Services on the Aged and Disabled Waiver

 
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Medicaid Related Assistance
Developmental Disabilities
 
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What you need to know

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Charting the LifeCourse Resource

Charting the LifeCourse (CtLC) can be used at any stage of life. 

​As a participant in Medicaid Home and Community-Based Services (HCBS) Waiver services, there are many community-based services you may choose. The services available to you are based on which waiver you have. HCBS Waivers Available for Eligible People looks at the four waivers and includes a chart of services by waiver.

The Medicaid Home and Community-Based Services (HCBS) Aged and Disabled (AD) Waiver offers an array of services to support people in their homes. This page focuses on those services, coordination of services, and providers of services.

Eligibility

To be eligible for AD Waiver services, you must receive Nebraska Medicaid, have a disability or be over the age of 65, meet Nursing Facility Level of Care, and have a need for waiver services.

Service Coordination

When you are on a waiver, a Service Coordinator provides case management to coordinate and oversee your services. 

Your Service Coordinator:

Contact Service Coordination Offices
  • Works with you to develop your service plan based on your needs
  • Helps you find and work with providers
  • Helps you access resources such as Medicaid, SSI, and SNAP
  • Helps you identify and access community resources
  • Holds meetings at least every six months to help you work toward life goals
  • Monitors your plan to ensure it is being implemented and adequately addresses your needs
  • Follows up with you to ensure your needs are being met
  • Follows up with your guardian and, as requested, your family
  • Adjusts your service plan when changes are needed for success
  • Helps advocate for what you need from your service provider(s), family, and community
  • Makes sure services promote independence, productivity, and inclusion

When you have the AD Waiver, your Service Coordination provider is determined by your age:

    • Birth to age three: Early Development Network
    • Ages three through 17: DHHS Local Offices
    • Ages 18 and older: Area Agencies on Aging​ or League of Human Dignity
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Aged and Disabled Waiver Services

AD Waiver services help people who are aged or have disabilities. Services meet needs while the participant lives where they choose. The following services are available to AD Waiver participants. 

Work with your AD Waiver Service Coordinator to see which services you qualify to receive.


Adult Day Health

Adult Day Health includes social activities, supervision, supportive services, meals, and health services provided in a licensed setting. A participant may need this service when they have physical, emotional, or cognitive impairments.

A participant in this service must be 18 years or older (19 in some situations) and need structured activities, support, and supervision. The service will help with individual needs and special diets as needed. The Service Coordinator must determine this service is needed.

To find an adult day center in your area, contact a DHHS office or your Service Coordinator, view a listing of licensed Adult Day services. 

Assisted Living

Assisted Living provides shelter, food, and other services, such as assistance with personal care activities, activities of daily living (ADL), instrumental activities of daily living (IADL), and health maintenance. Assisted living facilities are ​licensed through Public Health and regulated by MLTC.

Assisted Living offers:

  • Socialization activities;
  • Essential shopping;
  • Health maintenance activities;
  • Housekeeping activities;
  • Laundry services;
  • Medication assistance;
  • Personal care services; and
  • Transportation services.

The participant pays the room and board cost and any applicable Medicaid share of cost. ​

Assistive Technology

​Assistive Technology includes the purchase or rent of items, devices, or product systems to increase or maintain a person's functional status.

This service includes designing, fitting, adapting, and maintaining equipment, as well as training or technical assistance to use equipment.

This service also includes the assessments needed to identify the type of assistive technology necessary to aid the participant.

The services under the AD Waiver are limited to additional services not otherwise covered under the state plan, including Early and Periodic Screening, Diagnostic and Treatment (EPSDT), but consistent with waiver objectives of avoiding institutionalization.


Chore

Chore activities occur less frequently than services identified under the Companion service, but assist in ensuring the health and safety of the participant in their own home.

Types of assistance may include housekeeping activities such as in-home cleaning and care of household equipment, appliances, or furnishings; minor repairs of windows, screens, steps or ramps, furnishings, and household equipment; and landscaping. Landscaping includes snow and ice removal, mowing, raking, removing trash (to garbage pick-up point), pest remediation, and clearing water drains.

These services are provided only when neither the participant nor anyone else in the household is capable of performing or financially providing for them, and where no other relative, caregiver, landlord, community/volunteer agency, or third-party payer is capable of or responsible for their provision.


