Nebraska Medical Assistance Program (Nebraska Medicaid ) Long Term Care Programs, Benefits & Eligibility Requirements
Summary
Medicaid’s rules, benefits and name can all vary by state. In Nebraska, Medicaid is also called the Nebraska Medical Assistance Program. This article focuses on Nebraska Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.
Nebraska Medicaid Long Term Care Programs
Nursing Home / Institutional Medicaid
Nebraska Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Nebraska seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:
- Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
- Skilled nursing care
- Physician’s visits
- Prescription medication
- Medication management
- Mental health counseling
- Social activities
Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.
Nebraska Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $75/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.
Nebraska Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.
Home and Community Based Services (HCBS) Waivers
Nebraska Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help Nebraska Medicaid recipients who require a Nursing Facility Level of Care remain, or return to, living in the community instead of residing in a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for Nebraska residents who live in their own home, the home of loved one or an assisted living residence. While Nebraska HCBS Waivers may cover long-term care benefits in those settings, it will not pay for room and board costs.
The HCBS Waiver relevant to Nebraska seniors is the Aged and Disabled Waiver.
Aged and Disabled (AD) Waiver
Nebraska’s Aged and Disabled (AD) Waiver will provide long-term care benefits to Nebraska seniors who live in their own home, the home of a loved one or an assisted living residence. It can also be used to help Nebraska Nursing Home Medicaid recipients move out of their nursing home and return to living in the community.
AD Waiver benefits include nurse services, adult day care, home/vehicle modifications, housekeeping services, assistive technologies and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on each beneficiary’s needs and circumstances.
For AD Waiver beneficiaries who are moving from a nursing home to living in their own home, the home of a loved or an assisted living residence, the Waiver will cover transition expenses like movers, utility set-up fees, deposits and basic furnishings.
Unlike Nursing Home Medicaid, the AD Waiver is not an entitlement. Instead, it has a limited number of enrollment spots (about 8,000 per year as of 2023). Once those spots are full, additional applicants are placed on a waitlist.
Aged, Blind, and Disabled Medicaid
Nebraska’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited Nebraska residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.
Nebraska ABD Medicaid beneficiaries can receive long-term care benefits through the Personal Assistance Services (PAS) program and the Program of All-Inclusive Care for the Elderly (PACE).
1. Personal Assistance Services (PAS)
Nebraska’s Personal Assistance Services (PAS) program provides long-term care benefits to Nebraska ABD Medicaid recipients who are disabled or have a chronic medical condition. To be eligible for the PAS program, individuals must need help with their Activities of Daily Living (mobility, bathing, dressing, eating, toileting). PAS program participants can live in their own home or the home of a loved one. They can also live in assisted living residences, as long as they are not already receiving personal care assistance through the residence.
Program participants can receive up to 40 hours per week of PAS services and supports. These include housekeeping tasks, meal preparation, specialized procedures (such as oxygen or insulin administration), transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). The number of hours and types of benefits will depend on each beneficiary’s needs and circumstances. PAS benefits can be delivered by a licensed caregiver, or program participants can self-direct their care by hiring caregivers of their choice. This includes family members like adult children, but spouses and legal guardians can not be hired as PAS caregivers.
Like ABD Medicaid itself, Nebraska’s PAS program is an entitlement. This means that all eligible applicants are guaranteed by law to receive the appropriate benefits.
2. Program of All-Inclusive Care for the Elderly (PACE)
Nebraska residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Nebraska’s PACE program can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. PACE Nebraska is located in Omaha. To learn more about PACE, click here.
Eligibility Criteria For Nebraska Medicaid Long Term Care Programs
To be eligible for Nebraska Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.
Nebraska Nursing Home Medicaid Eligibility Criteria
Financial Requirements
Nebraska residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Nebraska Medicaid. For a single applicant in 2024, the asset limit is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for Nebraska Nursing Home Medicaid for a single applicant is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Nebraska Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $75/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.
For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Nebraska Nursing Home Medicaid is a combined $8,000, and the income limit is a combined $1,703/month. For a married applicant with just one spouse applying, the 2024 asset limit is $4,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $1,255/month for the applicant, and the income of the non-applicant spouse is not counted.
Functional Requirements
The functional, or medical, criteria for nursing home coverage through Nebraska Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. To determine level of care need for Medicaid purposes, Nebraska uses the interRAI Home Care Tool, which considers four factors – the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting); medical conditions that require continuous care or may be unstable; risk factors such as behavior, frailty and safety; cognitive defects like those commonly seen with Alzheimer’s disease and other dementias.
