Nebraska · waiver service
Aged and Disabled (AD) Waiver in Nebraska
The Aged and Disabled (AD) Waiver is a Nebraska Medicaid home and community-based waiver for people 65 and older and people of any age with a disability who need nursing-home level of care but want to stay home. It covers services like personal care, companion, chore, respite and adult day health. Relatives such as adult children can be hired as paid providers for most services, and a spouse or the parent of a minor child can be paid only through a narrow service called LRI Personal Care, which requires 'extraordinary care' needs, is capped at 40 hours a week, and is normally done through an agency.
Also called: AD Waiver · Nebraska AD Waiver · HCBS Waiver for Aged and Adults and Children with Disabilities · LRI Personal Care Nebraska
Who do you care for?
Quick facts
- Pay
- Rate negotiated per provider
- Adult children & other relatives
- Yes
- Spouse
- Sometimes
- Parent of a minor child
- Sometimes
- Waitlist
- possible
Who qualifies for Aged and Disabled (AD) Waiver
- You have Nebraska Medicaid (DHHS checks this first).
- You are 65 or older, or you have a disability (children and adults can both qualify).
- You meet Nursing Facility Level of Care on a DHHS assessment of daily living tasks, health, memory and support.
- You need waiver services to live safely at home or in the community.
- For a disabled child, DHHS says parental income is not counted for waiver-eligible children.
Who can be paid as the caregiver
- Adult children & other relatives Yes
- DHHS's July 2026 provider chart lets relatives (blood or marriage, to the third degree) provide Personal Care, Companion, Chore, Respite, Adult Day Health and most other AD services.
- Spouse Sometimes
- a spouse can only be paid for LRI Personal Care, and only if the participant meets Nebraska's Extraordinary Care test; capped at 40 hours a week and normally as an agency employee.
- Parent of a minor child Sometimes
- a parent of a minor child can only be paid for LRI Personal Care under the same Extraordinary Care test, 40-hour weekly cap and agency rule; it cannot happen during school hours.
- Living together
- relatives can live with you or apart; LRI Personal Care is by nature given by a spouse or parent in the household.
Who employs the caregiver: Either for most services: you can hire an AD Independent Provider you choose and supervise (they enroll with Medicaid and pass background checks), use an AD Agency Provider, or use an assisted living facility. LRI Personal Care may not be self-directed: the spouse or parent must work through an agency except in limited cases.
Spouse rules differ by program — see spouse pay in Nebraska.
How much Aged and Disabled (AD) Waiver pays
Rate negotiated per provider. DHHS does not publish one flat family-caregiver rate. The LRI Personal Care service summary (July 2026) says rates are set for each provider through negotiation with a DHHS Resource Developer, reviewed every year, and may not exceed what the provider charges private-pay clients; services are authorized hourly. Testimony on 2025 bill LB486 confirmed AD Waiver personal care providers individually negotiate their rates. Paid by Nebraska Medicaid to the enrolled provider or agency.
Hours and budget: Your Service Coordinator builds a person-centered plan from your assessment and authorizes each service. For LRI Personal Care, the coordinator scores the Extraordinary Care Tool (DD-26) every year; you must score 'yes' in at least three need areas, only those tasks count, and total LRI Personal Care cannot go over 40 hours a week. In January 2026 the Governor directed DHHS to drop a proposed 40-hour cap on live-in personal care and a 70-hour combined cap on LRI personal care and companion services from the waiver renewal.
Compare with other Nebraska programs on the Nebraska caregiver pay page, or across states in pay rates by state.
Is there a waitlist?
The AD Waiver has a federally approved yearly participant cap, so a wait is possible if slots fill. DHHS's current AD Waiver and eligibility pages do not mention an active waitlist.
How to apply for Aged and Disabled (AD) Waiver
- Apply online at iServe Nebraska (iserve.nebraska.gov), or print the DD-10 waiver application, or call (877) 667-6266 to have one mailed.
- Send the signed application by mail to HCBS Waiver Eligibility, PO Box 98947, Lincoln NE 68509-8947, by email to DHHS.HCBSWaiverApp@nebraska.gov, or by fax to (402) 328-6257.
- Apply for Medicaid too if you do not have it. Once you have Medicaid, DHHS calls to schedule the level-of-care assessment.
- Choose a Service Coordinator (DHHS office for any age, Area Agency on Aging for 65+, or Early Development Network for birth to 3) and build your person-centered plan, naming any relative you want hired.
- HCBS Waiver Eligibility (toll-free) · (877) 667-6266 · official site
- Nebraska DHHS (main line) · (402) 471-3121 · official site
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Aged and Disabled (AD) Waiver questions
Can a spouse get paid as a caregiver on the Nebraska AD Waiver?
Only through LRI Personal Care. The person must meet Nebraska's Extraordinary Care test (a 'yes' in at least three areas of hands-on need), pay is capped at 40 hours a week, and the spouse normally must be employed by an agency.
Can parents be paid to care for their disabled child in Nebraska?
Yes, in limited cases. A parent of a minor can be paid for LRI Personal Care on the AD Waiver if the child meets the Extraordinary Care test. It is capped at 40 hours a week, cannot be billed during school hours or while the parent works another job, and is usually through an agency.
Can my adult daughter be my paid caregiver on the AD Waiver?
Yes. Relatives who are not your spouse can provide Personal Care, Companion, Chore, Respite and most other AD services, either as an enrolled independent provider or through an agency.
How much does the Nebraska AD Waiver pay family caregivers?
There is no single published rate. DHHS sets rates provider by provider through negotiation, reviews them yearly, and caps them at the provider's private-pay rate.
What changed in the 2026 AD Waiver renewal?
In January 2026 DHHS dropped proposals for a 40-hour weekly cap on live-in personal care and a 70-hour combined cap on LRI personal care and companion services, after public comment. A second comment period ran February 2 to March 4, 2026.
Who can qualify for the AD Waiver?
Nebraska Medicaid members who are 65 or older or have a disability, meet nursing-facility level of care, and need waiver services to stay home.
Sources: dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · dhhs.ne.gov · medicaidplanningassistance.org · Updated 2026-10-08. Program rules change — always confirm with the program.
Where most Nebraska caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in Nebraska — pick yours for the local picture.
Across the line
States that border Nebraska
Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.