Following a detailed review and extensive public input, the Nebraska Department of Health and Human Services (DHHS) announced key updates to the Aged and Disabled (AD) and Traumatic Brain Injury (TBI) Waivers aimed at improving access to services and strengthening support for families caring for older adults and individuals with disabilities.
A major update in the revised waiver draft submitted to the Centers for Medicare & Medicaid Services (CMS) allows participants using in-home and out-of-home providers to request exceptions to cost limits. This change supports individuals in receiving care in the setting that best fits their needs.
“These changes reflect the state’s commitment to balancing access to supports and the ability to offer a sustainable waiver program,” said Tony Green, Director of DDD. “We closely reviewed the input received from individuals, families, and providers and adjusted the waiver to fit the needs of those we serve. We are also continuing to ensure that the cost of services are driven by needs assessments and clinical reviews.”
Previously, the proposed waiver set a cost limit at 150% of the average nursing facility rate. Although exceptions were allowed through a Developmental Disabilities Clinical Team review, the waiver did not clearly explain how those exceptions would apply when using only in-home providers or a mix of in-home and out-of-home services.
Under the updated waiver, participants using both in-home and out-of-home providers can request a threshold exemption. These requests will continue to be based on assessed needs and clinical evaluations.
A Developmental Disabilities Clinical Team made up of medical experts, behavioral clinicians, and caseworkers will review all exception requests to the 150% cost threshold.
The team will assess complex medical and support needs, evaluate health and safety risks, and determine appropriate levels of care based on each individual’s situation. This process is designed to ensure decisions remain consistent, clinically sound, and focused on participant well-being.
The AD Waiver is a Home and Community-Based Services (HCBS) program that enables older adults and individuals with disabilities to receive long-term care in their homes or communities instead of institutional settings. DHHS has continued to propose updates in response to rising costs, which have increased by more than 300% since 2016.
These revisions will not undergo another public review period.
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