How Medicaid Can Help Pay for Long-Term Care in Nebraska

Q: Why would turning 65 affect my Nebraska Medicaid coverage?

If you're on Heritage Health Adult (Nebraska's ACA expansion coverage), that program has no asset test and a higher income threshold. Once you're entitled to or enrolled in Medicare — typically at 65 — you leave that group and move to aged/blind/disabled rules, which add a $4,000 asset test and a lower income standard. Plan around this transition before the birthday or Medicare enrollment date, not after.

Q: What's the difference between Nebraska's AD Waiver and PAS?

The Aged and Disabled (AD) Waiver requires a Nursing Facility Level of Care determination and offers spousal protections (a Monthly Maintenance Needs Allowance and Community Spouse Resource Allowance). Personal Assistance Services (PAS) is a separate state plan benefit that doesn't require NFLOC, but has no spousal protections and a stricter, lower income limit.

Published August 28, 2026 How we keep this accurate

This page is Nebraska-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A real transition worth planning for ahead of time

If you're currently covered under Heritage Health Adult (Nebraska's ACA expansion coverage), that program has no asset test and a higher income threshold. Once you become entitled to or enrolled in Medicare — typically at 65, sometimes earlier through disability — you leave that group entirely and move to aged/blind/disabled rules, which add a real asset test and a lower income standard.

If a birthday or Medicare enrollment is approaching for you or a family member, that's the moment to plan — not the month after. Someone with modest savings who was comfortably covered under Heritage Health Adult can suddenly face a real asset test they never had to think about before, with no change in their actual income.

A more generous asset limit for long-term care itself

Nebraska's Medicaid asset limit for long-term care is $4,000 for a single applicant — double the $2,000 federal standard most states use.

Two different paths, with a real trade-off

	Aged and Disabled (AD) Waiver	Personal Assistance Services (PAS)
Requires NFLOC?	Yes	No
2026 income limit	Higher, with spousal protections	$1,330/month (single), stricter
Spousal protections?	Yes — MMNA and CSRA apply	No

Source: Nebraska Department of Health and Human Services (DHHS); figures effective 2026.

PAS is worth knowing about if you don't meet the AD Waiver's higher level-of-care standard — it's a real option for people who need help but aren't at a full nursing-facility level of need. Just know the trade-off: no spousal protections at all if you're married.

A concrete example of the transfer penalty

Nebraska's penalty divisor is based on its average nursing home cost (approximately $7,000/month). As an example: a $100,000 uncompensated transfer produces roughly 14.3 months of ineligibility — a real illustration of why gifts or transfers within the 60-month look-back need real planning first.

If your income is over the limit

Nebraska offers a Medically Needy spend-down with a genuinely low limit — $392/month after medical expenses — over a 1-month spend-down period. This is a real, if narrow, alternative worth understanding alongside the AD Waiver and PAS pathways.

How to actually start

Apply through ACCESSNebraska at accessnebraska.ne.gov, or call DHHS at 1-855-632-7633. For the AD Waiver specifically, contact the Aging and Disability Resource Center at 1-800-942-7830 to begin the interRAI-HC functional assessment.

If you or a family member is approaching 65 while on Heritage Health Adult, plan for the transition to aged/blind/disabled rules before the birthday arrives, not after.

Common Questions

Why would turning 65 affect my Nebraska Medicaid coverage?

You move from no-asset-test expansion coverage to aged/blind/disabled rules with a real asset test, even with no change in income.

What's the difference between Nebraska's AD Waiver and PAS?

AD Waiver requires NFLOC and offers spousal protections; PAS doesn't require NFLOC but has no spousal protections and a stricter income limit.

What is Nebraska's Medicaid asset limit for long-term care?

$4,000 for a single applicant — double the $2,000 federal standard.