The Room-and-Board Gap: What Nebraska's AD Waiver Pays in Omaha Assisted Living, and What It Doesn't

What Supported Residential Living covers

Supported Residential Living is the AD Waiver service delivered in an assisted-living facility. DHHS renamed it from “Assisted Living” and its July 2026 service summary lists what is included: personal care, help with daily and instrumental activities, health maintenance, medication assistance, housekeeping, laundry, socialization and activities, escort and essential shopping, at least five round-trip medical appointments, and three meals a day.

The meals are listed, but they are paid as part of room and board. The waiver's own payment is calculated to cover residential service costs and explicitly does not cover housing, food, comfort items or facility upkeep. DHHS sets the waiver rate, and the provider may not bill personal care separately on top of it.

Where the room-and-board money comes from

Room and board is the resident's responsibility, paid from Social Security, pensions and other income. Medicaid's budget for a waiver resident uses DHHS's Aged, Blind and Disabled Standard of Need. The 2025 guidance document, the latest it lists, gives these figures:

Source: Nebraska DHHS guidance document, Aged, Blind and Disabled (ABD) Standard of Need. These are budgeting standards, not prices. Ask the facility for its own room-and-board charge for a waiver resident, in writing.

Who qualifies, and how the waiver starts

A participant must have Nebraska Medicaid, be 65 or older or have a disability, meet Nursing Facility Level of Care and need waiver services. Medicaid's resource limit is $4,000 for one person. Income above the standard does not end eligibility; the Medically Needy program turns the excess into a monthly share of cost, and DHHS says that program suits waiver recipients.

Apply for Medicaid through iServe Nebraska or (855) 632-7633, and for the waiver through iServe or (877) 667-6266. A Nursing Facility Level of Care assessment follows. Once eligible, people 65 and older usually choose ENOA's services coordinators in Omaha.

Which Omaha-area buildings can bill the waiver

On the October 15, 2026 roster, 36 of the 79 ALFs in the five counties are waiver-certified, with a median of 70 licensed beds. Certified buildings must give each waiver participant a private room with at least a toilet and sink, unless DHHS approves a semi-private room, lockable doors, a lease within the service agreement, and basic furniture and hygiene items when the resident lacks them.

Certification lets a facility bill the waiver; it does not oblige it to accept any number of waiver residents. Some buildings keep a few waiver apartments and a waiting list. Others will convert a private-pay resident in place after spend-down. Ask which.

A worked budget for a waiver resident

Consider a parent with $1,500 a month in Social Security who qualifies for Medicaid and the AD Waiver and moves into a certified Omaha ALF. The waiver pays the facility its set rate for Supported Residential Living. The parent pays the facility's room-and-board charge from income. If that charge were close to the $967 standard of need, the parent would keep the difference for personal needs, clothing, phone and other costs. If the facility's charge is higher, the gap has to be closed somehow, and whether family may help is a question to settle in writing with the facility and DHHS before move-in.

A parent with more income may owe a share of cost under the Medically Needy program. DHHS calculates it; the facility collects it. Ask the facility's business office to walk you through a sample monthly statement for a waiver resident with your parent's income.

Mistakes families make with the waiver

The most common is assuming every assisted living building takes it. The second is waiting until savings are gone to apply, which can leave a gap of weeks or months between running out of money and having waiver coverage. The third is giving money to family during the five years before applying, which can trigger a penalty under the look-back. The fourth is not asking a certified building whether a private-pay resident can convert in place. Each of these is avoidable with a conversation a few months ahead.

Planning the transition before the money runs out

Families do best when they plan the switch a few months before savings reach the $4,000 limit. Gather five years of statements for the 60-month look-back, confirm the building's conversion policy, and budget the room-and-board charge against the parent's income. If income falls short of that charge, ask whether family may contribute toward room and board; that is a question for the facility and DHHS, and the answer belongs in writing.