Key takeaway
Nebraska pays family caregivers primarily through Medicaid Home and Community-Based Services, including the Aged & Disabled Waiver and Personal Assistance Services. Veterans benefits and LTC insurance offer additional pathways.
- Medicaid: Aged & Disabled Waiver and Personal Assistance Services (PAS) can pay many family caregivers.
- Self-direction lets the participant choose and supervise their family caregiver.
- Spouses and legal guardians are generally excluded from Nebraska Medicaid paid-caregiver roles.
- Veterans benefits, including Veteran Directed Care, may pay a spouse caregiver.
Overview
Nebraska’s Department of Health and Human Services (DHHS) administers Medicaid programs that allow eligible adults to remain at home with paid in-home support. The Aged & Disabled Waiver and the Personal Assistance Services (PAS) benefit are the main routes through which family members are paid to provide care.
Both programs require an assessment confirming the care recipient meets the appropriate level of care and financial eligibility under Nebraska Medicaid. Veterans and surviving spouses can add VA benefits, and qualifying long-term care insurance can reimburse a family caregiver for in-home services.
Programs that pay family caregivers in Nebraska
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Aged & Disabled Waiver (Medicaid HCBS Waiver) | Age 65+ or 18+ with a disability; meets nursing-facility level of care; income up to 300% of SSI; assets within Medicaid limits. | Funds personal assistance, homemaker, respite, and adult day. Family caregivers other than spouses can be paid through an enrolled provider. |
| Personal Assistance Services (PAS) (Medicaid State Plan) | Medicaid-eligible adults who need help with daily activities; does not require nursing-facility level of care. | Agency-directed model. Family caregivers may be hired as agency employees; some agencies offer self-direction. |
| Developmental Disabilities Adult Day & Residential Waivers (Medicaid HCBS Waiver) | Adults with developmental or intellectual disabilities; meets ICF/IID level of care. | Funds personal supports and respite. Family caregivers may be paid in some circumstances through the participant’s service plan. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse needing help with activities of daily living and meeting VA pension rules. | Increases the monthly VA pension; can be used to pay an adult child or relative caregiver. |
| Veteran Directed Care (VDC) (VA program) | Veterans enrolled in VA health care who need nursing-facility level of care and live within a participating VAMC area. | Veteran manages a flexible monthly budget to hire caregivers, including a spouse. |
| Long-Term Care Insurance (Private) | Policy must cover in-home care and allow payment to the policyholder or a chosen caregiver. | Cash/indemnity policies can usually pay a family caregiver directly; reimbursement-style policies may require a licensed agency. |
Nebraska Medicaid programs
Nebraska Medicaid funds two primary pathways to paid family caregiving: the Aged & Disabled Waiver and the Personal Assistance Services (PAS) state plan benefit. Each follows a unique enrollment process and offers different levels of self-direction.
Aged & Disabled Waiver
This 1915(c) waiver allows Nebraskans who need a nursing-facility level of care to remain at home with personal assistance, homemaker, respite, and other supports.
- Age 65+ or 18+ with a documented disability.
- Meets nursing-facility level of care based on the DHHS assessment.
- Income limit generally 300% of SSI; assets within Medicaid limits.
- Family caregivers other than spouses and legal guardians can be paid through an enrolled provider.
Personal Assistance Services (PAS)
PAS is Nebraska Medicaid’s state plan personal care benefit. It funds in-home help with activities of daily living and instrumental activities of daily living for Medicaid-eligible adults.
- Open to Medicaid-eligible adults who need help with personal care or household tasks.
- Does not require a nursing-facility level of care.
- Agency-directed model; family members may be hired as agency employees.
- Some PAS agencies offer self-directed options for greater participant control.
Developmental Disabilities Waivers
Nebraska also operates HCBS waivers for individuals with developmental and intellectual disabilities. These can include family-delivered supports tailored to the participant’s service plan.
- Adults with documented developmental or intellectual disabilities.
- Meets ICF/IID level of care.
- Family caregivers may be paid in some cases depending on the service authorized.
