Nebraska
Medicaid Program
Medicaid Services
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This information represents a general description of services covered under the
Nebraska Medicaid Program. For complete information, refer to Rules
and Regulations.
Hospital Services
Medicaid covers inpatient, outpatient, and emergency room services, as long as they are
medically necessary. Medicaid will not cover items such as: Private rooms; Private-duty
nursing while in the hospital; Any services not medically necessary; and Emergency room
services for routine treatment.
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Physician Services
Medicaid covers medical and surgical services performed at the physician's office, your
home, clinic, hospital, or other locations. Payment may also be made for diagnostic tests,
x-rays, and other procedures that are part of your diagnosis or treatment. Medicaid will
not cover services such as: Routine physical exams for adults; Acupuncture treatment;
Reversal of sterilization; Sex change surgery; Radial keratonomy; and Weight control
programs.
Services that have special requirements, limitations, and/or require approval from the
Medicaid program include:
- Medical transplants
- Cosmetic surgery
- Sterilizations and hysterectomies
- Abortions
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Laboratory and Radiology (X-ray) Services
Payment may be made for medically necessary diagnostic tests, x-rays, and other
procedures that are part of your diagnosis or treatment.
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Nurse Midwife Services
Medicaid pays for the following nurse midwife activities:
- Attending cases of normal childbirth
- Providing prenatal, intrapartum, and postpartum care
- Providing normal obstetrical and gynecological services for women;
and
- Providing care for the newborn immediately following birth
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Nurse Practitioner Services
Nebraska Medicaid covers nursing assessments as nurse practitioner services. The
services must be medically necessary. The initial medical diagnosis and institution of a
plan of therapy or referral may also be covered. Nebraska Medicaid also covers the
services of certified pediatric nurse practitioners and certified family nurse
practitioners, as required by federal law.
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Services Provided by Clinics
Nebraska Medicaid covers services provided by clinics, including rural health clinics,
federally qualified health centers, community mental health centers, and Indian Health
Services clinics if they participate in the Medicaid Program. Covered services may include
physician services, nurse practitioner services, and other services that are usually
covered by the Medicaid program.
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Family Planning Services
Nebraska Medicaid covers family planning services including consultation and treatment.
This may include initial physical examinations and health history, annual and follow-up
visits, laboratory services, prescribing and supplying contraceptive supplies and devices,
counseling services, and prescribing medications for specific treatment.
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HEALTH CHECK Services (EPSDT)
HEALTH CHECK is a service available to all individuals age 20 or younger who are
eligible for Medicaid. HEALTH CHECK provides complete check-ups on a regular basis and
provides diagnosis and treatment services for any health problems found at a check-up.
Some treatment services provided as a result of a HEALTH CHECK examination require the
provider to obtain approval from Medicaid before providing the service. Services included
in HEALTH CHECK are - Health and developmental history; Complete physical examination;
immunizations; necessary lab tests; health education; hearing check-ups; eye examinations;
dental examinations; treatment for identified problems; and well-baby, well-child, Head
Start, school, and sport physicals.
The local DHHS office can tell you which physicians,
dentists, and clinics accept payment from Medicaid. They can also help with scheduling
screening and treatment appointments.
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Home Health Agency Services
Nebraska Medicaid covers home health agency service when prescribed by a physician and
provided in your place of residence (this does not include a hospital or nursing
facility). The physician must certify that you are homebound and that staying home is
necessary for your care. Covered services include nursing services, aide services,
necessary medical supplies and equipment, and physical, speech, and occupational therapies
if there is no other way to receive these services. There are limitations on some
services. Contact your local DHHS representative for more
information.
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Personal Assistance Services
Medicaid covers medically necessary personal assistance services when ordered by the
client's physician. Personal assistance services are medically-oriented tasks related to
the client's physical requirements (as opposed to housekeeping requirements). Personal
assistance services are intended to help a client remain in the home when the client might
otherwise have to be in a hospital or nursing facility. Personal assistance services
include tasks such as basic personal care and grooming, assisting with medications and
nutrition, and accompanying the client to obtain medical treatment. There are limitations
to personal assistance services. Contact DHHS for more
information.
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Private-Duty Nursing Services
Nebraska Medicaid covers private-duty nursing series when ordered by the client's
physician and when medically necessary. Private duty nursing services may be provided in
the client's home or some other living arrangement.
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Medical Transportation Services
Nebraska Medicaid covers transportation services for trips necessary to obtain medical
treatment or medical care when the client has no other means of transportation. Medicaid
may cover transportation services for a parent/caretaker/attendant for travel to escort
someone to and from medical treatment or medical care when necessary and when there is no
other means of transportation. Medicaid does not cover transportation services for clients
residing in nursing facilities. The facility is responsible for providing needed health
care for its residents.
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Ambulance Services
Nebraska Medicaid covers ambulance services for certain conditions: the client's
condition must be such that transportation by ambulance is the ONLY medically appropriate
option; the service must be required during an emergency (accident, illness, or injury) or
required to obtain medical care. There are several ambulance services that Medicaid will
not cover. Please Contact Medicaid for more
information.
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Chiropractic Services
Nebraska Medicaid covers chiropractic services provided in the office or the client's
home. Covered services are limited to x-rays and manual manipulation of the spine. For
clients age 21 and older: Manual manipulation of the spine is limited to 12 treatments pre
calendar year. No more than one treatment per client per day is covered.
