Home Health Care in Nebraska: Regulations, Payment & Workforce Guide

Home Health Agency Requirements in Nebraska

Nebraska requires home health agencies providing skilled services to obtain licensure from the Department of Health and Human Services (DHHS) under Title 175, Chapter 14 of the Nebraska Administrative Code.

Agency Definition

A home health agency in Nebraska is defined as any person or legal entity providing skilled nursing care or at least one therapeutic service to individuals in their permanent or temporary residence (excluding hospitals or nursing homes). Covered services include:

• Skilled nursing care
• Physical therapy, occupational therapy, speech pathology
• Respiratory care services
• Home health aide services
• Social work services
• Intravenous therapy and dialysis services

Licensing Advantages

Nebraska offers a supportive regulatory environment for home health agencies:

• No Certificate of Need: Agencies can launch without CON approval, removing a common barrier to market entry
• Minimal licensing fees: Lower cost structure compared to many states
• Streamlined process: Online portal available for application submission

Initial Licensure Requirements

Initial licensure requirements are found in Title 175 NAC 14-003.01. Agencies must demonstrate compliance with staffing, supervision, and service delivery standards before receiving licensure.

Contact Information

For licensing questions, contact the DHHS Licensure Unit:

• Phone: (402) 471-4967
• Fax: (402) 742-2308
• Email: [email protected]
• Mail: DHHS Licensure Unit, Attn: Home Health Agencies, PO Box 94669, Lincoln, NE 68509-4669

Certified Nursing Assistant (CNA) Certification

Nebraska's Nurse Aide Registry, maintained by DHHS, certifies CNAs who complete approved training and pass competency examinations.

Training Requirements

Nebraska-approved CNA training programs require:

• 75 hours of total training (federal minimum)
• 16 hours of supervised clinical practice
• 1 hour of abuse, neglect, and misappropriation training
• RN supervision of all training activities

Curriculum Components

Training programs must cover:

• Basic nursing skills (patient environment, vital signs recording)
• Personal care skills (feeding, bathing, turning, repositioning)
• Resident rights and mental health topics
• Infection control (16 hours)
• Communication skills and emergency procedures
• Aging process education

Eligibility Requirements

• Minimum age: 16 years (18 to operate lifts independently)
• Acceptable legal background check
• English proficiency unless employed at facilities where another language is commonly used

Examination Process

The Nebraska Nurse Aide Exam consists of two sections:

• Written/oral examination: 50 multiple-choice questions (1 hour, $35)
• Skills demonstration: 6 skills including hand washing, patient movement, bed linens, and partial bed bath (1 hour, $50)

Payment is required at registration and is non-refundable.

Maintaining Certification

CNAs must work at least 8 hours in a paid CNA position within a Nebraska-licensed healthcare setting every 24 months. If inactive for more than 24 months, both written and skills exams must be retaken.

Alternative Pathways

• ICF/DD workers: 21 hours of training (reduced from standard 75)
• Nursing school coursework
• Military healthcare training
• Foreign nurse credentials or lapsed U.S. nursing license

Contact the Nursing Support team at (402) 471-4322 or [email protected] for certification questions.

Home Health Aide (HHA) Certification

Home health aides in Nebraska working for Medicare-certified agencies must meet federal competency requirements.

Federal Requirements

Medicare-certified home health agencies must ensure HHAs complete:

• 75 hours of training minimum
• 16 hours of supervised practical training
• Competency evaluation in required skill areas
• 12 hours of in-service training annually

State-Licensed Agency Standards

State-licensed home health agencies must ensure aides meet DHHS standards for competency and supervision. HHAs providing personal care under waiver programs must be appropriately trained and supervised according to waiver requirements.

Nebraska Medicaid and Home Care Services

Nebraska Medicaid provides coverage for home health services and supports individuals in community-based settings through multiple programs.

2025-2026 Financial Eligibility

For HCBS Waiver programs:

• Asset limit (single): $4,000
• Income limit (single): $1,304.17 per month (2025)
• Spousal income allowance: $2,644/month minimum (July 2025-June 2026)
• Community spouse assets (2026): 50% of couple's assets, up to $162,660 maximum

Covered Services

Nebraska Medicaid covers home health services including:

• Skilled nursing visits
• Home health aide services
• Physical, occupational, and speech therapy
• Medical supplies and equipment

Program Growth and Changes

Nebraska's HCBS programs have experienced significant growth. The state's primary waiver now serves more than 10,000 Nebraskans, with total costs increasing 322% over the past decade—from $91 million to $383.6 million. This growth is driving policy discussions about program sustainability and potential modifications.

Aged and Disabled (AD) Waiver

Nebraska's Aged and Disabled Waiver, formally called the HCBS Waiver for Aged and Adults and Children with Disabilities, is the state's primary 1915(c) waiver serving home care populations.

Eligibility Criteria

To qualify for AD Waiver services, individuals must:

• Receive Nebraska Medicaid
• Have a qualifying disability OR be age 65 or older
• Meet Nursing Facility Level of Care requirements
• Demonstrate need for waiver services

Covered Services

The AD Waiver provides a comprehensive array of home and community-based services designed to help participants remain in their homes and communities rather than institutional settings.

2025-2026 Waiver Renewal Process

Nebraska conducted a public comment period for HCBS Waiver Amendments from December 5, 2025 through January 5, 2026, with multiple Zoom presentations. DHHS plans to submit the state's waiver renewal request to CMS in early 2026.

