Medically Frail status is either for a 1- or 3-year period, depending on the condition.
Medically Frail status only applies if you're eligible for Medicaid in the Heritage Health Adult group.
You can ask your Heritage Health plan or provider to help you complete the initial Medically Frail review process. This might include providing DHHS your relevant health information.
If you are experiencing homelessness, you and your social service provider can complete the form below:
The following document contains instructions on how to upload forms and documentation to ACCESSNebraska:
Below are examples of conditions that can qualify as medically frail:
Nebraskans participating in Heritage Health Adult may be considered Medically Frail. Those individuals considered Medically Frail receive Prime benefits.
The Heritage Health plans or providers may refer their patient to DHHS to determine Medically Frail status. If this happens, a notice will be sent to you like the one below:
Once the determination is made, you will receive a notice of approval or denial.
If DHHS determines that you do not meet the Medically Frail criteria according to 477 NAC 29-003.03(A) and you disagree with the decision, you may take one or more of the following actions:
You may be asked to help your patient provide medical information or complete forms to send to DHHS if your patient is seeking Medically Frail status.
The following is a list of conditions that may qualify your patient for Medically Frail status. Please note, this list will be updated over time and should not be considered all-inclusive because there may be other conditions not on this list that may warrant Medically Frail status. Please subscribe to this page for updates.