Nebraska A&D Waiver: Get Paid To Care For A Family Member

It depends. Under standard Personal Assistance Services (PAS) and standard A&D Waiver self-direction, a spouse is a "legally responsible" person and cannot be paid for ordinary, everyday care. However, Nebraska created the Legally Responsible Individual (LRI) option under the A&D Waiver specifically so a spouse can be paid when the care is intensive enough. To qualify, a state assessor uses the DD-26 tool to confirm the person needs "extraordinary care" - hands-on help that goes well beyond what a household member would normally provide, such as complex feeding, catheter care, or wound management. So the short answer is: usually no for routine help, but yes through LRI when care is extraordinary. If your spouse does not qualify under LRI, an adult child or another relative can still be hired and paid instead.

In 2026, family and independent personal care providers in Nebraska generally earn in the range of about $13 to $18 per hour, depending on the specific service and the current Medicaid fee schedule. Some families also report a monthly program cap in the neighborhood of $2,747 for a single caregiver. Because Nebraska Medicaid sets these rates and updates them periodically, treat these figures as a researched range rather than a guarantee, and confirm the exact current rate with your Service Coordinator or DHHS. Providers are usually paid as W-2 employees through a Financial Management Services (FMS) agency or enrolled provider, which withholds taxes and handles Medicaid billing. The number of hours you can bill is capped by the assessed care plan, so total monthly pay depends on both the hourly rate and your authorized hours.

Plan for roughly one to three months, and sometimes longer. If the person receiving care is not yet on Nebraska Medicaid, that application alone can take up to 90 days. After Medicaid is in place, the state assessment, care-plan development with a Service Coordinator, and provider onboarding usually add a few more weeks. The Personal Assistance Services (PAS) route can be faster because it does not require nursing-facility level of care. You can speed things up by gathering documents early: proof of Nebraska residency, identification, Social Security number, proof of income and assets, and any medical records that show the need for hands-on help. Starting the caregiver's Medicaid provider enrollment and background check as soon as possible also helps, since those steps must be complete before the first paycheck can be issued.

You do not need to be a Certified Nursing Assistant (CNA), Home Health Aide, or licensed nurse to be a paid personal care provider in Nebraska. The programs are designed so the person receiving care can choose someone they trust, and that person is trained on the specific tasks that individual needs. There are still a few requirements before pay can begin: the caregiver must enroll as a Nebraska Medicaid provider (or through the FMS/agency), pass a background check, complete employment and tax paperwork, and finish any orientation the agency requires. For the LRI option that pays a spouse or a parent, the extraordinary-care standard means the caregiver may be performing more complex tasks, so some additional documentation or task-specific instruction may be involved. Overall, though, the barrier to entry is low compared with agency home-health jobs.

Both let you self-direct and hire your own provider, including many relatives, but they work differently. The A&D Waiver is a Home & Community-Based Services waiver for people who meet a nursing-facility level of care; it funds a broad set of supports (personal care, companion, respite, meals, home modifications, adult day health) so someone can avoid a nursing home. Personal Assistance Services (PAS) is a regular Medicaid state-plan benefit that covers hands-on help with daily activities up to about 40 hours a week and does not require nursing-facility level of care. Because PAS has a lower functional threshold, it is often the quicker path for families whose loved one needs help but is not yet nursing-home eligible. Many people start with PAS and move to the A&D Waiver if needs increase. Your Service Coordinator can help you pick the right program.

In Nebraska's self-directed model, the person receiving care (or their designated representative) picks and directs the provider, but payroll runs through a Financial Management Services (FMS) agency or an enrolled provider agency. That agency acts as the employer of record for tax purposes: it issues W-2s, withholds federal and state taxes, handles Social Security and Medicare, and submits the Medicaid billing. The family's job is to approve accurate timesheets each pay period so the FMS can pay the caregiver. This split keeps the control with the family - who does the caregiving, on what schedule - while the paperwork and compliance sit with professionals. It also means the caregiver gets a real paycheck with taxes handled, rather than informal cash, which matters for things like Social Security credits and future benefits.

Yes on both counts. An adult child can be hired and paid to care for a parent under both the A&D Waiver and Personal Assistance Services (PAS) - parents are not "legally responsible" for an adult child the way spouses are for each other, so the spousal restriction does not apply to the parent-child relationship in that direction. Living in the same household as the person you care for is allowed and common; many adult children who already live with an aging parent become their paid provider. What matters is that the care is documented, the hours are authorized in the care plan, and you only bill for hours actually worked. If more than one family member wants to help, the Service Coordinator can split the authorized hours between two providers, which also helps families stay within the weekly hour cap.

No. Enrolling in the A&D Waiver, Personal Assistance Services, or the LRI option does not reduce or replace the person's other Nebraska Medicaid benefits. They keep their doctor visits, hospital coverage, prescription drugs, and other covered services. These programs are a specific personal-care benefit that sits alongside the rest of the Medicaid package. If the person is dually eligible for Medicare and Medicaid, Medicare continues to cover acute care - hospital stays, doctor visits, and short-term skilled home health - while Medicaid covers the ongoing personal care through the waiver or PAS. The programs are meant to add support, not take anything away. Just be sure the person stays within Medicaid's income and asset limits so their eligibility continues; a Service Coordinator or benefits counselor can help you keep things in order at the annual reassessment.