With its wide-open plains and prairies, Nebraska serves as a gateway between the West and the Midwest, but it’s also become a promising destination for older adults who need assisted living. The Cornhusker State claimed fourth place in our 2022 Senior Living Report, beating out neighboring states such as Colorado, Iowa and Kansas. Nebraska received top-10 rankings for health care, transportation and affordability, and the state offers plenty of opportunities for community involvement, which may increase seniors’ well-being.

Nebraska is home to nearly 320,000 adults aged 65 and older, and the state expects its senior population to increase by 36% by 2035. Fortunately, the state’s retirees are in an excellent position. Top-rated medical facilities, such as the Nebraska Medical Center and Bryan Medical Center, are located in Nebraska’s major cities. The cost of living here is about 11% lower than the national average, and this includes assisted living, which averages just $4,076 per month.

This guide is designed to help you learn more about assisted living in Nebraska, including average prices, relevant state regulations and Medicaid programs that cover these costs. You’ll also find a directory of resources that are available in your community.

The Cost of Assisted Living in Nebraska

According to Genworth Financial’s 2021 Cost of Care Survey, you can expect to pay about $4,076 per month for assisted living in Nebraska. Looking at the state as a whole, rates are about 10% lower than the national average of $4,500. Prices are moderate compared to other states in the region. Seniors in Iowa pay slightly more at $4,367. Prices in Kansas ($4,580) are just $80 higher than the national average, and seniors in Colorado pay about $675 more per month at $4,750. At $3,350, South Dakota offers a more competitive value with potential monthly savings of $726.

$4076

Nebraska

$4500

The United States

$4580

Kansas

$4750

Colorado

$3350

South Dakota

$4367

Iowa

Assisted living prices vary significantly depending on the local cost of living and the facility selected. Prices in Omaha are about $150 higher than the national average at $4,652. Lincoln and other communities in the capital area have above-average prices of $4,715 per month, which is $639 higher than the state median. Prices in Norfolk, which is included in the Sioux City, Iowa, metropolitan area, are closer to the state average at $4,148. Grand Island offers a better value at $2,906, which translates to monthly savings of $1,170 compared to other parts of the state.

$4652

Omaha

$4715

Lincoln

$2906

Grand Island

$4148

Norfolk

Assisted living is an appealing option for seniors who have moderate means, since the all-inclusive rates cover room, board and personalized care. It’s significantly more affordable than the rates for home care or home health care services, which only include labor and average $5,148 and $5,339 per month, respectively. Adult day health care costs just $1,842, and it includes limited personal assistance and some of the social and recreational activities typically provided by assisted living facilities. However, since it doesn’t include room and board, prices aren’t comparable. Nursing homes provide the highest level of care, including 24-hour medical monitoring, and charge $7,483 for semiprivate accommodations. Private rooms average $8,289 per month, which is more than double the rate charged for assisted living.

$4076

Assisted Living

$5148

Home Care

$5339

Home Health Care

$1842

Adult Day Health Care

$7483

Nursing Home Care (semiprivate)

$8289

Nursing Home (private)

Does Medicaid Cover Assisted Living in Nebraska?

Nebraska covers assisted living indirectly through its Aged and Disabled Waiver. This Home- and Community-Based Services program is an extension of Medicaid that allows the state to cover additional services that aren’t normally available to beneficiaries. Individuals must meet medical and financial eligibility criteria since services are designed to provide a community-based alternative for residents who require a nursing home level of care. Here are some of the services covered under the Aged & Disabled Waiver. Your case manager will determine which supports you need.

  • Adult day health care
  • Assisted living
  • Assistive technology
  • Companionship
  • Delivered meals
  • Emergency response systems
  • Help with errands 
  • Home modifications
  • Housekeeping and chore assistance
  • Non Medical transportation
  • Personal care
  • Respite care
  • Skills training
  • Transition from a nursing home

What Assisted Living Services Are Covered in Nebraska? 

The Aged & Disabled Waiver covers a variety of personal care services provided in assisted living facilities. However, beneficiaries are still responsible for the cost of room and board, and there may be a sliding-scale share of cost based on the applicant’s income. Here are a few of the assisted living services it covers.

  • Personal care
  • Help with daily activities
  • Health maintenance support
  • Social and recreational programs
  • Help with shopping and errands
  • Housekeeping
  • Medication reminders
  • Transportation
  • Laundry

Similar benefits may be available through the Program of All-Inclusive Care for the Elderly. This Medicare-Medicaid alternative is available to adults aged 55 and older who require a nursing home level of care and live in the greater Omaha area.

