Nebraska Self-Directed Services for People with Disabilities

Nebraska's DD waivers don't require families to accept whatever provider agency DHHS assigns. Self-direction is an option that puts the individual (or their representative) in control of hiring, scheduling, and managing the workers who deliver waiver-funded services. For families transitioning out of the school system — where an IEP team made most service decisions — self-direction is a significant shift in both responsibility and autonomy.

What Self-Direction Means in Nebraska

Under self-directed services, the individual with a developmental disability (or their authorized representative) acts as the employer of record for their support workers. Instead of receiving services through an agency that hires, trains, and schedules staff, the individual:

• Recruits and hires their own workers
• Sets schedules that fit their life, not an agency's availability
• Trains workers on their specific needs and preferences
• Manages worker performance and can replace workers who aren't a good fit
• Directs how authorized service hours are used within the parameters of their Individualized Service Plan (ISP)

The independent provider submits billing through DHHS's systems and uses Electronic Visit Verification (EVV) when required. The individual or representative tracks the schedule and budget, while the Service Coordinator helps with authorization and the enrollment process. The individual controls the who, when, and how — but self-direction includes real administrative responsibility.

Which Waivers Offer Self-Direction

Self-direction is available under the CDD waiver for services like residential habilitation, day habilitation, and supported employment. The DDAD waiver also allows self-directed options for its daytime services. The Family Support Waiver (FSW) for children through age 21 also offers self-direction, but its $10,000 annual cap leaves less budget to manage independently.

Not every service on every waiver can be self-directed. Some specialized services (like nursing or behavioral health) may still require a licensed agency provider. The DHHS Service Coordinator can clarify which services in the ISP are eligible for self-direction.

Why Families Choose Self-Direction

Provider shortages. Nebraska's rural areas and even parts of Omaha and Lincoln have agency provider waitlists. Self-direction lets families hire neighbors, church members, college students, or extended family who are willing to work — people who would never apply to a staffing agency but are reliable and already know the individual.

Schedule flexibility. Agency-provided services often come on the agency's schedule. Self-direction means the individual's support worker shows up when the individual needs them, not when the agency has an opening.

Continuity. Agency staff turnover is chronic in disability services. Self-directed workers are personally hired and tend to stay longer because the relationship is direct, not mediated through a rotating agency roster.

Person-centered control. Self-direction aligns with person-centered planning principles. The individual isn't a passive recipient of whatever services an agency delivers — they're actively choosing who enters their home and how support is provided.

How to Start Self-Directing

1. Discuss it at the ISP meeting. Tell the DHHS Service Coordinator you want to explore self-direction for specific services. They'll explain which services are eligible and what the budget looks like.
2. Choose an independent provider. Nebraska maintains agency and independent provider options. The Service Coordinator can provide the list and explain the approval process.
3. Recruit workers. The individual or their representative finds and interviews potential support workers. Workers must meet background check requirements and any service-specific training standards.
4. Develop a service agreement. The details — hours, pay rate (within Medicaid rate guidelines), duties, expectations — are documented in an agreement between the individual and the worker, with help from the Service Coordinator.

Self-direction requires more hands-on management than agency services. The individual or their representative is responsible for finding replacements when a worker calls in sick, ensuring training requirements are met, and documenting service delivery. It's more work, but it's work that produces better-fitting support.

The Nebraska IEP Transition to Adulthood Guide covers the transition from school-managed services to self-directed adult services, including a Provider Selection Matrix for evaluating whether self-direction or agency-based services better fit your family's situation.

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