Companion

Companion is for adults ages 18 and older. Supervision and social supports are provided in a participant's home and possibly community settings.

This service may include light housekeeping tasks, as well as bill paying, errand service, essential shopping, food preparation, and laundry service.

The provision of Companion services does not entail hands-on nursing care.

When assistance with activities of daily living or health-related tasks is needed, this service should not be authorized and another service, such as Personal Care, should be considered.


Extra Care for Children with Disabilities

Extra Care for Children with Disabilities provides specialized care for the child or youth with disabilities up to age 18. Childcare is provided so the usual caregiver can be employed or take training to help the family's earning power. The child must be eligible for Medicaid and have care needs similar to people who live in a nursing home. There must be a need for this special service that cannot be met another way. Care is provided in the child's home by a DHHS-approved provider, or in a setting approved by DHHS.

You may need this service when you are the usual caregiver for a child or youth with disabilities and you need to:

  • Find employment or stay employed; 
  • Enroll in and regularly attend vocational or educational training; or
  • Earn a high school diploma or equivalent diploma, or first undergraduate degree. 

The family works with the Service Coordinator and is an active participant in developing the child's plan of services and supports. ​This service must be more than two hours per week every week and average less than 12 hours per day.​


Home Again

Home Again supports and enables nursing facility residents to move to a more independent residence. A person aged 18 or older must be a current nursing facility resident whose nursing facility services have been paid by Medicaid for at least three months. A person whose nursing facility stay is rehabilitative is not eligible.
 
This service includes non-recurring set-up expenses for a participant transitioning from a nursing facility to living in a private residence, where the participant is responsible for their own living expenses.
 
Items and services covered include essential furniture and furnishings; security deposits required to obtain a lease on an apartment or home; set-up fees or deposits for utility or service access, including telephone, electricity, heating and water; necessary home accessibility adaptations; and activities to assess need, arrange for, and obtain resources. Rent is not included.

Home and Vehicle Modifications

Home and Vehicle Modifications are physical changes to a private residence, automobile, or van, to accommodate the participant or improve their function.

The waiver does not cover home modifications considered to be of general utility, standard housing obligations of the participant or homeowner, and which are not of direct medical or remedial benefit. For example, excluded are carpeting, roof repair, sidewalks, storage and organizers, hot tubs, whirlpool tubs, elevators, landscaping, and general home repairs.

The waiver does not cover general construction costs in a new home or additions to a home purchased after the participant is enrolled in the waiver.

Waiver funds may be authorized to assist with adaptations of direct medical or remedial benefit (such as ramps, grab bars, widening doorways, and bathroom modifications) for a recently purchased home.

When modifications are needed for a home under construction, which requires special adaptation to the plan (such as a roll-in shower), the waiver may be used to fund the difference between the standard fixture and the modification required to accommodate the participant's need.

Environmental adaptations exclude costs for improvements exclusively required to meet local building codes.

Adaptations or alterations must be to an automobile or van that is the participant's primary means of transportation in order to accommodate the special needs of the participant.

Vehicle adaptations are specified by the service plan as necessary to enable the participant to integrate more fully into the community and to ensure the health, welfare, and safety of the participant.


Home-Delivered Meals

Home-delivered meals are delivered to your home; using sanitary utensils and equipment, maintaining proper food temperatures; and contain one-third of the minimum daily nutrition requirement for adults, using a variety of foods from day to day.

Home-delivered meals is not intended to add to your food budget. Your Service Coordinator must assess that:

  • You are unable to prepare your own meals due to physical, cognitive, or safety limitations or your nutrition risk assessment indicates “high risk;"
  • There is no other source to provide meals at no charge (such as a relative, neighbor, responsible adult, friend, or other program or agency); and 
  • You do not reside in a facility required to provide meals for you.

You may qualify for home-delivered meals when you are unable to prepare your own meals and an adult with disabilities or over the age of 60.

Independence Skills Building

Independence Skills Building (ISB) provides training for aged persons and adults with disabilities in activities of daily living, instrumental activities of daily living, and home management to increase independence. Training may occur in the participant's home or in the community and can involve the participant or the caregiver.

You may receive training with skills, such as bathing, dressing, grooming, eating, toileting, and transferring​.​

You may also receive training with home management skills, such as housekeeping, cleaning, managing money, and shopping.


