Your guide to Home and Community Based Waivers in Nebraska
What Waivers are Available for Children and Adults with Down syndrome?
Important Changes to Nebraska Waiver Law
In recent years, Nebraska law has changed in meaningful ways that expand access to Home and Community-Based Services for children and families. Historically, many families were told to place their child on a wait list, with limited waiver options available until adulthood. For individuals with Down syndrome who did not have significant co-occurring medical needs, services were often restricted to the Day Waiver after exiting the school system at age 21, followed by the Comprehensive Waiver only after an extended wait.
That framework has changed, with the addition of the Family Support Waiver and Katie Beckett eligibility in 2024. Nebraska now offers pathways to services at much younger ages. These changes were driven by sustained advocacy alongside families who knew that waiting years for support did not reflect children’s actual needs.
We know that early intervention and direct instruction matter. Providing appropriate supports earlier helps children build skills, increase independence, and often reduces the need for more intensive services later in life. Even if you were previously told prior to 2024 that your child would not be eligible for a waiver services until adulthood, it is worth revisiting your options.
In recent years, Nebraska law has changed in meaningful ways that expand access to Home and Community-Based Services for children and families. Historically, many families were told to place their child on a wait list, with limited waiver options available until adulthood. For individuals with Down syndrome who did not have significant co-occurring medical needs, services were often restricted to the Day Waiver after exiting the school system at age 21, followed by the Comprehensive Waiver only after an extended wait.
That framework has changed, with the addition of the Family Support Waiver and Katie Beckett eligibility in 2024. Nebraska now offers pathways to services at much younger ages. These changes were driven by sustained advocacy alongside families who knew that waiting years for support did not reflect children’s actual needs.
We know that early intervention and direct instruction matter. Providing appropriate supports earlier helps children build skills, increase independence, and often reduces the need for more intensive services later in life. Even if you were previously told prior to 2024 that your child would not be eligible for a waiver services until adulthood, it is worth revisiting your options.
Eligibility and Level of Care: Guidance for Families
To be eligible for for a waiver an individual needs to have a disability and current support needs that meet a legal level of care standard. This includes needs comparable to what would be provided in an Intermediate Care Facility (ICF) or, in some cases, a nursing facility. This standard does not mean that institutional placement is appropriate or expected; it is the measure used to determine whether Medicaid-funded supports can be provided in the community .For families of young children, Medicaid waiver assessments can feel especially challenging. Many skills evaluated — such as communication, self-care, safety awareness, and behavior regulation — are still developing at early ages. Parents are often hesitant to describe delays because they know their child is learning and making progress. In school and early intervention settings, families are encouraged to focus on strengths and growth. Medicaid eligibility, however, requires a different lens.
An ICF level of care may look like the need for constant supervision, frequent prompting, hands-on assistance, or direct instruction beyond what would be expected for age. A nursing facility level of care typically reflects significant medical or physical needs requiring regular health monitoring or skilled support.
Because families naturally provide intensive support — often without realizing how much — needs can easily be underestimated. When completing assessments, parents should describe what their child needs today, not what they are expected to learn in the future, and not what is possible only because a caregiver is consistently stepping in. This checklist might help you think of areas where you child would benefit from support. Waiver Needs Checklist.
An ICF level of care may look like the need for constant supervision, frequent prompting, hands-on assistance, or direct instruction beyond what would be expected for age. A nursing facility level of care typically reflects significant medical or physical needs requiring regular health monitoring or skilled support.
Because families naturally provide intensive support — often without realizing how much — needs can easily be underestimated. When completing assessments, parents should describe what their child needs today, not what they are expected to learn in the future, and not what is possible only because a caregiver is consistently stepping in. This checklist might help you think of areas where you child would benefit from support. Waiver Needs Checklist.
Nebraska Programs
Katie Beckett
Katie Beckett allows children with disabilities to qualify for Medicaid based on their needs rather than family income, helping families access medically necessary services.
Family Support Waiver
The Family Support Waiver is a Medicaid waiver that allows eligible children under age 21 with developmental disabilities to access Medicaid and limited services
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DDAD Adult Day Waiver
The Developmental Disabilities DD Waiver is a Medicaid waiver that provides day services and employment supports for adults with developmental disabilities after they exit the school system at age 21.
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CDD Comprehensive Waiver
The DD Comprehensive Waiver is a Medicaid HCBS waiver offering comprehensive residential, day, employment, and support services for adults with developmental disabilities.
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Aged & Disabled Waiver
The Aged and Disabled Waiver is a Medicaid waiver that provides in-home and community supports for individuals of any age who have significant physical, medical, or functional needs.
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Nebraska HCBS Waiver ComparisonThis helpful DHHS document provides a side-by-side comparison of Nebraska’s Home and Community-Based Services (HCBS) waivers, including the Family Support, DD Day, DD Comprehensive, and Aged & Disabled waivers. It outlines eligibility requirements, available services, and typical uses. Please note: an individual can only participate in one waiver at a time, so this guide can help families understand which waiver best fits their child’s current needs.
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How to Apply
For Nebraska Home & Community Based Services (HCBS), your best starting point is ACCESSNebraska at (855) 632-7633, or their local numbers in Omaha (402-595-1178) / Lincoln (402-473-7000), to apply for or manage benefits, or use the new iServe Nebraska Portal online.
For immediate crisis or behavioral health concerns, call the Nebraska Family Helpline at (800) 439-2273 (24/7).
For immediate crisis or behavioral health concerns, call the Nebraska Family Helpline at (800) 439-2273 (24/7).