Assisted Living Waiver Programs in Nebraska

Aged and Disabled Waiver

The Aged and Disabled Waiver is the primary source of funding for Medicaid-eligible seniors who require assisted living. This program is available to individuals who meet Medicaid’s income and asset limits and who require a nursing home level of care as determined by a personal needs assessment. The state will review your medical records as part of the application process. You can apply for waiver services by completing the paper application provided by the Department of Health and Human Services. You can submit your completed form by email to DHHS.ADwaiverApp@nebraska.gov or by mail or fax to: 

AD APPLICATIONS (AD/TBI)
Division of Developmental Disabilities
Nebraska Department of Health and Human Services
301 Centennial Mall South
P.O. Box 98947
Lincoln, NE 68509-8947
Fax: (402) 328-6257

To apply by phone or to have an application mailed to you, contact the Department of Developmental Disabilities at (877) 667-6266. You can also visit your nearest Department of Health and Human Services office to ask for assistance. 

How to Know if You’re Eligible for Medicaid in Nebraska

Medicaid is a safety net program for adults and families who have limited resources and may be unable to afford insurance or medical care. For this reason, Nebraska has strict financial eligibility requirements. Income limits are the same whether you’re applying for regular Medicaid for the Aged and Disabled or long-term care benefits, including home- and community-based services and coverage for nursing homes. However, you must meet additional medical or functional needs requirements before the state will cover these supports.

For 2022, the income limit for individual applicants is $13,596 per year, and the limit for couples applying together is $18,312 per year, which is 100% of the federal poverty level. When counting assets, the state may exclude certain items, such as a car, personal effects and a home that’s occupied by you or your spouse. The state may let you use a portion of your excess income for medical bills, which can help you meet the qualification requirements.

2022 Medicaid Income Limits for Seniors in Nebraska

.

Annual Income Limits

Asset Limits

Single Applicant

$13,596

$4,000

Two-Person Household
(Only One Person Applying)

$13,596

$4,000 for applicant

$137,400 for non-applicant

Two-Person Household
(Both People Applying)

$18,312

$6,000

Medicaid is available to individuals in target groups based on their age, health needs and other factors. To qualify, you must:

  • Be a U.S. citizen or legal immigrant residing in Nebraska
  • Be aged 65 and older or have a disability or visual impairment
  • Have a need for health insurance or waiver services
  • Require a nursing facility level of care

How To Apply for Medicaid in Nebraska

The easiest way to get started is by completing an online application using the ACCESSNebraska self-service portal. This system will screen you for Medicaid and other benefits and will send your application to the relevant agency for processing. You can also complete a paper application and mail it to your   nearest DHHS office or to: 

Medicaid Eligibility Program
P.O. Box 2992
Omaha, NE 68103-2992 

For assistance with your application or to apply over the phone, call the customer service hotline at (855) 632-7633. The Area Agency on Aging serving your area can provide more information or make a referral.

Information You Will Need

If you’re aged 65 or older or are applying for services that require a disability determination, you must complete an Application for Nebraska Medicaid for the Aged and Disabled. This document asks for a variety of information about your household, income, assets and expenses, as well as consent to release your medical records. Have the following items ready when you apply. 

  • Citizenship or residency information
  • Personal details
  • Contact information
  • Social Security number
  • Date of birth
  • Previous names
  • Monthly expenses
  • Information about existing insurance coverage
  • Income and tax information
  • Assets and resources, including property
  • A list of vehicles
  • Details about any items sold or given away in the past 5 years

How to Get Help Applying for Medicaid

If you have questions about Medicaid, the easiest way to get help is by contacting the Department of Health and Human Services, which is responsible for administering the program. Senior centers, legal aid societies and Area Agencies on Aging can also provide assistance.

Resource

Contact

Service

(855) 632-7633

If you need help completing your application or would like to apply over the phone, contact the ACCESSNebraska customer service hotline for assistance. Free interpreter services are available if you require help in another language.

(402) 471-3121

To locate an office where you can apply in person or speak to a case manager, contact the DHHS switchboard. The agency’s online locator tool provides a directory of locations by county and community.

(877) 667-6266

If you've applied for Medicaid and received a notice that you aren’t eligible, you can speak to the agent who reviewed your application. You may be able to submit additional information by reapplying. You also have a right to request a fair hearing.

