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Medicaid Related Assistance
Medicaid & Long-Term Care
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​​​​​​​​​​​​​​The State Plan is the official document describing the nature and scope of the Nebraska Medicaid Program. There are seven sections that comprise the State Plan (Part 1) as well as many accompanying attachments and amendments (Parts 2 and 3). Each part was developed by Nebraska and approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS).
Questions regarding the Nebraska State Plan may be sent to DHHS.MedicaidSPA@nebraska.gov.
The State Plan is available in 3 large sections (Parts 1-3), located at the bottom of the page.
Section 1 - Single State Agency Organization
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Section 2 - Coverage and Eligibility
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Section 2 - MMDL System Approvals
​Medicaid Eligibility
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​Medicaid Premiums and Cost Sharing
​
​Alternative Benefit Plan
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Section 2 - MACPro System Approvals
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Section 3 - Services: General Provisions
|
Subsection : 1 (57)
|  State Plan : Part 1 (1)
| |  | Amount, Duration, and Scope of Services |  State Plan : Part 2-3 (56)
| |  | Attachment 3.1a - Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy | |  | Item 1 - Limitations - Inpatient Hospitals | |  | Item 2a - Limitations - Outpatient Hospitals | |  | Item 2c - Limitations - Federally Qualified Health Centers | |  | Item 2b - Limitations - Rural Health Clinic Services | |  | Item 3 - Limitations - Other Laboratory and X-Ray Services | |  | Item 4a - Limitations - Assessments of Developmentally Disabled Person in SNF | |  | Item 4b - Limitations - Early and Periodic Screening and Diagnosis and Treatment of Conditions Found | |  | Item 5 - Limitations - Physician’s Services | |  | Item 6a - Limitations - Podiatrists’ Services | |  | Item 6b - Limitations - Optometrists’ Services | |  | Item 6c - Limitations - Chiropractic Services | |  | Item 6d - Limitations - Other Practitioners Services | |  | Item 7a - Limitations - Home Health Nursing Services | |  | Item 7b - Limitations - Home Health Agencies - Home Health Aide Services | |  | Item 7c - Limitations - Medical Supplies, Equipment, and Appliances Suitable for Use in the Home | |  | Item 7d - Limitations - Home Health Services - Physical Therapy, Occupational Therapy, and Speech Pathology and Audiology | |  | Item 8 - Limitations - Private Duty Nursing Services | |  | Item 9 - Limitations - Clinic Services | |  | Item 10 - Limitations - Dental Services | |  | Item 11a - Limitations - Physical Therapy | |  | Item 11b - Limitations - Occupational Therapy | |  | Item 11c - Limitations - Services for Individuals with Speech, Hearing, and Language Disorders | |  | Item 12a - Limitations - Prescribed Drugs | |  | Item 12b - Limitations - Dentures | |  | Item 12c - Limitations - Prosthetic Devices | |  | Item 12d - Limitations - Eye Glasses | |  | Item 13b - Limitations - Screening Services | |  | Item 13c - Limitations - Preventative Services | |  | Item 13d - Limitations - Rehabilitative Services | |  | Item 14a - Limitations - Services for Individuals Age 65 or Older in Institutions for Mental Diseases - Inpatient Hospital Services | |  | Item 14b - Limitations - Services for Individuals Age 65 or Older in Institutions for Mental Diseases - Skilled Nursing Facility Services | |  | Item 14c - Services for Individuals Age 65 or Older in Institutions for Mental Diseases - Intermediate Care Facility Services | |  | Item 15 - ICF-DD Services | |  | Item 16 - Inpatient Psychiatric Facility Services for Individuals Under Age 21 | |  | Item 17 - Nurse-Midwife Services | |  | Item 18 - Medical and Remedial Care and Services | |  | Item 20a - Limitations - Pregnancy -related and Postpartum Services for 60 Days After the Pregnancy Ends | |  | Item 20b - Limitations - Services for Any Other Medical Conditions that May Complicate Pregnancy | |  | Item 23 - Limitations - Certified Pediatric or Family Nurse Practitioners’ Services | |  | Item 24a - Limitations - Transportation | |  | Item 24d - Limitations - Nursing Facility Services for Patients Under 21 Years of Age | |  | Item 24e - Limitations - Emergency Hospital Services | |  | Item 24f - Limitations - Critical Access Hospitals | |  | Item 26 - Limitations - Personal Assistance Services | |  | Item 27 - Limitations - Freestanding Birth Center Services | |  | Supplements 1-3 - Case Management Services | |  | Supplement 4 - PACE | |  | Supplement 5 - MAT | |  | Attachment 3.1b - Amount, Duration, and Scope of Services Provided Medically Needy Groups | |  | Supplement 6 - MAT | |  | Attachment 3.1c - Standards and Methods of Assuring High Quality Care | |  | Attachment 3.1d - Transportation | |  | Attachment 3.1e - Standards for the Coverage of Organ Transplant Services | |  | Attachment 3.1f - MCO and enhanced PCCM programs (replaced with the 1915(b) Waiver) | |  | Attachment 3.1i - Therapeutic Family Care (TFC) Crisis Support Services | Subsection : 2 (2)
|  State Plan : Part 1 (1)
| |  | Coordination of Medicaid with Medicare and Other Insurance |  State Plan : Part 2-3 (1)
| |  | Attachment 3.2a - Coordination of Title XIX with Part B of Title XVIII | Subsection : 3 (1)
|  State Plan : Part 1 (1)
| |  | Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases | Subsection : 4 (1)
|  State Plan : Part 1 (1)
