Waiver (NE.40199). The 30-day public comment period was from December 5, 2025, through January 5, 2026.
Upon approval by the Centers for Medicare and Medicaid Services (CMS), these waiver amendments would go into effect July 1, 2026.
Nursing Facility Institutional Cost Limits
The posted waivers indicate a new institutional cost limit of 175% for waiver services. As Nursing Facility (NF) level of care waivers, this limit is based on the average per capita spending for nursing facilities in SFY 2025, which is $92,438. This figure reflects total annual nursing facility expenditures divided by the average number of recipients in SFY 2025.
A high utilization review would therefore take place when waiver spending exceeded $138,657 and waiver services would be limited to no more than $161,766.50.
Presentations
The same presentation of the proposed changes was given four times online via Zoom. The slides from the presentation are in the Documents section below.
- December 10 from 2:30 PM to 4:00 PM, Central Time
- December 11 from 8:30 AM to 10:00 AM, Central Time
- December 16 from 2:30 PM to 4:00, Central Time
- December 17 from 4:30 to 6:00 PM, Central Time
Documents
A hard copy of a waiver application can be requested via mail, email, or phone at 402-471-9156.
Submitting Comments
Interested persons were invited to submit written comments to the Department. Written comments must have been postmarked or received by January 5, 2026.
DHHS is currently reviewing comments received.
Next Steps
After the public comment period, when submitted to the CMS, the HCBS waiver will include a summary of the public comments received during the public input process, and if any comments were not adopted, the reasons why. The summary will also specify any modifications made to the waiver as a result of the public input process. The summary will also be posted on this webpage.
Past Public Comment - July 2025 Amendments
The following information was for the CDD, DDAD, FSW, and AD Waivers.
The Centers for Medicare and Medicaid Services (CMS) approved waiver amendments on June 26, 2025. The waivers went into effect July 1, 2025.
As part of discussions with CMS, the proposed Adult Day Retirement service was removed from the Comprehensive Developmental Disabilities (CDD) and Developmental Disabilities Adult Day (DDAD) waivers prior to approval. This change allowed the remainder of the amendments to be approved by CMS and proceed toward implementation on July 1, 2025. The State of Nebraska remains committed to the vision of Adult Day Retirement as a meaningful option for aging individuals with developmental disabilities, who deserve the same opportunity to retire with dignity as all people. Following implementation of the current amendments, the State will continue working with the Developmental Disabilities Advisory Committee, additional stakeholders, and CMS to explore ways to align this service with federal expectations and best support the needs of participants. Although implementation is not possible at this time, Nebraska remains committed to advancing innovative, person-centered services for individuals with intellectual and developmental disabilities.
On March 19, 2025, the HCBS Waivers with public comment periods below were submitted to CMS:
The 30-day public comment period was from February 13, 2025 through March 15, 2025.
Documents
Presentation
Additional Information - the Objective Assessment Process
DDD understands that there are questions about the objective assessment process. DDD held three presentations for stakeholders to learn more about the new interRAI assessment tool that the Division is adopting in the DD side of our work. This company offers many different assessments for various populations, and we already use two of the interRAI tools in our Aged & Disabled and Traumatic Brain Injury Waivers.
Myers & Stauffer guided a conversation and review of the interRAI tools for DD during these stakeholder meetings. Eventually these will become the tools used by the Division to determine budgets, level of care and as a needs assessment. Adopting these new tools will assist us in our new approach to eliminating the DD Waitlist.
This information is also on the Eliminating the DD Waitlist webpage.
The 30-day public comment period was from January 13, 2025 through February 13, 2025.
Presentation
There were five virtual presentations of the proposed changes. The same information was presented each time.
Documents
Next Steps
Significant changes were made to the DD Waivers as a result of the public comment period. These changes will be out for a second public comment period.
The AD Waiver was not included in the second public comment period.