If you’re new to Nebraska’s system of services for people with intellectual and developmental disabilities, one of the first things you’ll hear about is “the waiver.” Nebraska has three main Medicaid waivers for individuals with IDD: the Comprehensive Developmental Disability (CDD) Waiver, the Family Support Waiver (FSW), and the Developmental Disability Adult Day (DDAD) Waiver. Each serves different needs, covers different services, and has different eligibility requirements.
What Is a Medicaid Waiver and Why Does It Matter?
Medicaid waivers allow states to “waive” certain federal Medicaid rules so they can provide home and community-based services instead of institutional care. This means individuals with disabilities can receive support in their own homes, in family-style settings, or in community programs.
In Nebraska, these waivers are how most IDD services are funded. Without waiver enrollment, families either pay out of pocket for services or go without. With waiver enrollment, Medicaid covers the cost of residential services, day programs, therapies, personal care, and many other supports.
The Three Nebraska Waivers: Overview
CDD Waiver (Comprehensive Developmental Disability Waiver) is the most comprehensive program, designed for individuals who need significant support across multiple areas of life. It covers residential services, day programs, in-home support, therapies, and more.
FSW (Family Support Waiver) is designed for individuals living with family who need support but don’t require institutional level of care. It focuses on family-centered services, skill-building, and helping families sustain caregiving at home.
DDAD Waiver (Developmental Disability Adult Day Waiver) focuses specifically on daytime services for adults with IDD. It covers day programs and limited personal care but not residential services.
CDD Waiver: Comprehensive Support for Complex Needs
The CDD waiver is Nebraska’s most robust waiver for individuals with IDD. It’s designed for people who need the level of care typically provided in an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD).
Who Qualifies for the CDD Waiver?
To be eligible, an individual must have a developmental disability diagnosed before age 22, require institutional level of care, and meet financial eligibility requirements based on the individual’s own income and resources.
What Does the CDD Waiver Cover?
Residential services including residential habilitation in group homes or shared living settings, and supported living for individuals living more independently.
Day services including day habilitation programs, prevocational services, and supported employment with job coaching.
Personal care services including LRI Personal Care where family members can provide hands-on personal care, with up to 70 hours per week available.
In-home and community support including Supported Family Living, Independent Living Services, and behavioral consultation.
Therapies including occupational therapy, physical therapy, speech-language pathology, and nursing services.
Other supports including respite care, home modifications, assistive technology, transportation, and personal emergency response systems.
CDD Waiver Waiting List
The CDD waiver typically has a waiting list because demand exceeds available funding. Nebraska does have an urgent need process for individuals in crisis.
FSW: Family-Centered Support for Home-Based Care
The FSW waiver is designed specifically for individuals with IDD who live with family and need services to support that arrangement, but don’t require the institutional level of care needed for the CDD waiver.
Who Qualifies for the FSW Waiver?
To be eligible, an individual must have a developmental disability, be living with family or in their own home, not require institutional level of care, and meet financial eligibility requirements.
What Does the FSW Waiver Cover?
In-home and community services including Supported Family Living where family members can provide in-home support and be compensated, and Independent Living Services for skill-building.
Day and community engagement including day habilitation programs, prevocational services, and supported employment.
Learning and development services including Caregiver Continuing Education, Mentorship Network, and Family Unit Support.
Respite care providing temporary relief for family caregivers.
Therapies including occupational therapy, physical therapy, speech-language pathology, and behavioral consultation.
DDAD Waiver: Focused on Daytime Services
The DDAD waiver is designed specifically for adults with IDD who need daytime services but not the comprehensive supports of the CDD waiver or the family-focused services of the FSW.
Who Qualifies for the DDAD Waiver?
The DDAD waiver is for adults (age 19 and older) with developmental disabilities who need daytime support and structure but don’t require institutional level of care.
What Does the DDAD Waiver Cover?
Day services including day habilitation, prevocational services, and supported employment. Limited personal care through LRI Personal Care with up to 25 hours per week available.
Can You Switch Between Waivers?
Yes. If someone’s needs change over time, they can transition from one waiver to another. These transitions require reassessment and coordination with your case manager.
How to Apply for Nebraska Waivers
Connect with a case manager through Nebraska DHHS Division of Developmental Disabilities. Complete the level of care assessment to determine eligibility. Gather required documentation. Your case manager submits the application. If approved, you wait for a waiver slot to become available. Once a slot is available, you work with your case manager to develop an Individual Service Plan.
Which Waiver Should You Choose?
Does your loved one need 24/7 residential support outside the family home? If yes, CDD waiver is the only option. Are you committed to keeping your loved one at home and need family-centered supports? If yes, FSW waiver is designed for this. Does your loved one primarily need daytime structure without comprehensive supports? If yes, DDAD waiver might fit.
Geographic Considerations
For CDD waiver services specifically, there are current service restrictions in Lancaster, Douglas, and Sarpy counties. DDAD and FSW waiver services are available statewide without these restrictions.
The Bottom Line
Nebraska’s three Medicaid waivers — CDD, FSW, and DDAD — provide the framework for accessing IDD services in the state. The CDD waiver is for comprehensive needs and residential services. The FSW waiver is for family-centered support at home. The DDAD waiver is for daytime services. Understanding which waiver your loved one qualifies for and which best fits your family’s needs is the first step toward getting the supports that make life manageable.
