Nebraska Medicaid for Seniors & Long-Term Care

The Aged and Disabled Waiver is a Section 1915(c) Home and Community-Based Services waiver that lets Medicaid-eligible seniors and adults with physical disabilities receive long-term services and supports at home or in the community rather than in a nursing facility.

To qualify for the AD Waiver, a person must meet nursing facility level of care criteria and financial eligibility requirements. Because waiver slots are limited, there may be a waiting list. Nebraska also operates separate waiver programs for individuals with developmental disabilities and brain injuries through the Division of Developmental Disabilities — these have their own enrollment processes.

DHHS revised the AD Waiver in 2026 after proposing steep cuts to reimbursable in-home caregiver hours amid rising program costs (waiver spending grew from about $91 million in 2016 to roughly $384 million by mid-2025). The version submitted to CMS sets an annual cost limit of 150% of the average nursing facility rate rather than a flat cap on caregiver hours, and lets participants using in-home or a combination of in-home and out-of-home providers request an exception reviewed by a clinical team based on assessed medical need. Ask your Service Coordinator how the cost limit and exception process apply to your plan.

Nebraska Medicaid covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care, typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance, which is about $75/month in Nebraska (well above the $30/month federal minimum). Medicaid covers the gap. If income exceeds the institutional Medicaid limit, Nebraska may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible.

Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. Exempt assets are not counted: the primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt. Medicaid has a 60-month (5-year) lookback period for asset transfers; transfers for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income, the minimum monthly maintenance needs allowance (MMMNA). The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility.

Nebraska operates a Medicaid estate recovery program. The state may seek reimbursement from the estate of a deceased Medicaid member who was age 55 or older at the time they received long-term care services, nursing facility care, or certain other Medicaid benefits. The home is generally exempt from recovery while a surviving spouse or dependent child under 21 continues to live there. Consult a Nebraska-licensed elder law attorney before making asset transfers.

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Contact Nebraska DHHS to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.