Employment Supports


Assistive Technology

The Assistive Technology Partnership (ATP) is dedicated to helping Nebraskans with disabilities, their families and professionals obtain assistive technology devices and services. In addition, its website, www.nde.state.ne.us/atp, offers information on locating affordable housing and a free online service to list and find equipment for loan, sale, demonstration or to give-away. For more information, visit the website or call 402-471-0734 (V/TTY) or 1-888-806-6287 (V/TTY).


Vocational Rehabilitation

The Employment Network for the Ticket as well as a State/Federal program assists individuals with disabilities to prepare for, obtain and maintain employment. Vocational Rehabilitation works with people with all types of physical, mental or emotional disabilities who are willing and able to work. For more information, go to www.vocrehab.state.ne.us or call 1-877-637-3422.


Personal Assistance Services

Personal Assistance Services (PAS) are those defined under Nebraska Medicaid rules and regulations that include a range of assistance provided to persons with disabilities and chronic conditions of all ages. It includes a range of services, provided by one or more persons, designed to assist an individual with a disability to perform daily activities on and off the job that the individual would typically perform if the individual did not have a disability. For more information, go to www.dhhs.ne.gov/HCS/services/PAS.htm.

PAS services are designed to increase the individual's control in life and the individual's ability to perform activities on and off the job. PAS is consumer-directed and is intended to supplement the individual's own personal abilities and resources. PAS can be used at home, the worksite, and in some educational settings.

What are Personal Assistance Services (PAS) in the Workplace?
Personal Assistance Services are offered statewide to the extent necessary to enable an individual to be engaged in competitive employment. PAS are provided to help an employee in the workplace perform specific personal tasks that includes specialized procedures or health maintenance activities. This does not include job tasks required to perform the job. The employer's responsibility for providing reasonable accommodations begins when the employee reaches the job site and concludes when the work day ends.

The determination of need for PAS at the worksite is made by the local DHHS Medicaid Eligibility Worker on an individual basis as documented in a plan of care for that individual. PAS is intended to provide the needed support to live, get to and from work, and perform at the worksite.

Must my employer allow me to have Personal Assistance Services (PAS) in the workplace if I need them?
Yes. The employer must allow a Personal Assistant at the worksite but they do not have to provide them. Regulations say the services have to be related to the basic personal needs of the person and not a work duty.

What if I need more than 40 hours of PAS per week?
Nebraska Health & Human Services has policies in place to review individual requests from qualified, employed individuals with disabilities who believe they require more services than determined at their individual assessment, or a different type of physical or cognitive assistance than that which has been made available. You may explore your options with a local Medicaid Eligibility Worker.

Are Personal Assistance Services (PAS) allowed in college or career school settings?
Yes. PAS is allowable for qualified individuals in educational settings based on individual need and documented in a plan of care for that individual. All sources of services and programs used by the individual and their specific responsibilities need to be considered in determining the appropriateness of the PAS program.

What is the funding for the Personal Assistance (PAS) Service?
Nebraska Medical Assistance Program (Medicaid) or a Home and Community-Based Waiver (for persons who meet eligibility requirements). A person must remain eligible for Medicaid to receive PAS.

What is a home environment?
The home environment is the individual's primary residence which is not a hospital, nursing, or intermediate care facility.


Medicaid Insurance for Workers with Disabilities (MIWD)

Medicaid Insurance for Workers with Disabilities (MIWD), referred to by some as Nebraska's Medicaid Buy-In, is intended to allow people who are competitively employed and who, because of wages would lose their benefits, to purchase Medicaid like private insurance. The program is administered by Health & Human Services and was implemented in July of 1999.

Many people with disabilities want to work but worry that doing so could jeopardize their vital health and long term care coverage. MIWD offers people with disabilities who are working or interested in working the opportunity to keep their Medicaid coverage while on the job. Benefits include the same as those available through Nebraska Medicaid; the opportunity to earn more without the risk of losing health care benefits and support services; higher income eligibility; increased personal and financial independence; and Personal Assistance Services (PAS) at the workplace.

Your local DHHS Medicaid Eligibility Worker can provide you with eligibility and enrollment information or you can contact a Benefits Specialist with Easter Seals Nebraska to help you with your benefits and answer questions. Contact Easter Seals Nebraska at 1-800-471-6425.