Does Medicare Cover Assisted Living in Nebraska?

The short answer is that no, Medicare does not cover the cost of assisted living in Nebraska. Assisted living facilities are considered to be a “residential setting” and not a “clinical setting,” (think nursing homes). While Medicare doesn’t cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Nebraska.

Other Financial Assistance Options for Assisted Living in Nebraska

Seniors who are not eligible (due to location, financial situation, or other factors) for other types of financial assistance, do still have some options. See the table below for an overview of some of the most common ways to make Assisted Living affordable.

How to Apply

How It Works

Aid and Attendance

Learn more and apply online at va.gov.

Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for Assisted Living.

Reverse Mortgages

Learn more about your options and how to apply at ftc.gov

If you own a home, you may be able to use a reverse mortgage to help pay for Assisted Living. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.

Long-Term Care (LTC) Insurance

Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.

Seniors who already have long-term care insurance may be able to use it to pay for Assisted Living. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of Assisted Living will not typically be eligible to sign up for a LTC insurance policy.

Free and Low-Cost Resources for Seniors in Nebraska

If you’re looking for information about assisted living and healthy aging, Nebraska provides a variety of free resources. The following government agencies and nonprofits can help you access financial assistance, VA benefits and long-term care needs assessments to make the transition as smooth as possible.

Resource

Contact

Service

(844) 843-6364

Nebraska has eight Area Agencies on Aging that serve seniors and disabled adults in designated counties. These agencies administer government benefits and social services to protect the health and well-being of the state’s seniors and ensure that residents have access to community-based services, including meals, transportation, recreation and personal care.

(800) 942-7830

Nebraska’s Long-Term Care Ombudsman program employs certified staff and volunteer advocates who educate seniors about their rights and provide unbiased information to older adults and their families. Ombudsmen offer consultations to help families understand their loved one's needs and choose appropriate facilities, and they work to resolve complaints against specific providers.

(800) 698-2411

The VA operates a network of hospitals, community-based outpatient clinics and vet centers that serve beneficiaries across the state. Numerous federal benefits are available to service members and their spouses, including health care, pensions and medical transportation. Individuals who require assisted living may be eligible for an additional Aid & Attendance payment that can help with the cost of long-term care. Assistance with accessing these benefits is available through the Nebraska Department of Veterans' Affairs.

(800) 772-1213

The Social Security Administration operates a network of field offices in the state’s major cities. These offices are part of the SSA’s Kansas City Regional Office, which serves beneficiaries in four states. You can manage your benefits and apply for assistance online or by contacting your local office. Key programs include Social Security retirement, disability and SSI, which includes an optional payment for beneficiaries who reside in assisted living facilities.

(888) 991-9921

This statewide legal aid society has been representing low-income residents and vulnerable adults for more than 50 years. It operates seven regional offices and provides a variety of self-help resources on its website. Attorneys focus on cases related to housing, health care, government benefits, family law and consumer rights. Staff can help you create a will or set up a power of attorney for health care or financial decisions.

(402) 471-2307

The State Unit on Aging administers programs that help older residents maintain their health and independence while aging in place. These programs are founded by the Older American Act and the Nebraska Community Aging Services Act and are administered in partnership with the state’s Area Agencies on Aging. The agency provides a comprehensive directory of local senior centers offering meals, recreational activities and social services.

(800) 234-7119

SHIP is a free federally funded service available to all current and future Medicare beneficiaries in Nebraska. Counselors provide confidential consultations to help Medicare members and their families understand the different parts of the program. They can provide an unbiased overview of plans that are available in your area to help you select the best one for your needs. Financial assistance may be available if you need help paying your premiums and co-pays.

COVID-19 Rules for Assisted Living in Nebraska

The following information is based on research done on several government websites, including dhhs.ne.gov and cdc.gov. These rules apply to nursing homes and other types of senior living facilities. We’ve most recently updated this data on 3/22/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.

Visitation Policies

Rules for Nebraska Communities

Are loved ones allowed to visit to provide emotional support?

Yes (Conditions Apply)

Are relatives allowed to visit for end-of-life care?

Yes

Are residents required to quarantine after visiting with a loved one?

No

Are visitors required to wear PPE (including masks) in order to visit residents?

Yes

Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?

Yes

Are visitors checked for elevated temperatures?

Yes

Are visitors required to answer questions about health, travel, and potential virus contact?

