Self-Direction and FMS in Nebraska
All states: self-direction map
In short: No FMS vendor: participants hire independent providers who enroll in Medicaid and are paid directly by DHHS; spouses and parents of minors are limited.
Nebraska self-direction at a glance
| Self-directed programs | Self-direction in three DD waivers (CDD, DDAD and FSW). Independent provider options in the AD waiver, the TBI waiver and state plan Personal Assistance Services. |
|---|---|
| FMS model | No fiscal intermediary. The participant hires an independent provider and DHHS pays that provider directly. |
| FMS vendors | None. No program has a contracted FMS vendor. |
| Who is the employer | The participant, on the DD waivers and the AD waiver. Not confirmed for the TBI waiver. |
| Can family be paid | Yes, with limits. A spouse or the parent of a minor child can be paid only for LRI Personal Care, which is not self-directed. |
| EVV for self-directed workers | Yes. Therap app on the DD waivers, Netsmart Mobile Caregiver+ on the AD and TBI waivers and PAS. |
| Budget authority | No on the DD waivers. Not confirmed for the AD and TBI waivers. |
Last verified against state sources: 2026-10-13.
Which Medicaid programs in Nebraska offer self-direction?
Nebraska uses the word self-direction for three developmental disabilities (DD) waivers: the Comprehensive Developmental Disabilities (CDD) Waiver, the Developmental Disabilities Adult Day (DDAD) Waiver and the Family Support Waiver (FSW). In all three, the participant takes on employer duties for an independent provider, which is a person who enrolls as a Medicaid provider and works for the participant. The Aged and Disabled (AD) Waiver, the Traumatic Brain Injury (TBI) Waiver and state plan Personal Assistance Services (PAS) also use independent providers, but the Nebraska Department of Health and Human Services (DHHS) does not call those options self-direction.
- Comprehensive Developmental Disabilities (CDD) Waiver: a 1915(c) waiver that serves people of all ages with intellectual or developmental disabilities or autism. It is run by the DHHS Division of Disability and Aging (DDA). The participant has employer authority. DHHS has said the waiver does not include budget authority.
- Developmental Disabilities Adult Day (DDAD) Waiver: a 1915(c) waiver that serves adults age 21 and older with intellectual or developmental disabilities or autism. It is run by DDA. The participant has employer authority and not budget authority, on the same terms as the CDD waiver.
- Family Support Waiver (FSW): a 1915(c) waiver that serves children and youth from birth to age 21 with intellectual or developmental disabilities or autism. It is run by DDA. The family self-directs with independent providers. It has employer authority and not budget authority.
- Aged and Disabled (AD) Waiver, AD Independent Provider option: a 1915(c) waiver that serves people age 65 and older and people from birth to age 64 with physical disabilities. It is run by DDA, with service coordination through DHHS, Area Agencies on Aging and the Early Development Network. DHHS describes an AD Independent Provider as a person the participant employs, hires and supervises. We did not find a statement on budget authority.
- Traumatic Brain Injury (TBI) Waiver, independent provider option: a 1915(c) waiver that serves people age 18 and older with brain injury. It is run by DDA. DHHS publishes independent provider service codes for this waiver, but we did not find a DHHS statement that the participant is the employer, or any statement on budget authority.
- Medicaid State Plan Personal Assistance Services (PAS): state plan personal care for people of all ages with disabilities or chronic conditions. It is run by the DHHS Division of Medicaid and Long-Term Care. The state plan describes PAS as chosen and directed by the individual or a designee, and providers can be agencies or independent providers.
Employer authority means the participant recruits, hires, schedules and supervises the worker. Budget authority means the participant also manages a set amount of money and decides how to spend it. On the DD waivers, the Participant Guide to Self-Direction (July 2026) says a participant must be 19 or older to self-direct, and parents self-direct for those under 19. Services that can be self-directed include Homemaker, Independent Living, Respite, Supported Family Living, Supported Employment, Community Integration, Child Day Habilitation, Transportation, Assistive Technology and Home Modifications. Each participant has an annual budget amount set by assessment. It cannot be exceeded or carried over to the next year.