MIWD Brochure

Procedures for Working Disabled Medicaid Premium Payment:

Test A - Income Steps

  1. Disregard all the disabled individual's earned income.
  2. Disregard all the disabled individual's unearned income that is based on a trial work period.
    1. Social Security Disability payment is disregarded if he/she is in a trial work period. The worker must contact Social Security to verify the trial work period.
    2. VA Disability payment, Worker's Compensation payment , Civil Service disability, and private disability insurance must be verified with the source to determine if the receipt of the payment is based on that source's trial work period.
  3. Count all other unearned income for the disabled individual and spouse.
  4. Count the spouse's net earned income ($65 + 1/2 disregarded).
  5. Total the countable income for the individual or couple; if
    1. Greater than the single or couple FBR ($637 or $956) = Fail Eligibility
    2. Less than or equal to the single or couple FBR ($637 or $956) = Pass and go to Test B.

Test B - Income Steps

  1. Calculate the countable earned income. Give the $65 + 1/2 disregard to the individual or couple. [The disabled individual's earned income IS counted, unlike Test A.]
  2. Calculate all gross unearned income for the individual or couple. Only give the $20 general income disregard and the $10 interest/dividend disregard on ALL unearned income. [The disabled individual's unearned income that was disregarded in Test A is now counted.]
  3. Total all countable income for the individual or couple.
    1. If countable income is EQUAL to or GREATER than 250% of Federal Poverty Level for the household = FAIL eligibility for Working Disabled Medicaid Premium Payment (MIWD). Reject the case with a manual IM-8 unless the individual chooses a share of cost.
    2. If countable income is LESS than 200% of Federal Poverty Level for the household [101% through 199%] = PASS eligibility for Working Disabled Medicaid Premium PAYMENT. [200% FPL 1 = $1,734, 2=$2,334] The disabled individual would also be eligible for Medicare Part B buy-in.
    3. If countable income is 200% to 250% of Federal Poverty Level [200% through 249%] = PASS eligibility for Working Disabled Medicaid Premium Payment (MIWD) WITH A MONTHLY PREMIUM PAYMENT. [See chart] The disabled individual in NOT eligible for Medicare Part B buy-in.

Disability Determination
Individuals currently receiving a Social Security Disability payment (SSDI) will not need an additional disability determination. All other individuals considered for this new program must have a disability determination from the State Review Team (SRT). The following procedures is for SRT determination.

Frequently Asked Questions

What does MIWD stand for?
MIWD stands for Medicaid Insurance for Workers with Disabilities.

What is Medicaid?
Medicaid is an DHHS administered program designed to pay medical bills for low-income persons.

What is the difference between Medicaid and Medicare?
Medicaid eligibility is based primarily on financial needs and is administered on a state-by-state basis. Medicare is not based on financial need, but is instead linked to the receiving of Social Security benefits based on being age 65 or older or having a disability. The federal government administers this program.

What is the Social Security Disability Insurance (SSDI) program?
Social Security Disability Insurance is wage replacement income for individuals who have paid FICA taxes that meet Social Security's rules for disability. SSDI is financed with Social Security taxes paid by workers, employers and self-employed persons. SSDI provides a variety of benefits to family members when a primary wage earner becomes disabled or dies. SSDI benefits are payable to disabled workers, widows, widowers and children or adults disabled since childhood who are otherwise eligible.

What are the Social Security disability thresholds for 2008?
For Substantial Gainful Activity (SGA), they are:

  • Non-blind: $940 per month
  • Blind: $1,570 per month
  • For Trial Work Period (TWP), the threshold is $670 per month

Nebraska Department of Health and Human Services

The Nebraska Department of Health and Human Services has offices serving each of Nebraska's 93 counties. Contact information for each office, as well as other offices that provide DHHS-related services, can be found at the Nebraska Department of Health and Human Services website.

Working with Disability

These documents from Mathematical Policy Research, Inc., document the earnings of Medicaid Buy-In participants in 2004 and explain how the Medicaid Buy-In Program fits into other federal efforts to expand access to health insurance and enhance employment opportunities for adults with disabilities.