State-funded options
Nebraska’s Area Agencies on Aging and DHHS coordinate state-funded supports for older adults who do not yet qualify for Medicaid. Availability depends on local funding and waitlists.
An AAA case manager assesses needs and authorizes homemaker, personal care, or respite services. Some programs allow paying a family caregiver through a contracted provider.
Programs generally follow Medicaid-style rules and exclude spouses and legal guardians from paid caregiver roles.
Who qualifies
- Nebraska residents age 60 or older.
- Households meeting state income guidelines, often tied to the federal poverty level.
- Residents in regions where the AAA has program funding available.
Veterans’ programs
Nebraska veterans and surviving spouses can fund in-home family caregiving through VA benefits. Aid & Attendance and Veteran Directed Care are the two main federal pathways.
Aid & Attendance Pension
A&A adds to a qualifying veteran’s or surviving spouse’s monthly VA pension to help cover care needs. The payment goes to the veteran, who can use it to pay a family caregiver.
- Eligibility: wartime service, limited income and assets, and a need for help with activities of daily living.
- Adult children and other relatives can be paid; a spouse cannot be paid directly because household income is combined.
- Applications go through the VA Pension Management Center.
Veteran Directed Care (VDC)
VDC may be offered through VA Nebraska-Western Iowa Health Care System facilities (Omaha, Lincoln, Grand Island). The veteran manages a flexible monthly budget to hire caregivers, including family.
- Open to veterans needing nursing-facility level of care in the VA system.
- Spouses may be paid caregivers under VDC.
- A financial management service handles payroll and reporting.
Long-term care insurance
Qualifying long-term care insurance can pay a Nebraska family caregiver for in-home services. Confirm payment rules with the insurer before relying on this option.
What to check in the policy
- Policy covers in-home personal care, not just facility-based care.
- Benefits are paid as cash or indemnity to the policyholder, who can pay the caregiver directly.
When a policy only pays licensed agencies, the family caregiver can be hired by a Nebraska-licensed home care agency that bills the insurer and pays the caregiver through payroll.
How to apply in Nebraska (step-by-step)
- Identify the most likely path: Aged & Disabled Waiver, Personal Assistance Services, VA benefits, or LTC insurance.
- Gather documents: photo ID, Social Security details, proof of Nebraska residency, income and asset records, medical history, and veteran service records if applicable.
- Contact the right agency:
- Aged & Disabled Waiver or PAS: contact your local DHHS office to request a screening and assessment.
- State-funded options: contact your Area Agency on Aging.
- VA paths: speak with a VA social worker about Aid & Attendance or VDC.
- LTC insurance: call the insurer to confirm caregiver payment rules.
- Complete the level-of-care and financial eligibility assessments.
- Choose an enrolled provider or self-direction option, select your family caregiver, and complete required training and background checks.
- Begin services, submit time sheets or electronic visit verification records, and keep care notes for periodic reviews.
Nebraska paid caregiver FAQs
Can I be paid to care for my parent in Nebraska?
Yes. Adult children are commonly paid through the Aged & Disabled Waiver and Personal Assistance Services, as well as VA programs and qualifying LTC insurance.
Can a spouse be paid as a caregiver in Nebraska?
Spouses are generally excluded from Nebraska Medicaid paid-caregiver roles. Veteran Directed Care can pay spouses when the veteran qualifies.
What is the difference between the Aged & Disabled Waiver and PAS?
The Aged & Disabled Waiver is for adults who meet a nursing-facility level of care and provides a broader service package. PAS is a state plan benefit for Medicaid enrollees who need personal care but not necessarily nursing-facility level of care.
Is there a waitlist for Nebraska Medicaid waivers?
Waitlists for the Aged & Disabled Waiver are possible depending on capacity. PAS is a state plan benefit and does not carry a waitlist for eligible enrollees.
How long does Nebraska Medicaid approval take?
After the level-of-care and financial assessments, services usually begin within several weeks once the participant selects a provider and the caregiver completes paperwork.
