Nebraska Medicaid Office

Nebraska Medicaid office (DHHS MLTC)

Nebraska is mid-transition from ACCESSNebraska to a new self-service portal called iServe Nebraska. Both still work, but the phone numbers and intake addresses below are the ones DHHS publishes today. The Division of Medicaid and Long-Term Care (MLTC) inside DHHS pays for the program; the Eligibility Customer Service Center routes most member calls; and providers have their own claims and EDI lines.

Member contacts — phone, fax, mail

• Statewide toll-free (Eligibility Customer Service Center) — (855) 632-7633
• Lincoln — (402) 473-7000
• Omaha — (402) 595-1178
• TTY — (402) 471-7256
• Fax — (402) 742-2351
• Quick eligibility check (members only) — (800) 642-6092

Division of Medicaid and Long-Term Care

• MLTC phone — (402) 471-3121
• MLTC mailing address — P.O. Box 95026, Lincoln, NE 68509-5026

Submit documents — ACCESS Nebraska Document Imaging (ANDI) Center

Required documents (proof of income, identity, immigration status, insurance) can be submitted to DHHS three ways:

• Online — through ACCESSNebraska or iServe Nebraska
• Fax — (402) 742-2351
• Email — DHHS.ANDICenter@nebraska.gov
• Mail — ACCESS Nebraska Document Imaging Center, P.O. Box 2992, Omaha, NE 68103-2992

Providers and other contacts

• Provider claim status — (877) 255-3092
• Electronic Data Interchange (EDI) — (866) 498-4357
• Report Medicaid provider fraud — Medicaid Fraud and Patient Abuse Unit, Office of the Attorney General — (402) 471-3549 or toll-free (800) 727-6432; ago.medicaid.fraud@Nebraska.gov; 1221 N Street, Suite 500, Lincoln, NE 68509-8920
• Report Medicaid client fraud — Special Investigation Unit, Division of Public Health — (402) 595-3789; Investigations.SIU@nebraska.gov

Who qualifies for Nebraska Medicaid?

Nebraska adopted Medicaid expansion through Initiative Measure 427 in November 2018, and the state implemented Heritage Health Adult — its name for the expansion adult coverage group — in October 2020. That added adults age 19 to 64 with income up to 138% FPL to the populations DHHS already covered. People who have Medicare can qualify for Nebraska Medicaid in several ways, but they cannot qualify through Heritage Health Adult specifically — that path is for non-Medicare adults only.

Who can qualify for Nebraska Medicaid

• Adults age 65 or older
• Adults under 65 with a disability or visual impairment under Social Security guidelines
• Individuals 18 years of age or younger
• Adults aged 19 to 64 (covered through Heritage Health Adult / expansion)
• Pregnant women
• Parents or caretakers
• Former foster care youth

Resource (asset) rules — apply to some categories, not all

Children 18 and younger and eligible pregnant women are not subject to a resource test. For adults whose category does apply a resource test (typically aged, blind, or disabled tracks), several resources don't count toward the limit:

• Your home
• One motor vehicle
• Property used to operate a trade or business (machinery, equipment)
• Irrevocable burial fund

Beyond those exclusions, Nebraska sets the resource cap at $4,000 for a one-member family and $6,000 for a two-member family, plus $25 for each additional family member. ABLE (Enable) accounts let people who became blind or disabled before age 26 save up to $100,000 without it affecting Medicaid eligibility.

Children's continuous eligibility — now a full year

Nebraska Medicaid extended continuous coverage for all children found newly eligible for Medicaid from six months to a full year. This includes one year of continuous eligibility for kids found eligible at the time of their annual renewal. A family can submit a Medicaid application for the household at any time during the year; once the child qualifies, that coverage holds for the full 12 months.

CHIP and 599 CHIP

• CHIP — Children's Health Insurance Program for certain children who are without other health insurance and don't qualify for Medicaid. CHIP provides the same services covered under Nebraska Medicaid.
• 599 CHIP — designed for unborn children of pregnant women who are otherwise ineligible for coverage under Medicaid or CHIP.

If you're determined ineligible

An ineligibility determination doesn't end the application. DHHS sends ineligible Medicaid applications to the Federal Marketplace (HealthCare.gov), which can assist with private coverage and advance premium tax credits. Households don't need to file a separate marketplace application — the transfer is automatic.

Nebraska Medicaid income limits

Heritage Health Adult — Nebraska's name for the ACA expansion adult group — sets one clear income standard: 138% of the federal poverty level. DHHS publishes that as "about $22,000 a year for a single person" on its Medicaid Expansion page. Other Medicaid categories (children, pregnancy, aged/blind/disabled) use category-specific income standards published in the Federal Poverty Level and Program Eligibility chart on dhhs.ne.gov.

