Medically Frail

 
2
Medicaid Related Assistance
Medicaid & Long-Term Care
No

What would you like to do?

What you need to know

​​​​​I'm on Medicaid and think I'm Medically Frail

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:

Sending Documents to DHHS 

The following document contains instructions on how to upload forms and documentation to ACCESSNebraska:


Medically Frail - Health Conditions

Below are examples of conditions that can qualify as medically frail:

  • A disabling mental health condition;
  • A chronic substance use disorder;

  • A physical, intellectual, or developmental disability with functional impairment that significantly impairs an individual from performing one or more activities of daily living each time the activity occurs;
  • A disability determination based on Social Security Criteria;
  • A serious and complex medical condition; or
  • Chronically homeless as defined by the United States Department of Housing and Urban Development.
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Benefits

Nebraskans participating in Heritage Health Adult may be considered Medically Frail. Those individuals considered Medically Frail receive Prime benefits.

Medically Frail Notices

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.


​What if I'm determined not to be Medically Frail?

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 have the right to appeal this determination. For an explanation of your appeal rights, please refer to the Your Rights section at the end of the notice you received from DHHS.
  • ​You may work with your health care provider or Managed Care Plan to review your health care condition(s) and submit updated documentation to DHHS. This webpage includes the instructions and information for reassessing Medically Frail status. 
    • Nebraska Total Care: 1 (844) 385-2192
    • Healthy Blue: 1 (833) 388-1405
    • UnitedHealthcare: 1 (800) 641-1902



I'm a Medicaid Provider

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.


 

Medically Frail Webinar

If you have any questions about the Medically Frail program, please contact the Medically Frail team at DHHS.MedFrailReview@nebraska.gov.