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Dental Services
Nebraska Medicaid covers dental services such as cleaning of teeth, fillings,
extractions, X-rays, dental surgery, and dental disease control. some services require
that the dentist obtain approval from Medicaid before providing the service.
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Durable Medical Equipment, Orthotics, Prosthetics, and Medical
Supplies
Nebraska Medicaid covers certain medical equipment and supplies when they are medically
necessary and prescribed by a physician. There are limitations on supplies. Please Contact Medicaid for more information.
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Prescribed Drugs
Nebraska Medicaid covers most drugs prescribed by the client's physician. Some over-the
counter drugs may be covered is prescribed by the physician and approved by Medicaid.
There are several drugs Medicaid does not cover. Please Contact Medicaid for more information.
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Hearing Aid Services
Nebraska Medicaid covers hearing aids, hearing aid repairs, necessary batteries, and
supplies. There are limitations on hearing aid services. Please see http://www.dhhs.ne.gov/reg/t471.htm Chapter
8, hearing aids, for more information.
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Therapies: Physical, Occupational, Speech Pathology &
Audiology
Nebraska Medicaid covers speech, physical, and occupational therapies in the office, in
the client's home, hospital, nursing facilities, or other facilities. The services must be
prescribed by a physician. Therapy is limited to restoration of lost function due to
illness or injury if you are age 20 and older.
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Podiatry Services
Nebraska Medicaid covers medical and surgical services provided by a podiatrist, in the
podiatrist's office, the client's home, a clinic, hospital, or other location. Medicaid
may also cover diagnostic tests, X-rays, and other procedures that are part of the
treatment.
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Psychiatric Services for Individuals Age 21 and Older
Nebraska Medicaid covers medically necessary psychiatric services for medically
necessary primary psychiatric diagnoses for individuals age 21 and older in the following
categories:
- Outpatient Services -- this includes psychiatric evaluation, psychological evaluation,
psychological testing, individual psychotherapy, group psychotherapy, family
psychotherapy, family assessment, medication checks, and electroconvulsive therapy;
- Day Treatment -- an active treatment program that provides a package of services to
clients who are capable of functioning in the community, but still require significant
contact with mental health professionals. The program includes individual, family, and
group therapy in addition to other services.
- Adult inpatient hospital psychiatric services.
- Inpatient hospital services for clients age 65 or older in institutions for mental
disease (IMDs).
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Mental Health and Substance Abuse Services for Children and
Adolescents (ages 0-20)
Nebraska Medicaid covers mental health and substance abuse services for children and
adolescents in the following categories:
- Outpatient Services: This includes evaluation by a psychiatrist psychologist;
individual, group, and family psychotherapy; individual, group, and family substance abuse
counseling; family assessment; conferences with family or other responsible persons;
mileage for home- based family therapy; community treatment aid services; intensive family
preservation services; medication checks; treatment crisis intervention services.
- Middle Intensity Services: These services are designed to prevent hospitalization or to
help a hospitalized client learn to function within the community with less frequent
contact with the mental health or substance abuse provider. Services include:
- Treatment foster care services
- Treatment group home services
- Residential treatment services
- Inpatient mental health services
- Inpatient mental health services in institutions for mental disease (IMDs)
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Visual Care Services
Medicaid covers eye examinations to determine the need for glasses, the purchase of
glasses, and necessary repairs. Eye exams for adults 21 years and older are limited to one
every 24 months. Medicaid covers eyeglasses including lenses and frames when
required for the following medical reasons: the client’s first pair of prescription
eyeglasses; size change needed due to growth; or a prescribed lens change only if new
lenses cannot be accommodated by the current frame. Medicaid for clients 21 years and
older.
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Screening Services (Mammograms)
Nebraska Medicaid covers mammograms when provided based on a medically necessary
diagnosis. In the absence of a diagnosis, Nebraska Medicaid covers mammograms according to
the American Cancer Society's periodicity schedule.
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Nursing Facility Services
Nebraska Medicaid covers services provided in nursing facilities, intermediate care
facilities for person with mental retardation, and certain other long-term care living
arrangements. Services that a nursing facility must provide include:
- regular room
- dietary
- nursing services
- social services when required
- most medical supplies and equipment
- oxygen
- other routine services
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Hospice Services
Nebraska Medicaid covers hospice services provided in response to palliative management
of a terminal illness. Hospice services include nursing services, physician services,
medical social services, counseling services, home health aide/homemaker, medical
equipment, medical supplies, drugs and biologicals, physical therapy, occupational
therapy, speech language pathology, volunteer services and pastoral care services offered
on the individual’s needs and choice for terminally ill patients and their families.
Hospice services require authorization by Medicaid.
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ICF/MR Services
Nebraska Medicaid covers Intermediate Care Facility for Persons with Mental Retardation
(ICF/MR) for individuals with mental retardation, or a related condition.
ICF/MR Services are designed to serve individuals who cannot be served in the community
through Developmental Disability (DD) Services to assist the individual achieve his/her
independence potential. Training in all aspects of daily living, social behavior,
pre-vocational training, nursing care to the same degree as in a Nursing Home, physical,
occupational, and speech therapies. Placement in an ICF/MR is never considered permanent
as individuals needs and alternatives can change over time; other services may be more
appropriate.
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Case Management Services for Adults with Mental Retardation
See Older Adults and Adults with Disabilities. |
