medicaid application Preview on Page 1

Application for Nebraska Medicaid for Aged and Disabled - dhhs ne 2026

Here's how it works

  • 01. Edit your medicaid application online

    Type text, add images, blackout confidential details, add comments, highlights and more.

  • 02. Sign it in a few clicks

    Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

  • 03. Share your form with others

    Send medicaid waiver in omaha nebraska via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Application for Nebraska Medicaid for Aged and Disabled - dhhs ne with DocHub

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by checking if you need an interpreter. If so, indicate the language required.
  3. Mark all assistance options you wish to apply for, such as Medicaid or Personal Assistance Services.
  4. Fill in your personal information along with details of household members, including their relationship to you, birthdates, and Social Security Numbers.
  5. Provide your household address and contact numbers. If applicable, include a mailing address that differs from your household address.
  6. Indicate your living arrangement by selecting the appropriate option from the list provided.
  7. Answer questions regarding current expenses and income sources for yourself and other household members.
  8. Review all sections carefully before submitting the application to ensure accuracy and completeness.

Start using our platform today to fill out your application easily and for free!

See more medicaid application versions

We've got more versions of the medicaid application form. Select the right medicaid application version from the list and start editing it straight away!

VersionsForm popularityFillable & printable
20204.4 Satisfied (42 Votes)
20133.9 Satisfied (25 Votes)

be ready to get more

Complete this form in 5 minutes or less

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Medicaid Eligibility Customer Service Center Omaha Phone Number. (402) 595-1178. TTY Number. (402) 471-7256 ​ Fax Number. (402) 742-2351.
Benefits and Services Each program participant is eligible for up to $300 a month in assistive services. The types of services that are available include: Personal Care non-medical assistance to help individuals perform their activities of daily living, which includes bathing, grooming, dressing, eating, etc.
You may be eligible if you are: 65 years of age or older. An individual under 65 years of age who has a disability, or is visually impaired according to Social Security guidelines. An individual 18 years of age or younger.
Medicaid Eligibility Verification System You can contact the Help Desk by calling 1-866-498-4357, 402-471-9461, or DHHS.MedicaidEDI@nebraska.gov.
Under the newly expanded eligibility rules, adults with income up to 138% of the poverty level are eligible for Medicaid in Nebraska.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Related links

Supplemental Nutrition Assistance Program (SNAP)

Medicaid Related Aged Disabled (AD Waiver) SNAP toll free information hotline number: (800) 221-5689.

Learn more
Services on the Aged and Disabled Waiver

To be eligible for AD Waiver services, you must receive Nebraska Medicaid, have a disability or be over the age of 65, meet Nursing Facility Level of Care,

Learn more
If you believe that this page should be taken down, please follow our DMCA take down process here