I/DD Waivers in Nebraska

All states: Medicaid disability services map

Nebraska I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in Nebraska?

The Nebraska Department of Health and Human Services (DHHS) runs I/DD services. Its Division of Disability and Aging (DDA) operates the three developmental disability (DD) waivers, under the oversight of the DHHS Division of Medicaid and Long-Term Care (MLTC), the state Medicaid agency. DHHS also employs the service coordinators who plan each person's services, so there are no county boards or regional centers in this role.

• Division of Disability and Aging (DDA): until July 2026 this was the Division of Developmental Disabilities (DDD). The name changed under LB733, a 2026 state law, and many state documents still say DDD. The division certifies DD provider agencies, publishes the DD fee schedule and runs the waivers day to day.
• Division of Medicaid and Long-Term Care (MLTC): the Medicaid agency that the DD waivers operate under.
• Front door: people apply to DHHS for a home and community-based services (HCBS) waiver. See HCBS Waiver Eligibility for how to apply.
• Case management: DHHS service coordinators write the person-centered plan, make monthly contact and prior authorize services. Service coordination is paid as a Medicaid state plan targeted case management service, not as a waiver service. DHHS eligibility staff complete the level of care assessments.

What Medicaid waivers and programs serve people with I/DD in Nebraska?

Nebraska has three 1915(c) waivers for people with intellectual or developmental disabilities or autism. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The Comprehensive Developmental Disabilities (CDD) waiver serves all ages and is the only one with residential services. The DD Adult Day (DDAD) waiver serves adults, and the Family Support Waiver (FSW) serves children living with family.

• Comprehensive Developmental Disabilities Services Waiver (CDD) (control number NE.4154): serves people of any age with an intellectual or developmental disability or autism who meet the state's DD definition and intermediate care facility level of care. It covers up to 5,700 people in waiver year 5. Services include residential (Continuous Home, Youth Continuous Home, Host Home and Shared Living), day services (Day Supports, Community Integration, Adult Day and Child Day Habilitation), employment services (Prevocational, Small Group Vocational Support, Supported Employment, Employment Exploration and Benefits Counseling), in-home supports (Independent Living, Supported Family Living, Homemaker, Medical and Behavioral In-Home Habilitation and personal care by a legally responsible individual, called LRI Personal Care), respite, remote supports, assistive technology, home and vehicle modifications and transportation. Combined day services are capped at 1,820 hours a year.
• Developmental Disabilities Day Services Waiver for Adults (DD Adult Day, or DDAD) (control number NE.0394): serves adults 21 and older who meet the same level of care, with a focus on competitive integrated employment (a regular job in the community at regular pay). It covers 1,055 people per waiver year. It offers the same day, employment and in-home services as CDD, plus respite and related supports, but no residential services.
• Family Support Waiver (FSW) (control number NE.2366): serves children and youth from birth to 21 with an intellectual or developmental disability who live with their family and meet the same level of care. It began March 1, 2024 for up to 975 children in years 2 and 3. Each participant has a flat annual budget of $10,000. Services include respite, Child Day Habilitation, Community Integration, Day Supports, Homemaker, Independent Living, Supported Family Living, family and peer mentoring, family caregiver training, assistive technology, modifications and transportation.

The CDD and DDAD waivers were last amended on July 1, 2026. That amendment ended the Consultative Assessment service and replaced semi-annual team meetings with annual meetings. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), including the state-run Beatrice State Developmental Center, remain the institutional option that the waivers are an alternative to. Nebraska also has a Traumatic Brain Injury waiver, which serves adults with brain injury and is not counted here as an I/DD waiver.

Does Nebraska pay for I/DD services through managed care?

No. DD waiver services are carved out of Heritage Health, Nebraska's Medicaid managed care program, and DHHS pays them directly on a fee-for-service basis. Waiver participants still get their physical health, behavioral health and pharmacy benefits from a Heritage Health plan.

• Who pays claims: DHHS, using the statewide DD fee schedule. The Heritage Health provider FAQ says home and community-based services and long-term care, including HCBS waiver services and ICF/DD care, are paid through fee-for-service rather than the health plans.
• Heritage Health plans: Molina, Nebraska Total Care and UnitedHealthcare. They do not authorize or pay DD waiver services.
• Who coordinates services: DHHS service coordinators, not health plan care managers.

Is there a waiting list for I/DD services in Nebraska?

No. Nebraska ended its DD waiting list in June 2025, and the CDD and DDAD waivers approved for July 1, 2026 both state that Nebraska does not have a waiting list. The governor announced that 2,706 people were on the list in March 2024 and that more than 3,000 people received offer letters over the next 15 months.

