Nebraska Paid Family Caregiver for Disability — Waiver Rules and Hours

Most Nebraska families caring for a child or adult with intellectual or developmental disabilities don't know the state's Medicaid waivers can pay them for the caregiving they're already doing. The rules vary by waiver, the hours are capped differently, and there are restrictions on which family members qualify — but the option exists, and it's particularly relevant during the transition years when professional provider shortages make family-delivered care the only realistic option in many parts of the state.

Which Waivers Allow Paid Family Caregivers

Two of Nebraska's three DD waivers include provisions for paid family caregiving:

Family Support Waiver (FSW) — ages birth through 21: Parents of minor children and other legally responsible individuals (LRIs) can be paid for providing certain waiver services. The FSW has a strict $10,000 annual budget cap across all services, so paid caregiver hours are limited — typically 5 to 10 hours per week depending on other service utilization. The waiver funds respite, child day habilitation, homemaker services, and other supports, and the paid caregiver hours come from this same capped pool.

Comprehensive Developmental Disabilities (CDD) Waiver — all ages: The CDD waiver allows paid family caregivers for services like residential habilitation and supported employment. CDD authorizations can reach up to 70 hours per week for the most intensive support needs, though actual hours are determined by the individual's Individualized Service Plan (ISP) and Level of Care assessment. This is the waiver that covers 24-hour residential habilitation, so caregiver hours reflect the individual's full support needs.

DDAD Waiver — age 21+: The DDAD waiver covers daytime habilitation and employment supports but doesn't include the same residential caregiving structure. Family members may be able to provide some authorized services depending on DHHS policy, but it's more limited than CDD.

Who Can Be a Paid Caregiver

Not every family member automatically qualifies. DHHS rules distinguish between:

• Legally responsible individuals (LRIs): Parents of minor children and court-appointed guardians. LRIs can provide certain services under specific conditions, but there are restrictions — the services must be beyond what a typical parent would provide for a child of the same age without a disability.
• Non-LRI family members: Spouses, adult children, siblings, and other relatives who are not legally responsible for the individual. These family members generally have broader eligibility to serve as paid providers.

All paid family caregivers must meet provider qualifications, which typically include background checks, training requirements, and enrollment as a Medicaid provider through DHHS or an enrolled provider agency, as applicable.

How to Set It Up

1. Confirm waiver enrollment. The individual must be actively enrolled in the FSW or CDD waiver with an approved ISP.
2. Identify the services. Work with the DHHS Service Coordinator to determine which services the family member will provide. The ISP must specifically authorize family-delivered services.
3. Enroll as a provider. The family member completes the DHHS independent-provider or agency-provider enrollment process, as applicable. This includes a background check, orientation training, and any service-specific training requirements.
4. Document hours. Paid caregivers track and submit hours according to the applicable DHHS or provider billing procedures. Documentation must reflect actual services delivered, not general supervisory presence.

The Provider Shortage Context

Nebraska's provider shortage makes paid family caregiving more than a financial benefit — it's often the only way to activate a waiver. After the state eliminated the DD waiting list in June 2025, many families received offer letters but couldn't find agencies with staff to deliver services. In rural areas especially, professional providers are scarce.

Paying family members to deliver authorized services can help the individual receive support and compensates families for work that would otherwise go unpaid. It doesn't replace professional services entirely, but it fills gaps that would otherwise leave the individual without any support.

The Nebraska IEP Transition to Adulthood Guide includes a Paid Family Caregiver Log with hour-tracking worksheets and a breakdown of approved service categories under each waiver.

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