Non-Medical Transportation

Non-Medical Transportation Service provides transportation to participants age 19 or older to and from community resources that help them remain living at home.

You may need Transportation Service when you:

  • Do not own or have access to a working licensed vehicle;
  • Do not have a current valid driver's license;
  • Are unable to drive due to a documented physical, cognitive or developmental limitation;
  • Are unable to travel or wait by yourself; and
  • Are unable to secure free transportation.

Non-Medical Transportation provides transportation to and from other waiver services, to community activities where waiver services are not provided, public transit tokens or passes, and escorting a participant to non-medical activities or appointments.


Personal Care

Personal Care is a service for adults aged 18 and older. It includes assistance with activities of daily living and health-related tasks, and may include instrumental activities of daily living provided in a participant's home and other community settings.

This service offers a range of assistance to enable participants to accomplish tasks they would normally do for themselves if they did not have a disability.

  • This assistance may take the form of hands-on assistance (actually performing a task for the person) or cuing to prompt the participant to perform a task.
  • These services may be provided on an episodic or on a continuing basis.
  • Health-related services that are provided may include skilled or nursing care and medication administration to the extent permitted by state law.

Personal Care may include the supports offered in the Companion service when these supports are provided along with assistance with activities of daily living or health-related tasks.

Children age 16 and 17 can be authorized for this service when the child is transitioning to adult services. Personal care assistance provided under this service does not overlap with personal care assistance provided under the Extra Care for Children with Disabilities service.

Personal Care under the waiver differs in scope and nature from personal care offered under the State Plan, as supervision may be provided. A participant cannot be authorized to receive both services at the same time.

The services under the AD Waiver are limited to additional services not otherwise covered under the state plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization.

Participants are responsible for overseeing and supervising individual provider on an ongoing basis. Additionally, the Services Coordinator performs monitoring of a participant's person-centered plan with the participant. Monitoring includes the use or non-use of waiver services. At a minimum, monitoring occurs on a monthly basis.


Personal Emergency Response System (PERS)

PERS is a communication device, sometimes called lifeline, ​to call for help in an emergency. There are a range of devices offered to meet this need. A PERS is a button that can be worn around your neck. It can also be available to you in other ways, depending on your needs. For example, it can be worn as a wristband, on a belt, or carried in a pocket. Sometimes it can be adapted to a wheelchair.

You may be eligible for PERS when you:

  • Live alone or with a caregiver who also has health problems or works outside the home;
  • Have a history of falls; or
  • Have a health problem that might result in an emergency.
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You may qualify when you are an adult with a health need for the device, who is able to use the device properly, and have identified a person who can respond immediately. Someone will meet with you to explain how to use the device. After you push the button, a signal goes to an agency who contacts a person on a list of responders you supplied. The responder quickly contacts you to see what you need. 

Respite

Sometimes caregivers need a temporary break from caregiving so they can come back refreshed and ready to provide good care again. Respite pays someone to come into the home, take care of a participant and give the primary caregiver a temporary break.

Respite could mean:

  • A break;
  • A chance to get away;
  • A chance to shop;
  • A chance to spend time with other family members;
  • Time to take care of personal business; or
  • Time to get medical care.

You may qualify for Respite if you live with and care for someone, and you are not able to pay for respite. 
A need for this service must exist. You can only receive Respite from one funding source.

​A participant may be eligible for Respite to relieve their:

  • Ongoing, continuous caregiver;
  • Spouse who cares for them;
  • Parent, when they are an adult; or
  • Adult sibling who cares for them.

​You can only receive Respite from one source; if you are NOT on a waiver, you may be able to receive Lifespan Respite.​


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Provider Options

You can choose the provider(s) you want to work with. There are different types of providers available for Medicaid HCBS waiver services.

  • AD Agency Provider - A company enrolled as a Medicaid provider to provide the AD Waiver service you choose. The agency provider is responsible for hiring and supervising employees who work with you, and other administrative functions.
  • AD Independent Provider - A person enrolled as a Medicaid provider and employed by you. You are responsible for hiring and supervising your AD provider. Once you choose a person, the state has an approval process to ensure requirements are met. Your Service Coordinator will help with the process.
  • Assisted Living Facility - A facility, where you live in your own apartment while receiving a range of support services in a home-like environment. The​ assisted living facility has a resident service agreement with you to ensure your services are what you need, according to your person-centered plan.