Who handles financial management services (FMS) in Nebraska?
No one. Nebraska does not have an FMS vendor or fiscal intermediary in any of these programs. The participant hires an independent provider, the provider enrolls as a Medicaid provider, and DHHS pays the provider directly on the participant's behalf. Because there is no FMS vendor, there is no vendor for participants to choose.
A fiscal intermediary is an organization that runs payroll and files employer taxes for a person who self-directs. In March 2025, DHHS told its DD Advisory Committee that the DD waivers do not include budget authority and so do not use a fiscal intermediary. DHHS also said a fiscal intermediary would be a new expense.
- Legal employer: on the DD waivers the participant accepts all employer responsibilities. On the AD waiver, DHHS describes the independent provider as a person the participant employs. DHHS's prospective provider page says independent providers are not employees of DHHS or the State of Nebraska and work for the participant.
- Enrollment: independent providers enroll as Medicaid providers through Maximus, a state contractor. DD independent providers also sign an agreement with the DDA Central Office.
- Billing and payment: DD independent providers bill in Therap, the state's billing system, and must bill within 180 days. AD and TBI waiver providers have submitted claims and received authorizations in Therap since May 1, 2025. DHHS pays the provider.
- Pay rates: on the DD waivers the participant and the independent provider agree on an hourly rate, up to a state maximum for each service. There is no automatic rate increase, and the provider must accept the Medicaid payment as payment in full.
Maximus and Therap are state contractors for enrollment and billing. They are not FMS vendors and do not act as the employer's agent. We did not find a current DHHS statement on how employment taxes are handled for independent providers. Participants and providers should ask their Service Coordinator or the Division of Disability and Aging at (402) 471-8501.
Who can be a paid caregiver under self-direction in Nebraska?
Relatives can be paid in Nebraska, but the closest family members face the tightest limits. DHHS defines a legally responsible individual (LRI) as a spouse or the natural or adoptive parent of a minor child. On the AD, TBI and DD waivers an LRI can be paid only for one service, LRI Personal Care. Rules for guardians differ by waiver.
Important: LRI Personal Care is the only way a spouse or the parent of a minor child can be paid, and DHHS says this service may not be self-directed. On the DD waivers it is available only through an agency.
- DD waivers (CDD, DDAD and FSW): a participant can hire a neighbor, friend or family member as an independent provider. The independent provider cannot be a legally responsible person, which DHHS lists as a parent of a minor, a spouse, a guardian, a conservator or a power of attorney. A legal guardian may be paid only as an employee of a DD agency provider, and only for certain services. An independent provider may not live with the participant when providing Respite, Homemaker or Home Modifications.
- AD and TBI waivers: relatives (to the third degree, including step and foster relations) and legal guardians can be paid for most services, including Personal Care, Companion, Chore and Respite. Since July 1, 2025, a legal guardian who wants to become an AD waiver provider for their ward must be related to the ward and work as an agency employee, except in limited circumstances. Guardians who were already providing services were allowed to continue.
- LRI Personal Care: the provider must be an LRI of the participant and must have a working EVV system. On the AD and TBI waivers the service has both agency and independent provider codes. DHHS says LRI staff who work for an agency are W-2 employees.
- State plan PAS: we did not find the current rule on family members as PAS providers on an official state source. Ask the DHHS Division of Medicaid and Long-Term Care before assuming a relative can or cannot be paid.
On hours, the Medicaid state plan generally limits PAS to 40 hours per client in a seven-day period unless the Medicaid Division approves more. We did not find a confirmed hours limit for LRI Personal Care. DHHS publishes the full chart in its reference on relatives, guardians and LRIs (July 2026).
Does EVV apply to self-directed workers in Nebraska?
