Medicaid Disability Reviews


What would you like to do?

What you need to know

​​​​​​​​​​​​​​Sometimes, a person seeking Medicaid coverage or waiver services must prove they have a disability in order to qualify for coverage or services. If the individual does not have a disability determination from the Social Security Administration (SSA), Medicaid's State Review Team can make the disability determination. 

​What's the State Review Team? 

The State Review Team (SRT) is a group made up of medical professionals in the Division of Medicaid and Long-Term Care. The SRT reviews medical records submitted by the applicant.

The SRT makes a disability determination based on the Social Security Administration's disability guidelines. For more information on these SSA disability guidelines, visit Social Security's website.​

Forms & Guides


Medicaid applicants seeking a disability determination from the SRT should complete a Medicaid application and the MILTC-63 form​​. 

Health Care Providers

Complete the ​​DM-5 form f​​or your patient. 

Submit the completed form and supportive medical records to the SRT.

State Review Team
Medicaid & Long-Term Care
Department of Health & Human Services
Fax Number (For Medical Records Only)
(402) 742-2351​​
Mailing Address
ACCESSNebraska Document Imaging Center
P.O. Box 2992
Omaha, NE 68103-2992

With any general questions on how the State Review Team makes disability determinations, or any questions on a specific client application, please contact iServe​.​