Nebraska provides long-term care resources to seniors through its Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care. One of the DHHS Division of Medicaid and Long-Term Care resources is the State Unit on Aging. The State Unit on Aging grants state and federal funds to the eight Area Agencies on Aging in Nebraska (AAA) to support local programs and services. With the assistance of local individuals and advisory groups, each Area Agency on Aging determines needs and develops a plan to provide an appropriate array of services for its aging population. The State Unit on Aging also oversees Nebraska’s Aging and Disability Resource Center (ADRC) for older Nebraskans (age 60), people with disabilities of all ages, family members, caregivers, and advocates. Local ADRCs provide information, referral, and assistance for accessing community services and long-term care options.

In addition to the local resources provided through the ARDC, State Unit on Aging, and local AAAs, the DHHS Division of Medicaid and Long-Term Care administers a home-and-community based (HCBS) Medicaid Waiver for seniors aged 65 and older who require a nursing home-level of care and meet certain financial eligibility requirements but would rather live in their own home or community while receiving long-term care services.

Medicaid Waiver Program for Assisted Living and In-Home Care

Nebraska Aged & Disabled Home-and-Community Based Waiver Medicaid Waiver (HCBS A&D Waiver)

Nebraska administers the A&D waiver program through its Department of Health and Human Services, Division of Medicaid and Long-Term Care. It is managed regionally through the state’s local Area Agencies on Aging, which the applicant must go through when applying for the waiver or if they have any questions regarding eligibility for Medicaid and/or the A&D waiver. The A&D waiver provides a number of services(see below) for seniors who are Medicaid-eligible and meet the other requirements for the program.

Services

Some of the services included in the A&D waiver program include: Services Coordination – provided by specially trained staff who help match your needs with services and providers based on your preferences; In-home help, such as home-delivered meals, cleaning, laundry, getting groceries (chore), maintaining good nutrition; personal emergency response system (PERS); and special equipment to make tasks easier to perform, or modifying your home to make it easier to get around (assistive technology/home modifications); Relief time for family caregivers (respite); Training to increase independence in activities of daily living at home (independence skills building); Child care so the caregiver can maintain employment (child care for children with disabilities); Community supports like adult day services and transportation for essential activities such as medical appointments; Assisted Living services.

Eligibility

Generally, eligible applicants for the A&D waiver must: be financially eligible for Medicaid, have physical and health needs which require services similar to those provided by a nursing facility, and have an individualized plan of services and supports that will keep them safe in their home.

  1. Health: Applicants for the A&D waiver must require a Nursing Home Level of Care. This means you have needs which require you to receive services similar to those provided to individuals who live in a nursing home. For example, you may need assistance with everyday tasks such as getting dressed, taking a bath or shower, eating, or walking safely. When applying for Medicaid, the applicant is assessed to see if their needs are the same as those of people who live in a nursing home.
  2. Financial: Applicants must meet the financial requirements, which include income and asset limits. For 2022, the income limit is 100% of the Federal Benefit Rate, which is $1,063. For the medically needy provision that the state allows, the applicant can have any amount of income so long as they spend down the income on medical or remedial expenses that bring it under the income limit, which is currently $392. Nebraska also has asset requirements and limits for the spouse of a married applicant (or “community spouse”) if the spouse is neither enrolled in the A&D waiver nor in an institution. The community spouse’s assets must be considered in the eligibility determination, known as the Community Spouse Resource Allowance (CSRA). In 2022, the maximum allowable CSRA is $128,640, meaning that anything over that amount is factored into the applicant’s asset limit. Further, in Nebraska, if the A&D waiver enrollee is not in an assisted living facility, then the medically needy standards apply to the community spouse, while otherwise, the SSI criteria above are applicable.

Practical Considerations

A certain number of assisted living facilities are licensed by the state that is also participants in the A&D waiver program. The assisted living facilities list available here shows which accept participants enrolled in the A&D waiver program. The strict financial criteria make it more difficult than in other states for participants with more income than the limit to become eligible. However, the relatively small waitlist for the number of slots makes it a reasonable option for seniors looking to live in assisted living or in their homes while receiving Medicaid benefits for their living and additional services provided.

Conclusion

Nebraska’s financial eligibility requirements, even with the “medically needy” spend-down provisions, make it difficult for anyone with income above the 100% FBR limit of $1,063 to become eligible for the Medicaid A&D waiver program. Accordingly, if you choose to apply for benefits in Nebraska, it will be essential to have a Medicaid Planning specialist help categorize all your expenses so that if you earn more than the income limit, you can optimize your spending to reach the limit as soon as possible.

Access all state Medicaid Waiver pages.