Yes

Outings & Social Activities

Rules for Nebraska Communities

Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?

Yes

Are residents who leave required to quarantine when they return?

No (Conditions Apply)

Are senior living communities required to cancel all group outings?

No

Are residents allowed to eat meals together in a common area?

Yes (Conditions Apply)

Are residents allowed to gather in common areas for group activites?

Yes (Conditions Apply)

COVID-19 Safety Measures for Staff and Residents

Rules for Nebraska Communities

Are staff members regularly required to do a temperature check?

Yes

Are staff members regularly tested for COVID-19?

Yes (Conditions Apply)

Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?

Yes

Are residents regularly screened for COVID-19 symptoms?

Yes

Are residents regularly checked for elevated temperatures?

Yes

Are residents regularly tested for COVID-19?

Yes (Conditions Apply)

Assisted Living Laws and Regulations in Nebraska

Nebraska has strict licensing requirements for assisted living facilities. These regulations are enforced by the Licensure Unit at the Department of Health & Human Services, Division of Public Health. Some of the most important provisions are highlighted below.

NEBRASKA LAWS AND REGULATIONS

Assisted Living Service Plan Requirements

Assisted living facilities must establish records for each resident within 5 business days of admission. Records must include personal information, medical needs, allergies and monthly documentation showing any personal assistance the facility has provided. Facilities must evaluate each resident to prepare a written service agreement that’s approved by the resident or their authorized representative.

Assisted Living Admission Requirements

Assisted living facilities may admit adults who want or require food, shelter and personal assistance due to age, disability, illness or functional limitations. Facilities may not admit residents who have complex or unpredictable medical needs that require skilled nursing care. The resident must have sufficient mental capacity to make rational decisions about their care, and the person must not pose a danger to others.

Assisted Living Scope of Care

Assisted living facilities are licensed to provide 24-hour care to four or more residents. These services include food, shelter, supervision and assistance with the activities of daily living. Additionally, facilities must provide social and recreational activities to meet residents' physical and emotional needs. Supplemental services include transportation, laundry, housekeeping, hair care, spiritual services, case management and bill pay assistance.

Assisted Living Medicaid Policy

Nebraska’s Medicaid program may pay for services provided in an assisted living facility if the applicant meets financial and medical requirements. The facility must be authorized to accept Medicaid. Help with room and board may be available for individuals who receive SSI.

Assisted Living Facility Requirements

Assisted living facilities must provide properly equipped bedrooms or apartments and common areas. For newly built facilities, rooms must include at least 80 square feet for a single resident or 60 square feet per resident if shared. Private apartments must have at least 150 square feet of living space or at least 260 square feet if shared with a companion. Additionally, the facility must provide at least one toilet for every four to six beds or one en suite bathroom per apartment as well as sufficient storage.

Medication Management Regulations

Assisted living residents may self-administer medications if they are competent. Otherwise, medications must be administered by a licensed health professional or certified medication aide. Facilities must have a registered nurse review all medication administration policies and train unlicensed medication aides. Providers must maintain detailed records of all medications they administer.

Staffing Requirements

Nebraska doesn't have a minimum staffing ratio. However, facilities must maintain a sufficient number of staff to provide personal care and supervision as described in each resident's service agreement. At least one staff member must be on-site at all times to meet residents’ personal needs. Facilities must employ a registered nurse to oversee staff training, review policies and complete other routine tasks.

Staff Training Requirements

In addition to completing a 75-hour training program to become a certified nursing assistant, direct-care staff members must complete a comprehensive orientation program within 2 weeks of employment to become familiar with the facility’s procedures. Staff must complete 12 hours of annual in-service training. Administrators are also required to complete annual continuing education after completing an initial 30-hour certification program. Additional training is required for staff who care for special populations.

Background Checks for Assisted Living

Facilities must conduct a criminal background check on all unlicensed direct-care staff at the time of hiring. This screening process includes a search of the nurse aide registry and other databases. Facilities may not employ staff who are associated with findings of abuse, neglect or misappropriation of property.

Requirements for Reporting Abuse

Facilities must establish written procedures for reporting and investigating allegations of abuse, neglect or exploitation in accordance with the Adult Protective Services Act. Reports of abuse can be made to the Department of Health Facility Investigations. Individuals can call the complaint intake line at (402) 471-0316 or Adult Protective Services at (800) 652-1999. The state also provides an online complaint form.