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REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-045

• Meals and lodging when necessary to obtain approved health services and only if the client is away from home for 12 hours or more per day. The allowance for cost of meals is $12 per day. The cost of lodging will be allowed if reasonable and the cost is verified. The allowance for meals and lodging may be allowed for an attendant if one is needed to accompany the recipient. • Actual fees for case management services provided by an Area Agency on Aging or a Nebraska Medicaid provider who is approved to provide case management services. Prior approval may be necessary if case management services are provided by another source. • The amount of medical premiums, including Medicare premiums, paid by an individual can be used as an obligation to the SOC amount. In most cases, this amount will be deducted before the SOC amount is calculated. • Remedial care services are an allowable obligation, whether or not they are covered by Nebraska Medicaid. Remedial care services are those services which assist in curing, alleviating, or easing a medical condition. This includes medically necessary over the counter drugs. • Medical expenses paid by another state, county, or city program may be used toward the individual’s obligation if no federal funds are used to pay the medical expense. This would include programs such as county general assistance, the Renal Disease Program or the Medically Handicapped Children's Program (MHCP). • Deductibles and co-pays from another insurance policy (including Medicare) may be used to meet an individual’s SOC. • Room and board expenses may NOT be used to meet the SOC obligation. Any expense incurred to meet the SOC obligation will not be paid by Nebraska Medicaid. Coordination of Benefits When an individual with a SOC obligation has medical insurance (including Medicare, worker's compensation, etc.), the following procedures apply: 1. A claim for payment is submitted to the insurance company before consideration of the SOC obligation. 2. The amount of the claim which is allowed or disallowed by the insurance company is verified (i.e., Medicare Explanation of Benefits (EOB’s), or other insurance benefit explanation forms). 3. The amount that the insurance company allowed must not be counted toward the individual's SOC obligation. 4. The amount of the claim which the individual incurs is counted toward the SOC obligation. This procedure applies to all persons whose medical expenses are being used to meet the SOC obligation.