Nebraska Medicaid Waiver for Home Care: AD Waiver Eligibility and Services

Nebraska's Aged and Disabled (AD) Waiver is the primary Medicaid pathway that funds home care and assisted living as alternatives to nursing home placement. If your parent qualifies clinically and financially for nursing home care but prefers to stay at home or in an assisted living facility, this waiver makes that possible with Medicaid funding.

Understanding how the AD Waiver differs from standard Personal Assistance Services — and what changed in 2026 — is critical to getting your parent the right services.

What the AD Waiver Covers

The AD Waiver funds a broad range of home and community-based services, coordinated through a designated Service Coordinator and customized into a person-centered care plan:

• Personal care: hands-on assistance with bathing, dressing, toileting, transfers
• Adult day care: supervised daytime programming at licensed centers
• Home-delivered meals
• Chore services: heavy cleaning, yard work, minor home repairs
• Home and vehicle modifications: wheelchair ramps, grab bars, bathroom conversions, vehicle adaptations for wheelchair access
• Non-medical transportation: rides to medical appointments, social activities, community programs
• Assistive technology: medical alert systems, adaptive equipment
• Personal emergency response systems (PERS)
• Respite care: temporary relief for family caregivers

The waiver can also fund the care component of assisted living for residents in licensed ALFs — though room and board remain the resident's responsibility.

AD Waiver vs. Personal Assistance Services (PAS)

Nebraska operates two separate Medicaid home care programs, and families frequently confuse them. The differences are operationally significant:

Personal Assistance Services (PAS) is funded under the standard Medicaid State Plan. It's more restrictive — services must be delivered strictly inside the client's home. The one exception is essential grocery shopping, during which the client is legally prohibited from accompanying the provider. PAS cannot fund care in an assisted living facility.

The AD Waiver offers far more flexibility. Services can be delivered in community settings (restaurants, stores, social events), not just in the home. And critically, the AD Waiver can fund assisted living care, which PAS cannot.

For families weighing these options: if your parent's needs are limited to in-home personal care during predictable hours, PAS may suffice. If they need community access, flexible scheduling, or assisted living support, the AD Waiver is the right pathway.

Eligibility Requirements

The AD Waiver has the same eligibility requirements as nursing home Medicaid — because it's designed for people who would otherwise need a nursing home:

Clinical: the applicant must meet the Nursing Facility Level of Care (NF-LOC) standard. A DHHS assessor administers the interRAI Home Care assessment, measuring ADL deficits, cognitive function, medical complexity, and safety risks. This assessment must be completed within 14 days of application and is renewed annually.

Financial: the same asset and income rules as nursing home Medicaid apply — $4,000 countable asset limit for a single applicant, income spend-down via Nebraska's medically needy pathway. The five-year look-back period applies to AD Waiver applications just as it does to nursing home applications.

For applicants under 65: a formal disability determination is required. Nebraska Medicaid automatically accepts determinations from the Social Security Administration. If SSA hasn't made one, the DHHS State Review Team reviews medical records using the same federal criteria.

Room and Board Under the Waiver

For waiver participants living in an assisted living facility, Nebraska uses a "Standard of Need" (SON) framework to calculate room and board obligations.

As of January 2026:

• Room and board standard: $919/month
• Personal needs allowance: $75/month
• Total Standard of Need for ALF waiver residents: $994/month

For residents who don't qualify for the waiver but meet the medically needy threshold, the Standard of Need is calculated differently: $392 MNIL + $1,055 remedial care costs = $1,447/month.

The 2026 Service Coordination Change

On April 1, 2026, DHHS made a significant structural change: the state ended its contract with the League of Human Dignity for service coordination under the AD Waiver. All service coordination has been consolidated directly under DHHS.

What this means for families: you now work through regional DHHS Service District Administrators (SDAs) until a permanent State Service Coordinator is assigned to your parent's case. This transition has introduced short-term administrative friction — expect potential delays in initial care plan development and service authorization during the consolidation period.

The Home Again Program

Nebraska's Home Again program helps individuals transition out of a nursing home and back into a community residence. If your parent was placed in a nursing home temporarily (after a hospitalization, for example) and has stabilized enough for community living, Home Again coordinates the transition — including securing housing, setting up in-home services, and arranging the necessary support infrastructure.

This program operates under the AD Waiver umbrella and requires the same clinical and financial eligibility.

How to Apply

File through iServe Nebraska (iServe.nebraska.gov) or submit the DD-10 form by mail to HCBS Waiver Eligibility, PO Box 98947, Lincoln, NE 68509-8947. The Nebraska Care Decision Guide includes the complete waiver pathway guide, from NF-LOC assessment preparation through service plan development.

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