Nebraska Medicaid can pay for care at home or in the community for someone who would otherwise need a nursing facility, mainly through one program: the Aged and Disabled (AD) Waiver.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Nebraska Medicaid HCBS waivers are the route to that community care, and for older adults the main route is this single waiver. The AD Waiver is the state's primary Medicaid home and community-based services (HCBS) waiver, and it serves adults age 65 and older along with people from birth to age 64 who have disabilities.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 To use the AD Waiver, you must keep Nebraska Medicaid, meet a nursing-facility level of care, and choose waiver services instead of living in an institution, along with the other requirements below.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
In This Guide
- What Are Nebraska Medicaid HCBS Waivers?
- The Aged and Disabled (AD) Waiver in Detail
- Who Qualifies for Nebraska Medicaid HCBS Waivers?
- What the AD Waiver Covers
- How Enrollment and Your Service Coordinator Work
- How to Apply for the AD Waiver
What Are Nebraska Medicaid HCBS Waivers?
Home and community-based services (HCBS) is the part of Medicaid that pays for long-term care delivered outside an institution, in your own home, a family member's home, or another community setting rather than in a nursing facility. One common way states deliver these services is a federal authority called a 1915(c) HCBS waiver, named for the section of federal law that created it. Federal law ties these waiver services to a finding that, without them, the person would need the level of care a hospital, nursing facility, or similar institution provides.U.S. Government Publishing Office. (n.d.). 42 CFR 441.302 — State assurances (eCFR, current). ecfr.gov. Retrieved Oct 3, 2026, from https://www.ecfr.gov/current/title-42/section-441.302
For older adults and people with physical disabilities, Nebraska's primary Medicaid HCBS waiver is the Aged and Disabled (AD) Waiver, a Section 1915(c) waiver run by the Nebraska Department of Health and Human Services (DHHS).Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Federally, it is recorded as the "NE HCBS Waiver for Aged, Adults, and Children with Disabilities," its status is approved, and its current term runs from July 1, 2026, through June 30, 2031.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
The idea behind the waiver is straightforward. If your needs are high enough that you would otherwise need nursing-facility care, the AD Waiver lets you choose waiver services instead of living in an institution.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 That single decision, home instead of institution, is what the whole program is built around.
The Aged and Disabled (AD) Waiver in Detail
The AD Waiver is administered by the Nebraska Department of Health and Human Services (DHHS).Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Because it is a Section 1915(c) waiver, federal rules require an evaluation of your need for an institutional level of care before you get in, and a reevaluation at least once a year after that.U.S. Government Publishing Office. (n.d.). 42 CFR 441.302 — State assurances (eCFR, current). ecfr.gov. Retrieved Oct 3, 2026, from https://www.ecfr.gov/current/title-42/section-441.302
Who the waiver is for is defined by age and disability. It covers adults ages 65 and older and people from birth to age 64 who have disabilities.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 A younger adult with a disability and an older adult who has grown frail can both be served by the same waiver, as long as each one meets every point of eligibility DHHS lists, covered in the next section.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
One point worth stating plainly: the waiver pays for care and services, not for your housing. Even in supported residential living, the waiver service provided in a licensed assisted living facility, the participant pays the room and board cost plus any applicable Medicaid share of cost.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 So the program covers the help you need, while your ordinary living costs stay your own.
Who Qualifies for Nebraska Medicaid HCBS Waivers?
DHHS says you must meet every point of eligibility. Two basics come first: you must be a Nebraska resident and a U.S. citizen or a lawfully present qualified alien.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 After that come two tests, and you have to clear both. The first is functional, about your level of need. The second is financial, about your income and assets.
The functional test: nursing-facility level of care
To be eligible for the AD Waiver, you must meet Nursing Facility Level of Care as Nebraska's rules define it (471 NAC 12), choose to receive waiver services instead of living in an institutional setting, and have a need for special supports and assistance that is expected to be lifelong.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 In plain terms, your care needs have to be serious enough that you could qualify for care in a nursing facility. If your needs are lighter than that, the AD Waiver is not the right door, though other community programs might be. DHHS completes an assessment to determine your level of care.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
The financial test: Nebraska Medicaid eligibility
You also have to qualify for Nebraska Medicaid itself. Nebraska is a medically needy state, sometimes called a "share of cost" state, which changes how the income side works. A person whose income is above the limit can still qualify by obligating their monthly income above the medically needy income level to their medical bills, and DHHS says this route suits people receiving waiver services.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 As of 2026, the medically needy income level DHHS uses is $392 per month for a one- or two-person household, and your medical expenses must at least equal the gap between your income and that level.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
Assets are tested separately. For the aged, blind, and disabled category, the countable-resource limit is $4,000 for one person and $6,000 for two people.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 If only one spouse needs care, that limit is not a test of everything the couple owns: Nebraska's 2026 standards set a spousal impoverishment reserved amount of at least $32,532 and at most $162,660.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Our guide to Nebraska spousal impoverishment rules explains how that protects the spouse at home. Countable resources are things like bank accounts and other savings; certain assets are treated differently under Medicaid's rules, which is worth confirming with DHHS for your own situation.
| Standard | Amount |
|---|---|
| Medically needy income level (1 or 2 people) | $392 per month |
| Countable-resource limit (1 person) | $4,000 |
| Countable-resource limit (2 people) | $6,000 |
| Room and board in supported residential living | Paid by the participant |
Because Nebraska has a medically needy route, being over the income level is not automatically a "no"; it can mean a share of cost rather than a denial.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 For a fuller walk through the numbers, see our guide to Nebraska Medicaid income and asset limits.
