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." Someone will tell you that your loved one needs to "get on the waiver" to access services. Your case manager will ask which waiver you're pursuing. Forms will reference waiver programs without explaining what they actually are.

And you'll probably feel completely lost.

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.

Understanding which waiver your loved one qualifies for and which one best fits your family's situation is the foundation of accessing services in Nebraska. This guide breaks down all three waivers, explains what they cover, who they're designed for, and how to navigate the system.

What Is a Medicaid Waiver and Why Does It Matter?

Before diving into the specific waivers, it helps to understand what a Medicaid waiver actually is and why Nebraska uses this system.

Traditionally, Medicaid only pays for institutional care — nursing homes, hospitals, and facilities. If someone needed long-term care and support, they had to live in an institution to access Medicaid funding.

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 rather than being forced into institutions to get the services they need.

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 waiver you're enrolled in determines what services are available, how many hours can be authorized, and what level of support your loved one can access.

The Three Nebraska Waivers: Overview

Nebraska offers three main waivers for individuals with intellectual and developmental disabilities:

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. It requires meeting institutional level of care criteria.

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 or comprehensive supports.

Each waiver serves a specific population and need. Some people clearly qualify for only one. Others might be eligible for multiple waivers and have to choose which best fits their situation.

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 institutional setting — specifically, an Intermediate Care Facility for Individuals with Developmental Disabilities (ICF/DD).

Who Qualifies for the CDD Waiver?

To be eligible for the CDD waiver, 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.

The "institutional level of care" requirement is key. This means the person needs significant support with activities of daily living, health and safety supervision, or behavioral management. It's the waiver for individuals with more intensive needs.

What Does the CDD Waiver Cover?

The CDD waiver offers the widest range of services:

Residential services including residential habilitation in group homes or shared living settings, and supported living for individuals living more independently with support.

Day services including day habilitation programs, prevocational services to prepare for work, and supported employment with job coaching.

Personal care services including LRI Personal Care where family members can provide hands-on personal care for individuals meeting Extraordinary Care criteria, with up to 70 hours per week available.

In-home and community support including Supported Family Living for in-home skill-building that can be provided by family members, Independent Living Services focused on developing independence skills, and behavioral consultation for individuals with challenging behaviors.

Therapies including occupational therapy, physical therapy, speech-language pathology, and nursing services.

Other supports including respite care for family caregiver relief, home modifications to accommodate disabilities, assistive technology, transportation, and personal emergency response systems.

The CDD waiver is designed to provide comprehensive support across residential, day, health, and family support needs.

CDD Waiver Waiting List

The CDD waiver typically has a waiting list because demand exceeds available funding. Even when approved as eligible, families may wait months or years before services begin.

Nebraska does have an urgent need process for individuals in crisis — those at immediate risk of losing their current placement, experiencing significant health or safety concerns, or aging out of another system without supports. Urgent need cases can sometimes access services more quickly.

Who Should Pursue the CDD Waiver?

The CDD waiver makes sense for individuals who need 24/7 residential support outside the family home, require extensive personal care assistance, have complex medical or behavioral needs requiring comprehensive services, need a combination of residential, day, and therapy services, or are transitioning from pediatric services and need full adult support.

Think of the CDD waiver as the option for people who need the full continuum of care.

FSW: Family-Centered Support for Home-Based Care

The FSW waiver takes a different approach. It's 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 for the FSW waiver, 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.

The FSW waiver is built for individuals with lower support needs who are living at home but still need services to develop skills, stay engaged in the community, and help families manage caregiving.

What Does the FSW Waiver Cover?

The FSW waiver offers targeted services focused on family support and skill development:

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 toward greater independence.

Day and community engagement including day habilitation programs, prevocational services, and supported employment.

Learning and development services including Caregiver Continuing Education to train family caregivers, Mentorship Network connecting families with experienced mentors, and Family Unit Support offering one-on-one training for families.

Respite care providing temporary relief for family caregivers.

Therapies including occupational therapy, physical therapy, speech-language pathology, and behavioral consultation.

The FSW waiver doesn't cover 24/7 residential services. It's built around the assumption that the individual lives with family or independently, and services support that living arrangement.

