Get Paid as a Family Caregiver Through Nebraska Medicaid

What the LRI Program Is

Nebraska's Legally Responsible Individual (LRI) program is one of the only ways a family member can get paid by Medicaid for providing caregiving to a loved one. It operates under the Aged and Disabled (AD) Waiver and compensates spouses and parents of minor children for providing "extraordinary care" — care that goes beyond what's normally expected in that family relationship.

This matters because most Medicaid programs nationwide don't pay family members for caregiving. Nebraska's LRI provision is an exception, and families often don't know it exists until they're deep into the AD Waiver application process.

Who Qualifies as an LRI

The program is narrower than many families hope. Only two categories of family members qualify:

Spouses. If your parent's spouse provides daily hands-on care — bathing, toileting, transferring, medication management — that spouse can be compensated through the LRI program. This is the most common scenario: one spouse is declining physically or cognitively while the other provides all-day care at home.

Parents of minor children. If the Medicaid recipient is a disabled child under 18, a parent can qualify.

Adult children, siblings, grandchildren, and other relatives are not eligible for the LRI program. An adult child caring for an aging parent cannot be paid as an LRI. This is a frequent source of confusion — the program name suggests broader eligibility than it actually provides.

Adult children who are providing care may qualify as non-LRI home care workers through the AD Waiver, but that's a different pathway with different requirements and rate structures.

What "Extraordinary Care" Means

The LRI program doesn't pay for ordinary household tasks. It compensates for care that exceeds what's expected in a typical marital or parent-child relationship — the kind of care that would otherwise require a paid aide or nursing facility placement.

DHHS determines extraordinary care through the DD-26 assessment tool, which evaluates how much the care recipient's needs exceed normal expectations. The assessment looks at:

• Activities of daily living (bathing, dressing, eating, toileting, transferring, mobility) that require hands-on physical assistance
• Cognitive supervision needs (wandering prevention, behavioral management, constant monitoring for safety)
• Skilled tasks that a family member performs (wound care, catheter management, medication administration)

The gap between what's "normal" for the relationship and what the caregiver actually provides determines the compensable hours. A spouse who helps their partner get dressed in the morning — that's ordinary. A spouse who provides full physical assistance with bathing, toileting, and transferring multiple times daily because of advanced Parkinson's — that's extraordinary.

How Compensation Works

LRI caregivers are paid through a fiscal intermediary (payroll agency) that handles tax withholding, workers' compensation, and payment processing. The caregiver doesn't bill DHHS directly.

Compensation rates are set by the state and are modest. LRI rates are generally lower than what a home care agency would charge, but for families where the spouse is already providing the care regardless, any compensation helps offset the household income loss.

The authorized hours are specified in the recipient's Person-Centered Plan (PCP), developed with a DHHS service coordinator. Hours vary based on the DD-26 assessment results and the specific care needs documented in the plan.

There are strict documentation requirements. The LRI caregiver must:

• Track daily care hours on shift-documentation forms
• Record the specific tasks performed during each shift
• Submit timesheets to the fiscal intermediary on schedule
• Participate in reassessments when DHHS reviews the care plan

Missing documentation or late timesheets can delay or stop payment. DHHS also conducts periodic audits to verify that care hours match the authorized plan.

The AD Waiver Connection

The LRI program exists only within the AD Waiver — it's not available through institutional Medicaid or any other program. That means the care recipient must meet all AD Waiver eligibility requirements:

• Meet the Nursing Facility Level of Care (NFLOC) clinical threshold
• Have countable assets at or below $4,000
• Meet income requirements through the medically needy spend-down
• Receive care in a home setting (private home, adult family home, or assisted living)
• Use at least one authorized waiver service every 90 days

One important change: on April 1, 2026, the League of Human Dignity stopped serving as a service coordination agency for the AD Waiver. All cases transferred to DHHS service coordinators. This transition created administrative delays that are still being resolved, so families starting the process now should expect longer processing times for care plan approvals.

What This Means for Your Family

If your parent is married and the well spouse is providing extensive daily care at home, the LRI program can turn unpaid labor into compensated work. It won't replace a full salary, but it acknowledges the reality that spousal caregivers sacrifice income, career advancement, and their own health to keep a loved one at home.

The Nebraska Medicaid Long-Term Care & Asset Protection Guide includes an LRI setup kit with the DD-26 assessment criteria, daily shift-documentation templates, and a walkthrough of the fiscal intermediary enrollment process — so caregiving families can apply knowing exactly what DHHS expects.

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