Heritage Health Adult — 138% FPL

Other Medicaid categories

Non-MAGI resource limits

For categories that do apply a resource test (typically aged, blind, or disabled adults), Nebraska's resource cap is $4,000 for a one-member family, $6,000 for a two-member family, and $25 for each additional family member. Children 18 and younger and eligible pregnant women are exempt from any resource test. The home, one motor vehicle, property used in a trade or business, and an irrevocable burial fund are excluded from the resource count. ABLE (Enable) accounts allow people who became blind or disabled before age 26 to save up to $100,000 without affecting Medicaid eligibility.

FPL updates each January

The 138% FPL standard for Heritage Health Adult is stable; the dollar amount updates every January when the federal poverty level resets. Verify the current figure with DHHS or in the Federal Poverty Level and Program Eligibility chart on dhhs.ne.gov before relying on a specific number.

How to apply for Nebraska Medicaid

Nebraska is mid-transition between two consumer portals. The legacy ACCESSNebraska system is being replaced by iServe Nebraska, a new self-service portal that handles applications and benefit management for Medicaid and Economic Assistance programs. Both addresses still work; iServe is where new applications go.

Apply online at iServe Nebraska

Start a new application at iserve.nebraska.gov/apply/start. Existing members manage their case at iserve.nebraska.gov/benefit-inquiry — the My Benefits Dashboard centralizes letters from DHHS, action alerts, submitted applications and renewals, and a "Next Review Due" date for each active program.

Apply or get help by phone

Live customer service is available Monday through Friday, 8 a.m. to 5 p.m. Central. Pick the right number based on what you're applying for:

Automated Benefit Inquiry runs 24 hours a day for case status checks outside live-service hours.

Apply in person

DHHS maintains local offices statewide for in-person assistance. Most local offices have kiosks and telephones available, so you can sit down and complete the iServe online application using the office's own equipment if you don't have internet access at home.

How long does a decision take?

Federal Medicaid rules give Nebraska up to 45 days to decide a non-disability application and up to 90 days for an application based on disability. Pregnancy presumptive-eligibility decisions can be same-day at qualified hospitals. Federal rules also allow retroactive coverage up to three months before the application month when the applicant had qualifying medical bills during that window.

What happens after a Medicaid application is denied

If DHHS determines you're not eligible for Medicaid, your application is transferred to the Federal Marketplace (HealthCare.gov) automatically. The Marketplace can help with private coverage and advance premium tax credits — no separate marketplace application is required.

Continuous eligibility for children

Once a child is found newly eligible for Nebraska Medicaid, coverage continues for a full 12 months (the state extended this from the previous six-month period). This applies both to newly eligible kids and to kids whose eligibility is confirmed at annual renewal — they keep coverage for 12 months even if family income changes during the year.

What Nebraska Medicaid covers

Heritage Health is Nebraska's Medicaid managed care program — it combines most of the state's Medicaid services (physical health, behavioral health, pharmacy, and dental) into a single comprehensive system for Medicaid and CHIP members. Three contracted MCOs share the work, and all three are NCQA-accredited. The expansion-specific subset of Heritage Health, called Heritage Health Adult, covers the 19-to-64 adult expansion population.

The three Heritage Health MCOs

UnitedHealthcare and Nebraska Total Care also operate Highly Integrated Dual Special Needs plans (HIDE DSNPs) for members who are dually eligible for Medicaid and Medicare. The HIDE DSNPs are exempt from the external quality review by the State for the 2023-2024 reporting cycle.

What Heritage Health covers

The Heritage Health Adult benefit list (published on the Medicaid Expansion page) is also the baseline benefit set for non-expansion Medicaid members, with children receiving expanded EPSDT services on top:

• Doctor's office visits and specialist care
• Hospital visits — inpatient and outpatient
• Prescription drugs
• Dental coverage — applies to all expansion adults automatically
• Vision coverage — applies to all expansion adults automatically
• Over-the-counter drug coverage
• Behavioral health and substance-use treatment
• Maternity and pregnancy care
• Non-Emergency Medical Transportation (NEMT) through each MCO's MTM contract

Heritage Health Adult — equal benefits since October 1, 2021

Everyone eligible for Medicaid through Heritage Health Adult automatically receives equal benefits, including dental, vision, and over-the-counter medications, effective October 1, 2021. Before that date, dental, vision, and OTC coverage in the expansion track was subject to specific criteria. Today there is no separate benefit-level test — every HHA enrollee gets the full benefit package.

EPSDT for children

Children under 21 enrolled in Nebraska Medicaid receive Early and Periodic Screening, Diagnostic, and Treatment benefits — the federal mandate that covers any medically necessary service for a child. Coverage continues for a full 12 months once a child is found newly eligible (Nebraska extended children's continuous eligibility from 6 months to a full year).

Long-term services run through MLTC, not the Heritage Health MCOs

The Division of Medicaid and Long-Term Care (MLTC) administers nursing facility care and HCBS waivers separately from the Heritage Health MCO contracts. Members in long-term care or on a waiver still interact with one of the three MCOs for their primary care, but the LTSS authorization and case management run through MLTC. Call MLTC at (402) 471-3121 for long-term care questions.

Other state Medicaid pages