FSW Waiver and Transitions

The FSW waiver specifically emphasizes transition support. It's particularly valuable for young adults aging out of special education who need services to replace what they lost when school ended, individuals working toward greater independence who need skill-building and support, and families navigating changing caregiving capacity as parents age or circumstances shift.

FSW Waiver Waiting List

The FSW waiver tends to have shorter wait times than the CDD waiver, making it more accessible for families who need services sooner rather than later.

Who Should Pursue the FSW Waiver?

The FSW waiver is ideal for individuals who live at home with family, don't need 24/7 residential support, are working on building independence skills, are transitioning from school to adult life, or have families committed to caregiving but needing support, training, and respite to make that sustainable.

Think of the FSW waiver as the option for families who want to keep their loved one at home and need tools and services to make that work long-term.

DDAD Waiver: Focused on Daytime Services

The DDAD waiver is the most specialized of the three. It's 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 or full family support services.

What Does the DDAD Waiver Cover?

The DDAD waiver covers:

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 for intermittent daytime services (compared to 70 hours per week on the CDD waiver).

The DDAD waiver is much narrower in scope than CDD or FSW. It doesn't cover residential services, comprehensive therapies, or family support services.

Who Should Pursue the DDAD Waiver?

The DDAD waiver makes sense for individuals who need daytime structure through day programs or employment supports, may need some personal care assistance during the day but not comprehensive 24/7 support, are living at home or independently and don't need residential services, and don't require the broader family support services offered through FSW.

The DDAD waiver serves a niche — adults who need something more than no services but less than the full CDD or FSW programs.

Can You Switch Between Waivers?

Yes. If someone's needs change over time, they can transition from one waiver to another.

For example, someone might start on the FSW waiver while living at home with family after aging out of school. As they develop independence skills and their family's capacity changes, they might transition to the CDD waiver for residential services.

Conversely, someone on the CDD waiver who moves back home with family and no longer needs 24/7 residential support might transition to the FSW waiver.

These transitions require reassessment and coordination with your case manager, but the system is designed to be flexible as needs and circumstances evolve.

How to Apply for Nebraska Waivers

The application process for all three waivers follows a similar path:

Connect with a case manager through Nebraska DHHS Division of Developmental Disabilities. They guide you through the waiver application process.

Complete the level of care assessment to determine eligibility. This assessment is required for CDD (to show institutional level of care is needed) and helps determine which waiver is most appropriate.

Gather required documentation including proof of developmental disability, proof of Nebraska residency, Social Security information, Medicaid eligibility documentation, and medical records if applicable.

Your case manager submits the application to Nebraska DHHS for review.

If approved, you wait for a waiver slot to become available (if there's a waiting list).

Once a slot is available, you work with your case manager to develop an Individual Service Plan outlining what services will be provided.

Connect with approved provider agencies to begin receiving services.

The entire process from application to services beginning can take weeks to years depending on the waiver, whether there's a waiting list, and how quickly documentation is gathered.

Which Waiver Should You Choose?

If you're eligible for multiple waivers or trying to decide which to pursue, here are questions to guide your decision:

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.

How intensive are the support needs? If very intensive, CDD waiver. If moderate, FSW. If primarily daytime support, DDAD.

Can you wait for services or do you need them soon? FSW typically has shorter wait times than CDD.

Your case manager can help you navigate this decision based on your specific situation and your loved one's assessed needs.

Geographic Considerations

One important note: for CDD waiver services specifically, there are current service restrictions in Lancaster, Douglas, and Sarpy counties due to how services are structured in those areas. DDAD and FSW waiver services are available statewide without these restrictions.

If you live in these counties and need CDD services, talk to your case manager about what this means for your access to services.

The Bottom Line

Nebraska's three Medicaid waivers — CDD, FSW, and DDAD — provide the framework for accessing IDD services in the state. 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.

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. Each serves a specific population and purpose.

The application process requires patience, documentation, and coordination with case managers. Waiting lists exist for some waivers. But once enrolled, these waivers open the door to services that can genuinely improve quality of life for individuals with IDD and their families.

Trying to figure out which Nebraska waiver is right for your family? Connect with Alora Supports to talk through your situation and explore what services might be available through CDD, FSW, or DDAD waivers.