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REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-045

Procedures for Institutionalized Individuals Nebraska Medicaid recipients in medical institutions and certain recipients of Home and Community Based Services Waivers are considered institutionalized individuals. These recipients owe a portion of their income to the provider each month. This amount is also referred to as a SOC but is handled differently than for non-institutionalized individuals. • No form is sent each month because the need for ongoing medical services has been established in determining their eligibility for long-term care. • The amount that the recipient is responsible for is paid directly to the provider. • The amount of expected institutional expenses for the month are projected in order to establish that the person has a medical need. • An institutionalized individual may use additional medical expenses not covered by Nebraska Medicaid (e.g., health insurance premiums, incontinence supplies not provided by the facility) in order to meet their SOC obligation for the month. These expenses are the same as listed above. Change in Facilities If the Nebraska Medicaid recipient moves from one facility into another during the same month, the SOC is applied to the care received in the first facility. If the SOC amount is greater than the cost of care provided in the first facility, the SOC is split, and any remaining amount is applied to care in the second facility.

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Official source

REV. AUGUST 6, 2025 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY

HEALTH AND HUMAN SERVICES 477-000-045

Procedures for Institutionalized Individuals Nebraska Medicaid recipients in medical institutions and certain recipients of Home and Community Based Services Waivers are considered institutionalized individuals. These recipients owe a portion of their income to the provider each month. This amount is also referred to as a SOC but is handled differently than for non-institutionalized individuals. • No form is sent each month because the need for ongoing medical services has been established in determining their eligibility for long-term care. • The amount that the recipient is responsible for is paid directly to the provider. • The amount of expected institutional expenses for the month are projected in order to establish that the person has a medical need. • An institutionalized individual may use additional medical expenses not covered by Nebraska Medicaid (e.g., health insurance premiums, incontinence supplies not provided by the facility) in order to meet their SOC obligation for the month. These expenses are the same as listed above. Change in Facilities If the Nebraska Medicaid recipient moves from one facility into another during the same month, the SOC is applied to the care received in the first facility. If the SOC amount is greater than the cost of care provided in the first facility, the SOC is split, and any remaining amount is applied to care in the second facility.