Below are services covered under Nebraska Medicaid. For more information, see our Rules and Regulations.
Nebraska Medicaid covers ambulance services for certain conditions. The service must be required during an emergency or required to obtain medical care.
Nebraska Medicaid limits coverage of chiropractic services to the following: certain spinal x-rays, manual manipulation of the spine, certain evaluation and management services, traction, electrical stimulation, ultrasound, and certain therapeutic procedures, activities, and techniques designed and implemented to improve, develop, or maintain the function of the area treated.
Nebraska Medicaid covers dental services such as cleaning of teeth, fillings, extractions, X-rays, dental surgery, and dental disease control. Some services require prior authorization.
Nebraska Medicaid covers certain medical equipment and supplies when they are medically necessary and prescribed by a physician.
Nebraska Medicaid covers family planning services, including consultation and procedures. 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 medication for specific treatment.
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.
Nebraska Medicaid covers hearing aids, hearing aid repairs, necessary batteries, and supplies. There are limits on hearing aid services.
Nebraska Medicaid covers home health agency services when prescribed by a physician or APRN and provided wherever they are necessary. The physician or APRN must certify the services are medically necessary and appropriate to be provided in the home. 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 limits on some 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, and speech language pathology. Hospice services require prior authorization by Medicaid.
Medicaid covers medically necessary inpatient, outpatient, and emergency room services. Medicaid will not cover items such as private rooms; private-duty nursing while in the hospital; and emergency room services for routine treatment.
Nebraska Medicaid covers Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/DD) services for individuals with developmental/intellectual disabilities or a related condition.
ICF/DD Services are designed to serve individuals who cannot be served in the community through Developmental Disability (DD) Services. ICF/DD services provide diagnosis and active treatment to support individuals to achieve their independence potential. Services include training in all aspects of daily living, social behavior, pre-vocational training, nursing care to the same degree as in a nursing facility, physical, occupational, and speech therapies.
ICF/DD Services must be prior authorized.
Payment may be made for medically necessary diagnostic tests, X-rays, and other procedures that are part of your diagnosis or treatment.
Nebraska Medicaid covers transportation for trips necessary to obtain medical treatment or medical care when the client has no other 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. Medicaid may also cover travel to a pharmacy.
Nebraska Medicaid covers mental health and substance abuse services for children and adolescents including outpatient services, middle intensity services, day treatment, and hospital services.
For more information, see Medicaid Behavioral Health Services.
Nebraska Medicaid covers nurse midwife services which are medically necessary and provided in accordance with the practice as defined by law. Nebraska Medicaid covers pre-natal care, delivery, and post-partum care services.
Nebraska Medicaid covers nurse practitioner services, in accordance with the scope of practice applicable to their specific licensure designation. The services must be medically necessary. A nurse practitioner may provide services within the specialty areas in which they hold certification.
Nebraska Medicaid covers services provided in nursing facilities, intermediate care facilities for people with intellectual disabilities, and certain other long-term care living arrangements. Services that a nursing facility must provide include:
To receive Medicaid-covered nursing facility care, you must meet nursing facility level of care criteria and have a Pre-admission Screening and Resident Review (PASRR).
Medicaid covers medically necessary physicians' services performed within program guidelines. Medicaid will not cover services such as: acupuncture treatment; reversal of sterilization; sex change procedures; d rugs or items prescribed or recommended for weight control and/or appetite suppression.
Services that have special requirements, limitations, and/or require approval from the Medicaid program include:
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.
Nebraska Medicaid covers most drugs prescribed by the client's physician. Some over-the-counter drugs may be covered if prescribed by the physician and approved by Medicaid. There are several drugs Medicaid does not cover.
Nebraska Medicaid covers medically necessary private-duty nursing services when ordered by the client's physician or APRN. Private-duty nursing services may be provided in the client's home or some other living arrangement outside of a hospital or nursing facility. Prior authorization is required for these services.
Nebraska Medicaid covers medically necessary psychiatric and substance use disorder services for medically necessary primary psychiatric and/or substance use disorder diagnoses for individuals age 21 and older, including outpatient services, day treatment, substance use disorder treatment, and hospital services.
For more information, see Medicaid Behavioral Health Services.
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.
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.
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. Medicaid will cover up to 60 combined visits per year.
Nebraska Medicaid covers medically necessary and appropriate visual care services within program guidelines. Examination, diagnosis and treatment services are also allowable to diagnose or treat a specific eye illness, symptom, complaint, or injury. Medicaid covers eyeglasses, including lenses and frames, when coverage criteria is met. Eye exams for adults 21 years and older are limited to once every 24 months, eye exams for recipients age 20 and younger are limited to once every 12 months. More frequent eye examinations will be covered when medically necessary.