Nebraska Aged and Disabled Waiver — Services, Eligibility, and Transition

Families often hear about Nebraska's developmental disability waivers — the CDD and DDAD — but the Aged and Disabled (A&D) waiver serves a different population with a different set of rules, and the overlap during transition planning trips people up.

What the A&D Waiver Covers

The Nebraska Aged and Disabled waiver is a Medicaid Home and Community-Based Services (HCBS) waiver that funds supports for individuals who are aged (65+) or who have a physical disability. It is administered by the Nebraska Department of Health and Human Services (DHHS), and its service menu includes:

• Personal assistance services (bathing, dressing, meal prep)
• Home modifications and adaptive equipment
• Adult day services
• Respite care
• Chore services
• Skilled nursing (in the home)
• Service coordination

The waiver's purpose is to keep eligible individuals in their homes and communities rather than institutional settings. Services are delivered by agency providers or through a self-directed model.

Who Qualifies

To qualify for the A&D waiver, a person must meet Nebraska Medicaid financial eligibility requirements and demonstrate a nursing-facility level of care need through a Level of Care (LOC) assessment. The disability must be physical rather than primarily intellectual or developmental — individuals with intellectual or developmental disabilities are routed to the DD waiver system (CDD, DDAD, or Family Support Waiver).

However, the lines aren't always clean. Some young adults have both physical and developmental diagnoses. When a child receiving A&D waiver services is reassessed using updated LOC tools and found ineligible to continue on the A&D waiver, DHHS provides a pathway to transfer them to a Developmental Disability waiver. This continuity-of-care policy prevents a gap in services when assessment criteria shift.

Service Coordination Transition: LHD to DHHS

Nebraska recently transitioned A&D waiver service coordination responsibilities from the League of Human Dignity (LHD) to DHHS. This change means the service coordinators who manage A&D waiver participants' care plans are now DHHS employees rather than LHD staff.

For families, the practical impact is administrative: contact information, reporting channels, and the coordinator assigned to a case may all change during the handover. The services themselves remain the same, but families should confirm their new coordinator assignment and verify that the current service plan transferred accurately.

A&D Waiver vs. DD Waivers During Transition

For families navigating the IEP transition to adulthood, the key question is which waiver system their young adult falls under. The distinction determines who manages the case, what services are available, and how eligibility is assessed:

A&D Waiver — Physical disability focus. Nursing-facility LOC standard. Service coordination through DHHS (formerly LHD). Does not require a developmental disability diagnosis under Neb. Rev. Stat. § 83-1205.

CDD/DDAD Waivers — Intellectual and developmental disability focus. ICF/IID LOC standard assessed via the interRAI tool. Service coordination through DHHS Division of Disability and Aging. Requires the § 83-1205 diagnostic criteria (severe chronic disability manifested before age 22 with substantial functional limitations in at least three areas).

If a student has a physical disability that doesn't meet the DD definition, the A&D waiver is typically the right path. If they have both, the IEP team and family should coordinate with DHHS to determine which waiver best matches the individual's service needs — and use the transfer pathway if the initial placement doesn't work.

Planning During the IEP

The IEP transition plan can document the waiver the family intends to pursue, but an IEP goal cannot compel DHHS to provide waiver services. Eligibility is determined by DHHS through clinical assessment, not by the school district. The practical step is to begin the DHHS application process well before school exit — at least two years ahead if possible — so there is time to pursue eligibility, service approval, and provider coordination before FAPE ends.

The Nebraska IEP Transition to Adulthood Guide includes a DHHS waiver comparison worksheet and a timeline tracker that maps the school district hand-off against adult service applications, helping families avoid the gap between school exit and waiver activation.

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