Nebraska Home and Community Based Services (HCBS) Waivers Eligibility Criteria
Financial Requirements
Nebraska residents have to meet an asset limit and an income limit in order to be financially eligible for Home and Community Based Service (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in Nebraska is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for HCBS Waivers in Nebraska for a single applicant is $1,255/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.
For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in Nebraska is a combined $8,000, and the income limit is a combined $1,703/month. For a married applicant with just one spouse applying, the 2024 asset limit is $4,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $1,255/month for the applicant, and the income of the non-applicant spouse is not counted.
Functional Requirements
The functional, or medical, criteria for Home and Community Based Services (HCBS) Waivers through Nebraska Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is usually associated with a nursing home. Nebraska uses the interRAI Home Care Tool to determine if HCBS Waiver applicants require a Nursing Facility Level of Care. Four factors are considered – the applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting); medical conditions that require continuous care or may be unstable; risk factors such as behavior, frailty and safety; cognitive defects like those commonly seen with Alzheimer’s disease and other dementias.
Nebraska Aged, Blind, and Disabled Medicaid Eligibility Criteria
Financial Requirements
Nebraska residents have to meet an asset limit and an income limit in order to be financially eligible for Aged Blind and Disabled (ABD) Medicaid. For a single applicant in 2024, the asset limit is $4,000, which means they must have $4,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.
The 2024 income limit for a single applicant is $1,255/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.
For married applicants, the 2024 asset limit for ABD Medicaid through Nebraska Medicaid is a combined $6,000, and the income limit is a combined $1,703/month. This applies to married couples with both spouses applying or with just one spouse applying.
Functional Requirements
The only functional requirement to receive basic healthcare coverage through Nebraska ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.
How Nebraska Medicaid Treats the Home for Eligibility Purposes
One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:
- If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
- If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
- If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.
These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.
Nebraska Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Nebraska and how you can protect your home from it, click here.
Applying For Nebraska Medicaid Long Term Care Programs
The first step in applying for Nebraska Medicaid Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Service (HCBS) Waivers or Aged Blind and Disabled (ABD) Medicaid.
The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Nebraska Medicaid when not financially eligible will result in the application, and benefits, being denied.
During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Nebraska Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.
After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Nebraska residents can apply online at ACCESS Nebraska. They can also apply over the phone by calling the Department of Health and Human Services at 855-632-7633, or by calling their local Public Assistance Office.
For a comprehensive guide that will take you through the application process for all three types of Medicaid Long Term Care, click on the program you want: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.
Choosing a Nebraska Medicaid Nursing Home
After being approved for nursing home coverage through Nebraska Medicaid, a senior needs to choose which Medicaid-accepting nursing home best fits their needs and situation. Even though Nebraska Medicaid nursing home coverage is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available spaces. Finding the right nursing home can be a challenge, especially if you’re looking in a specific area.
Nebraska has about 180 total nursing homes that accept Medicaid, and they are spread throughout the state with some clusters around the largest cities. There are roughly 20 nursing homes that take Medicaid within 10 miles of Omaha, which includes Bellevue and Papillion. There are about 20 more nursing homes a little further west in Lincoln. The choices narrow from there, with a dozen or so facilities in the Grand Island area and just four around North Platte.
Residents in some Nebraska communities may cross the state line on a regular basis for personal or business reasons, including healthcare. Medicaid coverage, however, does not cross state lines. So, someone with Nebraska Medicaid would not be covered for a stay in a nursing home in Council Bluffs, Iowa, for example, even that facility is well-suited and convenient for the Nebraska Medicaid beneficiary.
When you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you can be a great source of information. You can also contact your local Area Agency on Aging find out more information about nursing homes in the state.
After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: Does the residence offer social activities? How does it help residents with vision and dental care? Who are the staff doctors? What is the food like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.
Data collected by CMS from 2019-2022 shows that Nebraska nursing homes are near the national averages when it comes to health standards and fire safety. The data also shows that only 4% of residents in Nebraska nursing homes have depressive symptoms, which is less than half the national average of 8.1%. On the other hand, 4.7% of residents in Nebraska nursing homes experienced a major fall with an injury during that time frame, which is noticeably more than the national average of 3.4%.