| |  | Special Requirements Applicable to Sterilization Procedures | Subsection : 5 (1)
|  State Plan : Part 1 (1)
| |  | Families Receiving Extended Medicaid Benefits |
|
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Section 4 - General Program Administration
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+'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/expirationconfig.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'tag') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Hold.aspx'
+'?Tag=true&ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
FileType
xsn
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.2
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.3
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.4
255
Document Set Version History
/_layouts/15/images/versions.gif?rev=43
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+
'/_layouts/15/DocSetVersions.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=43
javascript:GoToPage('{SiteUrl}' +
'/_layouts/15/docsetsend.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
Section 5 - Personnel Administration
Follow
javascript: SP.SOD.executeFunc('followingcommon.js', 'FollowDoc', function() { FollowDoc('{ListId}', {ItemId}); });
0x0
0x0
ContentType
0x01
1100
Compliance Details
javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+
'/_layouts/15/itemexpiration.aspx'
+'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/hold.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Reporting.aspx'
+'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/expirationconfig.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'tag') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Hold.aspx'
+'?Tag=true&ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
FileType
xsn
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.2
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.3
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.4
255
Document Set Version History
/_layouts/15/images/versions.gif?rev=43
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+
'/_layouts/15/DocSetVersions.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=43
javascript:GoToPage('{SiteUrl}' +
'/_layouts/15/docsetsend.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
Section 6 - Financial Administration
Follow
javascript: SP.SOD.executeFunc('followingcommon.js', 'FollowDoc', function() { FollowDoc('{ListId}', {ItemId}); });
0x0
0x0
ContentType
0x01
1100
Compliance Details
javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+
'/_layouts/15/itemexpiration.aspx'
+'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/hold.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Reporting.aspx'
+'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/expirationconfig.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'tag') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Hold.aspx'
+'?Tag=true&ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
FileType
xsn
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.2
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.3
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.4
255
Document Set Version History
/_layouts/15/images/versions.gif?rev=43
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+
'/_layouts/15/DocSetVersions.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=43
javascript:GoToPage('{SiteUrl}' +
'/_layouts/15/docsetsend.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
Section 7 - General Provisions
Follow
javascript: SP.SOD.executeFunc('followingcommon.js', 'FollowDoc', function() { FollowDoc('{ListId}', {ItemId}); });
0x0
0x0
ContentType
0x01
1100
Compliance Details
javascript:if (typeof CalloutManager !== 'undefined' && Boolean(CalloutManager) && Boolean(CalloutManager.closeAll)) CalloutManager.closeAll(); commonShowModalDialog('{SiteUrl}'+
'/_layouts/15/itemexpiration.aspx'
+'?ID={ItemId}&List={ListId}', 'center:1;dialogHeight:500px;dialogWidth:500px;resizable:yes;status:no;location:no;menubar:no;help:no', function GotoPageAfterClose(pageid){if(pageid == 'hold') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/hold.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'audit') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Reporting.aspx'
+'?Category=Auditing&backtype=item&ID={ItemId}&List={ListId}'); return false;} if(pageid == 'config') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/expirationconfig.aspx'
+'?ID={ItemId}&List={ListId}'); return false;} if(pageid == 'tag') {STSNavigate(unescape(decodeURI('{SiteUrl}'))+
'/_layouts/15/Hold.aspx'
+'?Tag=true&ID={ItemId}&List={ListId}'); return false;}}, null);
0x0
0x1
ContentType
0x01
898
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
FileType
xsn
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.2
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.3
255
Edit in Browser
/_layouts/15/images/icxddoc.gif?rev=43
/_layouts/15/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser&Source={Source}
0x0
0x1
ProgId
InfoPath.Document.4
255
Document Set Version History
/_layouts/15/images/versions.gif?rev=43
javascript:SP.UI.ModalDialog.ShowPopupDialog('{SiteUrl}'+
'/_layouts/15/DocSetVersions.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
330
Send To other location
/_layouts/15/images/sendOtherLoc.gif?rev=43
javascript:GoToPage('{SiteUrl}' +
'/_layouts/15/docsetsend.aspx'
+ '?List={ListId}&ID={ItemId}')
0x0
0x0
ContentType
0x0120D520
350
State Plan Parts 1-3
Part 1 (Sections 1-7)
Part 2 (Attachments 1.1a through 4.17a)
Part 3 (Attachments 4.18a through 7.7c)​