• Source of the finding: the governor's June 23, 2025 release and the text of the approved CDD and DDAD waivers. We could not open the DHHS DD Wait List page itself.
• If a list were needed again: the CDD waiver says applicants would be prioritized under Neb. Rev. Stat. 83-1216, the state law on DD service priorities. The waiver says a list is not expected to be needed.
• Family Support Waiver: we did not find a separate statement on whether the FSW keeps a waiting list. Families can ask DHHS at (877) 667-6266.

How do people apply for I/DD services in Nebraska, and how are budgets set?

People apply to DHHS for an HCBS waiver, online through iServe Nebraska or on paper form DD-10. DHHS decides DD eligibility, usually within 90 days of getting the application and documents. Since July 1, 2025 DHHS uses interRAI assessments to set level of care and, for CDD and DDAD, an individual budget amount in one of five tiers.

• How to apply: apply online through iServe Nebraska, or send form DD-10 by mail (HCBS Waiver Eligibility, PO Box 98947, Lincoln NE 68509-8947), email (DHHS.HCBSWaiverApp@nebraska.gov) or fax. Call (877) 667-6266 for a mailed application or visit a local DHHS office for help. A separate Medicaid application is needed if the person does not already have Medicaid.
• Eligibility: Nebraska Medicaid, a developmental disability as defined in Neb. Rev. Stat. 83-1205 (limits in intellectual, social and practical skills), intermediate care facility level of care and a need for waiver services. DHHS collects psychologist assessments, school multidisciplinary team reports and the individualized education program (IEP). DD eligibility is reviewed at ages 10 and 18, and a process exists so parent income is not counted for children who meet waiver eligibility.
• Assessment tool: the interRAI Intellectual Disability (ID) assessment for adults and the interRAI ChYMH-DD for children and youth. They replaced the Developmental Index and the ICAP on July 1, 2025. The assessment is done every year, 60 to 90 days before the budget year, and is used for level of care, choice of waiver, the budget and service planning. DHHS says about 80 percent of participants kept or increased their funding level after the switch.
• Budget tiers (CDD and DDAD): Basic, Intermediate, High, Advanced and Risk, tied to interRAI case-mix index ranges (Basic .45 to .75, Intermediate .76 to 1.23, High 1.24 to 1.5, Advanced 1.51 to 2.01). The Risk tier is set through an exception process, and exception reviews are available when needs go beyond the tier.
• Family Support Waiver budget: a flat $10,000 a year per participant.
• Self-direction: participants in all three waivers can choose independent providers. An independent provider agrees an hourly rate with the participant, up to the state maximum, and is paid by DHHS.

What day and residential services can I/DD providers offer in Nebraska?

DD agencies certified by DHHS can offer hourly day and employment services under all three waivers and daily-rate residential services under the CDD waiver. Certification is under the Developmental Disabilities Services Act (Neb. Rev. Stat. 83-1201 to 83-1226), and certified DD programs are exempt from adult day licensure. Most rates are tiered by assessed need, and some are set by staff ratio.

Day and employment services

• Day Supports (CDD, DDAD, FSW): habilitation in a provider-owned or controlled non-residential setting for people without a current job goal, covering self-help, social, behavioral and daily living skills, personal care and supervision. Up to 10 hours a week may be virtual. Billed hourly ($10.39 at Basic to $45.42 at Advanced as of July 1, 2026). The research did not find a published staff ratio.
• Community Integration (CDD, DDAD, FSW): habilitation delivered in the community that builds skills and supports regular community activities. Billed hourly, by a certified agency or an enrolled independent provider. The research did not find a published staff ratio.
• Adult Day (CDD, DDAD): a non-habilitative service for people 21 and older, with meaningful day activities, help with daily living and supervision in a community setting. Billed hourly (service code 6221, $10.84 maximum from July 1, 2026). The research did not find a published staff ratio.
• Child Day Habilitation (CDD, FSW): habilitation for children after school, in summer and during school breaks, not during school hours. Billed hourly. The research did not find a published staff ratio.
• Prevocational (CDD, DDAD): teaches general work skills that lead toward a regular community job, mostly in the community. Billed hourly, with rates for individual (1:1), small group (1:2 to 1:3) and large group (1:4 to 1:5).
• Small Group Vocational Support and Supported Employment (CDD, DDAD): Small Group Vocational Support serves teams of 2 to 5 people at a community business or on a mobile crew. Supported Employment (Individual and Follow Along) helps a person get and keep an individual job and can also be delivered by independent providers. Both are billed hourly.

All day services combined are capped at 1,820 hours a year.