Important Considerations

At a December 2025 emergency meeting, DHHS officials indicated changes are needed because program costs have been "far outpacing" population growth. Agencies should monitor waiver renewal outcomes and any service modifications that may affect provider participation.

Application Process

Individuals can apply for the AD Waiver through:

• Online at iServe Nebraska
• Downloaded application form
• Phone request at 877-667-6266

Other HCBS Programs

Nebraska operates additional waiver and Medicaid programs serving specific populations.

Developmental Disabilities Programs

Nebraska's DD waiver programs serve individuals with developmental disabilities through comprehensive supports. Workers in Intermediate Care Facilities for individuals with developmental disabilities (ICF/DD) have reduced training requirements (21 hours versus 75 hours for standard CNAs).

Federal Medicaid Considerations

The first federal Medicaid cuts began in 2026 with elimination of enhanced federal funds for states that expanded Medicaid under the Affordable Care Act. While nursing home care is protected, HCBS programs may face reductions. Agencies should monitor federal and state budget developments affecting waiver funding.

Electronic Visit Verification (EVV)

Nebraska implements EVV requirements in compliance with the 21st Century Cures Act for personal care services and home health services requiring in-home visits.

Required Data Elements

Nebraska's EVV system captures:

• Type of service performed
• Individual receiving the service
• Date and location of service delivery
• Individual providing the service
• Time service begins and ends

Provider Responsibilities

Agencies must ensure EVV integration with billing systems and train staff on proper visit documentation procedures to maintain compliance and avoid claim denials.

Medicare Home Health in Nebraska

Medicare-certified home health agencies in Nebraska must maintain both federal certification and state licensure.

Certification Requirements

Agencies seeking Medicare certification must:

• Hold valid Nebraska home health agency license
• Meet all federal Conditions of Participation
• Complete successful initial survey
• Maintain ongoing compliance with quality standards

PDGM Operations

Nebraska agencies operate under the Patient-Driven Groupings Model (PDGM) with 30-day payment periods. Success requires accurate OASIS assessment, appropriate clinical coding, and efficient visit utilization aligned with patient needs.

Nebraska Labor Laws for Home Care

Nebraska's labor laws underwent significant changes in 2025-2026, including substantial minimum wage increases and new paid sick time requirements.

Minimum Wage Schedule

Effective Date	Minimum Wage
January 1, 2025	$13.50/hour
January 1, 2026	$15.00/hour
January 1, 2027 and beyond	CPI-U indexed (Midwest Region)

Beginning in 2027, the minimum wage will increase annually based on the consumer price index for all urban consumers (CPI-U) for the Midwest Region.

Overtime Requirements

Nebraska follows federal Fair Labor Standards Act (FLSA) overtime standards:

• Non-exempt employees receive 1.5x regular rate after 40 hours per workweek
• Home care workers employed by agencies are generally covered by FLSA overtime rules
• Live-in employees: Exempt from overtime requirements

Paid Sick Time (Effective October 1, 2025)

Nebraska implemented paid sick time requirements effective October 1, 2025. Employers must:

• Provide paid sick leave according to state standards
• Allow use for employee illness, family care, and related purposes
• Maintain records of accrual and usage

Workers' Compensation

Nebraska household employers are not required to have workers' compensation coverage for employees. However, agencies may choose voluntary policies to protect both the business and workers in case of injury.

No Domestic Workers Bill of Rights

Unlike some states, Nebraska has not enacted a domestic workers bill of rights providing additional protections for household and care workers beyond standard labor law coverage.

Workforce Challenges and Strategies

Nebraska agencies face workforce dynamics shaped by rural geography, wage competition, and new regulatory requirements.

Key Challenges

• Rural coverage: Large geographic areas with sparse population create service delivery challenges
• Wage adjustments: $15 minimum wage in 2026 requires compensation structure updates
• Sick time compliance: New tracking and administration requirements add operational complexity
• Waiver uncertainty: Program changes may affect service volumes and reimbursement
• Competition: Healthcare worker shortages affect all provider types

Effective Strategies

• Proactive wage planning: Budget for $15 minimum wage and anticipate 2027 CPI adjustments
• Leverage no-CON advantage: Nebraska's lack of CON requirements enables market expansion
• Community college partnerships: Work with CNA training programs to build recruitment pipelines
• Technology adoption: Use scheduling software to optimize rural route efficiency
• Sick time systems: Implement tracking tools meeting new compliance requirements
• Alternative training pathways: Utilize military, nursing school, and foreign credential pathways

Retention Best Practices

• Competitive wages above minimum with clear advancement tiers
• Mileage reimbursement for rural travel
• Flexible scheduling respecting work-life balance
• Career ladders from CNA to LPN to RN
• Recognition programs celebrating service milestones

Resources and Links

• DHHS Home Health Agency Licensing
• Nebraska One Stop License Portal
• Aged and Disabled Waiver Services
• Nebraska Department of Labor Standards
• Nebraska HHS License Search
• Title 175 Nebraska Administrative Code

The Bottom Line

Nebraska's home health care environment combines a business-friendly licensing structure with evolving labor requirements. The absence of Certificate of Need requirements lowers barriers to entry, while the $15 minimum wage (2026), new paid sick time laws, and potential HCBS waiver modifications require proactive operational planning. Agencies succeeding in the Cornhusker State embrace strategic workforce development, efficient rural service delivery, and compliance readiness for the changing regulatory landscape.