Accessing I/DD Services
Who Does What and Where to Start
NASP member organizations provide a variety of high quality I/DD services across the state of Nebraska via contracts with the state. In order to receive services from one of our member agencies, you must first apply and be approved for Medicaid Waiver services. You can learn more by visiting the Division of Developmental Disabilities (DHHS-DD) website or, call toll free at (877) 667-6266. The information outlined below and more can be found here: Resources for DDD.
NASP does not provide direct services to individuals with I/DD. Rather, our role as the state association is to support the provider agencies in their work of delivering direct services.
Getting Started
To be eligible for DD services, an applicant must: 1) Be a citizen of the United States of America or a qualified alien under the federal Immigration and Nationality Act and be lawfully present in the United States 2) Be a resident of the State of Nebraska 3) Have a developmental disability (DD).
As defined in Nebraska Revised Statute 83-1205: “Developmental disability shall mean a severe, chronic disability, including an intellectual disability, other than mental illness, which: (1) Is attributable to a mental or physical impairment unless the impairment is solely attributable to a severe emotional disturbance or persistent mental illness; (2) Is manifested before the age of twenty-two years; (3) Is likely to continue indefinitely; (4) Results in substantial functional limitations in one of each of the following areas of adaptive functioning: (a) Conceptual skills, including language, literacy, money, time, number concepts, and self-direction; (b) Social skills, including interpersonal skills, social responsibility, self-esteem, gullibility, wariness, social problem solving, and the ability to follow laws and rules and to avoid being victimized; and (c) Practical skills, including activities of daily living, personal care, occupational skills, healthcare, mobility, and the capacity for independent living; and (5) Reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated. An individual from birth through the age of nine years inclusive who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the major life activities described in subdivision (4) of this section if the individual, without services and support, has a high probability of meeting those criteria later in life.”
Being eligible for services is the first step! Unfortunately, it doesn’t mean you will immediately receive services. Because there is only so much money to go around, services will be offered only when funding is available for you. In the meantime, you will be assigned a DD coordinator (either a Service Coordinator or Community Coordinator Specialist) to help you through the process.
A Medicaid Home and Community-Based Services (HCBS) waiver allows states to use Medicaid funds to provide services to people with disabilities in their homes and community, who would otherwise be served in an institution. The Centers for Medicare and Medicaid Services (CMS) approves state waivers. Waiver services are funded by state appropriations and matching federal Medicaid funds from CMS.
The state of Nebraska has four Medicaid HCBS waivers administered by the Division of Developmental Disabilities (DDD). There are two waivers to serve people with disabilities who meet nursing facility level of care:
• Aged and Disabled (AD) Waiver: Offers services and supports in the community, including respite, extraordinary childcare, and assistive technology and modifications for children living with their family.
• Traumatic Brain Injury (TBI) Waiver: Offers services and supports to people age 18 through 64 who want to live in assisted living.
The other two waivers serve people with developmental disabilities who have the same level of care needs as people living in an intermediate care facility for people with developmental disabilities (ICF-DD):
• Developmental Disabilities Adult Day (DDAD) Waiver: Offers services that focus on daytime community integration and inclusion, including employment and job support or teaching skills for future employment.
• Comprehensive Developmental Disabilities (CDD) Waiver: Offers the same services as the DDAD waiver, and includes residential support. The focus is on teaching independent living skills in a person’s home. Medicaid HCBS Developmental Disabilities Waiver services are person-centered and voluntary.
A couple things to note:
• All of the services outlined here may not be available to you. Your DD coordinator can tell you what services you may choose.
• The terms “habilitation” and “habilitative” refer to training or teaching skills to help you become more independent.
This is great news! You can now begin to think about what is possible for you to live out your dreams of living, working, and playing in your community. There are many choices, both in the type of services and in who can deliver the services. The first step is to know how much service funding you will receive. Your DD service coordinator with the state will tell you what this amount is per year. Then, you can begin to make your plan. Not to worry, it is your DD service coordinator’s job to help you make these important decisions and put together the plan that is best for you.
TYPES OF SERVICES
Day Services occur most often during daytime hours and outside of the home.
Habilitative Community Inclusion: Habilitative Community Inclusion teaches self-help, appropriate behaviors, socialization, and adaptive skills. This service mostly takes place in the community. You decide where and how often you want to go places. This service increases your independence and personal choice, and interactions with people in your community. Your provider helps you with activities of daily living, health maintenance, and supervision.
Enclave: Enclave is provided at a business or in your community. You work alone or with a team to learn work skills and behavior. The business pays your provider and you are paid by your provider. You may interact with employees or customers. Your provider helps you with activities of daily living, health maintenance, and supervision.
Adult Day: Adult Day provides meaningful day activities in a safe, supervised place away from your home. You can use this service to do things in your community. You cannot use this service for a job or volunteering. Your provider helps you become more independent with health and social needs. Your provider helps you with activities of daily living, health maintenance, and supervision.
Prevocational: Prevocational teaches you general job-related skills needed to get a job in the community. This service can be used for up to 12 months. Your provider helps you with activities of daily living, health maintenance, and supervision.
Habilitative Workshop: Habilitative Workshop provides activities in a provider-controlled day location. Your provider teaches self-help, appropriate behaviors, socialization, and adaptive skills. This service is available when you do not have an employment goal and are not looking for a job. Your provider helps you with activities of daily living, health maintenance, and supervision. This is a habilitative service.
Employment Services are designed to help you get and keep a job.
Supported Employment – Follow-Along: Helps you keep your competitive job. This service may be provided with you or by communicating with your employer for you. This service has a yearly limit of 25 hours.
Supported Employment – Individual: Provides a job coach for one-on-one teaching to help you keep your competitive job. This service is provided at your job. Your provider helps you with job skills and referrals for other resources.
Residential Habilitation Services are designed to help you live in your community.
Independent Living: Provided in your own home. Your provider teaches skills for living independently and to do things in your community. Your provider helps you with activities of daily living, health maintenance, and social and leisure skills. This service has a limit of 25 hours per week on the DDAD waiver and 70 hours per week on the CDD waiver. A week is defined as 12:00 AM Monday through 11:59 PM Sunday.
Supported Family Living: Provided in your family home. Your provider teaches you skills for living independently and to do things in your community. Your provider helps you with activities of daily living, health maintenance, social and leisure skills, and community access. This service has a limit of 25 hours per week on the DDAD waiver and 70 hours per week on the CDD waiver. A week is defined as 12:00 AM Monday through 11:59 PM Sunday.
Residential Habilitation – Continuous Home: Provided in a provider-controlled home with shift staff. Your provider teaches you skills for living independently and to do things in your community. Your provider helps you with activities of daily living, health maintenance, social and leisure skills, and supervision.
Residential Habilitation – Host Home: Provided in the home of an agency provider employee. You live with the employee and share daily life with the family in the home and community. Your provider teaches you skills for living independently and to do things in your community. Your provider helps you with activities of daily living, health maintenance, social and leisure skills, and supervision.
Residential Habilitation – Shared Living: Provided in the home of an agency provider contractor. You live with the contractor and share daily life with the family in the home and community. Your provider teaches you skills for living independently and to do things in your community. Your provider helps you with activities of daily living, health maintenance, social and leisure skills, and supervision.
Respite is a short-term service you can use when you cannot care for yourself. Respite is temporary relief to the usual caregiver who lives with you.
Your provider helps with activities of daily living, health maintenance, and supervision. This service has yearly limits of 240 hours on the DDAD waiver and 360 on the CDD waiver.