What the AD Waiver Covers
The AD Waiver funds a broad set of home and community supports, chosen to fit what a particular person needs to live safely in the community. Covered services include:Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
- Personal care, including LRI personal care, where a Legally Responsible Individual provides the personal care service. A relative who is not legally responsible for the participant may be paid for Personal Care, Respite and Chore, while a spouse may be paid only through LRI Personal Care, when the participant meets Nebraska's Extraordinary Care test, for up to 40 hours a week.Nebraska Department of Health and Human Services. (2026). CMS approval letter, NE.0187.R08.00 renewal of the HCBS Waiver for Aged and Adults and Children with Disabilities (June 17, 2026), as posted by Nebraska DHHS. dhhs.ne.gov. Retrieved Oct 14, 2026, from https://dhhs.ne.gov/DD%20Documents/NE%200187.R08.00%20-%20Approval%20Letter%20-%20Renewal%206-17-2026%20signed.pdf
- Respite care, which pays someone to step in and care for the participant so the primary caregiver gets a temporary break.
- Adult day health, structured daytime care and supervision outside the home.
- Home-delivered meals and chore services.
- Companion and non-medical transportation services.
- Assistive technology, home and vehicle modifications, and a personal emergency response system (PERS), the wearable or in-home device that summons help in an emergency.
- Independence skills building and home again, the waiver's nursing-facility transition support for people moving from an institution back into the community.
- Supported residential living (formerly called assisted living), provided in a licensed assisted living facility and covering shelter, food, personal care, medication assistance, housekeeping, and transportation, with the participant paying room and board.
- Extra care for children with disabilities, since the waiver also serves children.
Not every participant receives every service. Your Service Coordinator writes your person-centered plan and helps determine which of these you qualify to receive.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 The through-line is consistent: each service exists to replace a reason someone might otherwise have to enter a nursing facility.
How Enrollment and Your Service Coordinator Work
Enrollment in the AD Waiver runs through a Service Coordinator, and understanding that role early makes the rest of the process clearer. Your Service Coordinator is a local person who writes your person-centered plan and helps determine which services you qualify to receive.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Depending on age, you may have a choice of who provides it: DHHS local offices serve all ages, and people 65 and older can use their Area Agency on Aging unless they already have a DHHS Service Coordinator they want to keep. DHHS gives you contact information for the office you choose after your nursing-facility level of care is determined.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 The plan is built around you, your needs, your goals, and the supports that let you stay at home, rather than around a fixed package handed to everyone. Services start only after you are found eligible and have a plan, and they cannot be backdated, so apply as soon as care at home is on the table.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
Availability of waiver services can change over time, so it is worth confirming current openings and timelines directly with DHHS when you start. Federal rules require your plan to be reviewed at least every 12 months, when your needs change significantly, or when you ask.U.S. Government Publishing Office. (n.d.). 42 CFR 441.301 — Contents of request for a waiver (eCFR, current). ecfr.gov. Retrieved Oct 2, 2026, from https://www.ecfr.gov/current/title-42/section-441.301 If you are weighing the waiver against a nursing-home stay, our guide to Nebraska Medicaid and nursing home care walks through how the institutional side works.
How to Apply for the AD Waiver
Applying for the AD Waiver starts with applying for Nebraska Medicaid, since Medicaid eligibility is the foundation the waiver sits on. There are three ways to begin.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
- Apply online. File through iServe Nebraska, the state's online application portal, for Medicaid, the waiver, or both.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
- Apply by paper. Call DHHS at 877-667-6266 to have a paper application mailed to you, then sign it and mail it to HCBS Eligibility, PO Box 98947, Lincoln, NE 68509-8947, or scan and email it to dhhs.hcbswaiverapp@nebraska.gov.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
- Apply in person. Go to any DHHS office and ask for help.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
Once your application is in, DHHS reviews it and a Service Coordinator helps develop your person-centered plan and determine which services you qualify to receive.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 Federal Medicaid rules set outer limits on how long the state may take to decide: no more than 90 days for applicants who apply for Medicaid on the basis of disability, and no more than 45 days for all other applicants.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 Which limit applies turns on the basis you applied under, not on whether a disability question comes up along the way, so an applicant age 65 or older applying on the basis of age is on the 45-day clock even though the AD Waiver also requires a level-of-care assessment. Those are outer ceilings rather than typical timelines, and Nebraska must also set its own timeliness standards in its State plan and tell applicants what they are.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The limits can be exceeded in unusual circumstances, for example when an applicant or examining physician delays a required step or an emergency is beyond the agency's control, and the agency must document the reason for any delay in your case record.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 The agency also may not use the time limits as a waiting period or as a reason to deny you, so on an age-basis application anything past day 45 is worth asking about.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
For a step-by-step look at the Medicaid application itself, see our guide on how to apply for Nebraska Medicaid.
Frequently Asked Questions
Does the AD Waiver mean I have to go into a nursing home?
No, it is the opposite. The Aged and Disabled (AD) Waiver is for people who choose to receive waiver services instead of living in an institutional setting such as a nursing facility.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441 You do have to meet a nursing-facility level of care to qualify, meaning your needs are serious enough that institutional care would otherwise be on the table, but the waiver then lets you receive services at home or in the community rather than moving into one.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
What if my income is too high for regular Medicaid?
Being over the income limit is not an automatic denial. Because Nebraska is a medically needy, or "share of cost," state, someone whose income sits above the state's threshold can still reach the Nebraska Medicaid coverage the AD Waiver depends on by obligating their monthly income above the medically needy income level to their medical bills, rather than being turned away outright.Centers for Medicare & Medicaid Services. (n.d.). NE HCBS Waiver for Aged, Adults, and Children with Disabilities (0187.R08.00) - Medicaid.gov waiver record. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/82441
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