Yes. Independent providers in Nebraska must use electronic visit verification (EVV) for the services that require it. DD waiver providers check in and out on the Therap mobile app. AD waiver, TBI waiver and PAS providers use Netsmart Mobile Caregiver+ or an approved alternate vendor. Payment depends on it, because a visit without compliant EVV cannot be billed.
- DD waivers: the Participant Guide marks which services are EVV services, for example Homemaker, Independent Living, Respite and Supported Family Living. The independent provider must check in and out on the mobile app before a claim can be submitted. The provider needs a smartphone or tablet for the app and a computer for billing.
- AD waiver: independent providers use EVV for Personal Care, Companion, in-home Respite and Extra Care for Children with Disabilities in the home. Claims without compliant EVV are not paid.
- TBI waiver: Personal Care, Companion and in-home Respite require EVV.
- State plan PAS: both agency and independent providers must use GPS verified EVV. Telephone check-in (IVR) is not allowed, and personal care that is not billed through EVV is not paid.
Living with the participant does not remove the requirement. The DHHS EVV FAQ for personal care services says live-in parent caregivers are not exempt on the AD and TBI waivers, the DD waivers or PAS. The same FAQ says a visit entered by hand gets an error that the provider cannot clear, and it cannot be submitted for payment without an adjustment request to the state (called Force Pay). It also says a caregiver may work more than 40 hours a week if the authorization allows it.
What is changing next for self-direction in Nebraska?
We did not find an upcoming change to self-direction in Nebraska as of the last check on October 13, 2026. The most recent DHHS statement we found on a fiscal intermediary is from March 12, 2025, when DHHS told its DD Advisory Committee that no request for proposals had been released and that there was no expected timeline. We did not find a later state source showing a fiscal intermediary procurement.
Several recent changes are already in effect and touch independent providers or the agencies around them:
- AD waiver renewal: the renewed Aged and Disabled Waiver took effect July 1, 2026 and runs to June 30, 2031, according to the federal waiver listing.
- Training: as of July 1, 2026, all AD and TBI waiver providers, including independent providers, must have abuse and neglect training, with 60 days to comply, according to the DHHS AD provider page.
- Agency enrollment moratorium: on October 1, 2026, DHHS placed a temporary moratorium on enrolling new agency providers in its 1915(c) waivers, effective immediately (Provider Bulletin 26-17). The bulletin names agency providers only and does not mention independent providers. Anyone planning to enroll should confirm with DHHS how it applies to them.
For the current status of any of these, start with the participant's Service Coordinator or the DHHS Division of Disability and Aging.
Get notified when Nebraska self-direction rules change
Leave your email and we will let you know when Nebraska changes its self-direction program, FMS vendors or rules. No newsletter, only changes for this state.
Who to ask about self-direction in Nebraska
Questions about self-direction in Nebraska are best put to the state. Start with Nebraska DHHS, HCBS Participant Planning (self-direction section and Participant Guide to Self-Direction). Published contact: Division of Disability and Aging, Home and Community-Based Waivers: (402) 471-8501, DHHS.DDDCommunityBasedServices@nebraska.gov (toll free (877) 667-6266).
Nebraska self-direction sources
- Nebraska DHHS: Participant Guide to Self-Direction (July 2026)
- Nebraska DHHS: How to Become an Independent Provider
- Nebraska DHHS: HCBS Prospective Provider
- Nebraska DHHS: Medicaid Aged and Disabled Waiver
- Nebraska DHHS: LRI Reference for HCBS (relatives, guardians and legally responsible individuals)
- Nebraska DHHS: DD Advisory Committee minutes and handouts, March 12, 2025
- Nebraska DHHS: EVV Personal Care Services FAQ
- Nebraska Medicaid State Plan: Item 26, Personal Assistance Services
- Nebraska DHHS: Provider Bulletin 26-17
Related reading
- Self-Directed Medicaid Home Care Services in 2026
- Understanding Self-Direction and FMS
- Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
- 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
- Self-direction in every state (map)
- Nebraska EVV requirements
Other states with state-run payroll and no FMS vendor
Mississippi. See every state on the self-direction map.
Page history
- October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.