Residential and in-home services

• Continuous Home and Youth Continuous Home (CDD): a provider-owned, leased or controlled home staffed by agency shift staff who do not live there. Paid a daily rate when staff are present 10 or more hours in a day and half the rate for less (Continuous Home ranges from $220.32 a day at Basic to $862.32 at Risk as of July 1, 2026). Youth Continuous Home is for participants 18 and under when the planning team chooses it. The agency must complete a self-assessment at least 15 business days before opening a new residential setting.
• Host Home (CDD): the person lives in the private home of an individual, couple or family employed by the DD agency. Daily rate, tiered by need.
• Shared Living (CDD): the person lives in the private home of an individual, couple or family who are independent contractors of the DD agency. Shared Living providers complete a home study survey and training. Daily rate, tiered by need.
• Independent Living and Supported Family Living (CDD, DDAD, FSW): hourly habilitation in the person's own home or family home, by a certified agency or an enrolled independent provider, with rates by staff ratio (1:1 to 1:3). These services require electronic visit verification (EVV).
• ICF/IID: outside the waivers, intermediate care facilities are licensed under 175 NAC, Nebraska's health care facility licensure rules, and paid fee-for-service.

How are I/DD provider rates set and how do agencies enroll in Nebraska?

DHHS publishes one statewide DD fee schedule of maximum rates for all three waivers. The current DD Fee Schedule took effect July 1, 2026, and the rates we sampled are the same as on the July 1, 2025 schedule, so we did not find a general rate increase for 2026. Agencies must be certified by DHHS and enrolled in Medicaid, but DHHS paused new waiver agency enrollment on October 1, 2026.

• How rates are set: the CDD waiver says the division's central office sets rates with stakeholder input, reviews them every year and completes full rate determinations every five years. Residential and most day rates are tiered by assessed need (FSW, Basic, Intermediate, High, Advanced and Risk). Prevocational, Independent Living, Supported Family Living and respite rates are set by staff ratio.
• Example rates as of July 1, 2026: Continuous Home $220.32 (Basic) to $862.32 (Risk) a day, Day Support $10.39 (Basic) to $45.42 (Advanced) an hour and Adult Day $10.84 an hour.
• Independent providers: agree an hourly rate with the participant, up to the state maximum.
• Enrollment: agencies must be certified by DHHS under the Developmental Disabilities Services Act and enrolled as Nebraska Medicaid providers. Details are on the DHHS DD Providers page. DD Provider Relations can be reached at DHHS.DDProviderRelations@nebraska.gov.
• EVV: Independent Living, Supported Family Living, Respite, Homemaker and LRI Personal Care require EVV. Providers clock in and out in the Therap app or an approved alternate vendor, and Netsmart is the state aggregator. Since February 19, 2025, visits without GPS or approved phone (IVR) verification cannot be billed without a Force Pay request to the state. Residential and day services are not on the EVV service code list.

What is changing next for I/DD services in Nebraska?

Three things are in motion as of October 23, 2026. DHHS paused enrollment of new waiver agency providers on October 1, 2026, it plans an independent review of its interRAI-based budgets, and the Family Support Waiver's first approval ends in February 2027. None of these has a confirmed outcome or end date yet.

• Agency enrollment pause: the temporary moratorium on new HCBS 1915(c) agency providers began October 1, 2026. We did not find an end date or a statement on whether it covers DD agency certification.
• interRAI evaluation: on August 31, 2026 DHHS said it would use a formal request for proposals (RFP) to pick an independent firm to evaluate how it uses the interRAI to set budgets. This replaced a no-bid contract it had announced on August 18. No timeline has been published, and it is not known whether the review will change the budget tiers.
• Family Support Waiver renewal: the waiver's first three-year approval began March 1, 2024, so a renewal is due before it ends in February 2027. We did not find a renewal draft on the DDA public comment page as of October 23, 2026. Watch that page for any change to the $10,000 budget or the number of slots.

Recent changes already in place: the division was renamed the Division of Disability and Aging in July 2026, and the July 1, 2026 CDD and DDAD amendments ended Consultative Assessment and moved team meetings to once a year.

Nebraska I/DD sources

• Nebraska DHHS: Division of Disability and Aging
• Nebraska DHHS: Comprehensive Developmental Disabilities Services Waiver NE.4154.R07.03 (effective July 1, 2026)
• Nebraska DHHS: DD Adult Day Waiver NE.0394.R04.03 (effective July 1, 2026)
• CMS approval letter: Family Support Waiver NE.2366.R00.00
• Office of the Governor: DD waitlist eliminated (June 23, 2025)
• Nebraska DHHS: HCBS Waiver Eligibility
• Nebraska DHHS: interRAI
• Nebraska DHHS: DD Fee Schedule effective July 1, 2026
• Nebraska DHHS: Heritage Health Provider FAQ
• Nebraska Medicaid Provider Bulletin 26-17 (October 1, 2026)

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Nebraska EVV requirements

Other states that report no I/DD waiting list

California, Hawaii, Minnesota, Wisconsin. See every state on the I/DD services map.

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.