What is the short answer?

Under Nebraska's Aged and Disabled Waiver, Personal Care includes assistance with activities of daily living and health-related tasks and may include instrumental activities of daily living. Companion provides supervision and social supports and may include specific household and community tasks, but Nebraska DHHS says it does not include hands-on nursing care.

At a glance

If a participant needs help with activities such as bathing, dressing, toileting, transferring, eating, or authorized health-related tasks, Personal Care may be the service to discuss. If the primary need is supervision, social support, and listed household or community assistance without ADL or health-related help, Companion may be considered. Only the participant's assessment, person-centered plan, and formal authorization determine the service.

Why do the service names matter?

“Companion,” “caregiver,” “personal care,” and “home care” are sometimes used casually as if they mean the same thing. In a Medicaid waiver, however, each authorized service has a defined purpose, scope, provider requirements, documentation rules, and billing code. A familiar label cannot expand what the plan authorizes.

The current Nebraska AD Waiver is a federally approved 1915(c) waiver effective July 1, 2026 through June 30, 2031. Nebraska DHHS explains that AD Waiver participants work with a service coordinator to develop a person-centered plan based on assessed needs and life goals. Enrollment in the waiver does not automatically authorize every service or task.

What does Nebraska Personal Care include?

Nebraska DHHS describes Personal Care as a service for adults age 18 and older that includes assistance with activities of daily living and health-related tasks. It may also include instrumental activities of daily living in the participant's home and other community settings.

Assistance may be hands-on, meaning the worker performs part or all of a task for the participant, or it may involve cueing that helps the participant perform the task. Nebraska states that the support may be episodic or continuing, depending on the authorization.

Examples of topics that may need to be addressed in an assessment or plan include:

  • bathing, grooming, dressing, eating, toileting, mobility, or transferring;
  • the type and level of cueing or hands-on assistance required;
  • authorized health-related tasks and whether state law or delegation requirements apply;
  • the participant's abilities, preferences, routines, privacy, and safety;
  • instrumental activities such as meals, laundry, shopping, or household tasks when included with qualifying Personal Care needs; and
  • the schedule, location, backup plan, and documentation expected.

This list is educational rather than an authorization checklist. The service coordinator and planning team must determine which assessed needs belong in the person-centered plan and which tasks the selected provider may perform.

What does Nebraska Companion include?

Nebraska DHHS describes Companion as a service for adults age 18 and older that provides supervision and social supports in a participant's home and possibly in community settings. The state says it may include light housekeeping, bill paying, errands, essential shopping, food preparation, and laundry.

Companion does not entail hands-on nursing care. Nebraska further states that when assistance with activities of daily living or health-related tasks is needed, Companion should not be authorized and another service, such as Personal Care, should be considered.

That distinction protects the participant and the worker. A Companion authorization should not quietly turn into unplanned hands-on care. If needs change, the family should contact the service coordinator rather than asking a worker to perform tasks outside the authorized service.

Side-by-side comparison

  • Primary purpose: Personal Care addresses ADLs and health-related tasks; Companion centers on supervision and social support.
  • Hands-on ADL help: May be included in Personal Care when authorized; it is not the purpose of Companion.
  • Health-related tasks: May be included in Personal Care to the extent authorized and allowed by law; Companion does not include hands-on nursing care.
  • Household and community tasks: Both may involve certain instrumental activities, but the authorized service and participant need determine what is included.
  • Setting: Both may be provided in the participant's home and, as described by Nebraska, in appropriate community settings.
  • Planning: Both must match assessed needs and be reflected in the person-centered plan and authorization.
  • Visit verification: Nebraska lists both among AD Waiver services subject to Electronic Visit Verification.

Can Personal Care include Companion supports?

Yes. Nebraska DHHS says Personal Care may include the supports offered in Companion when those supports are provided along with assistance with activities of daily living or health-related tasks. This does not mean every Companion task is automatically approved. The participant's plan and service authorization still govern the work.

For example, a participant who needs authorized hands-on help with dressing may also need meal preparation or essential shopping. The team can discuss whether those needs fit within the Personal Care service and how they should be documented. Families should not split or combine services on their own for billing convenience.

How should a family prepare for the planning conversation?

Describe what happens during an ordinary day instead of beginning with a preferred service label. Useful information includes:

  • which tasks the participant completes independently;
  • where verbal reminders, setup, standby assistance, or hands-on help is needed;
  • how often the need occurs and at what times;
  • whether the need relates to an ADL, a health-related task, supervision, safety, or an instrumental activity;
  • what happens if support is not available;
  • which routines, cultural preferences, communication methods, accessibility needs, and privacy choices matter;
  • what unpaid supports are available and whether they are reliable and sustainable; and
  • which outcomes the participant wants from paid support.

A participant does not need to minimize needs to appear independent, and a family should not exaggerate a task to obtain a particular service. Specific, factual examples help the service coordinator understand the level and type of assistance required.

What is Electronic Visit Verification?

Nebraska Medicaid requires EVV for listed personal assistance and home health services. The state currently includes AD Waiver Personal Care and Companion in its EVV service-code list. Nebraska explains that providers use an electronic system to record the date, time, service, worker, participant, and location of a visit.

Before services begin, ask how the provider handles clock-in and clock-out, service notes, missed entries, corrections, participant verification, device or connectivity problems, and privacy questions. EVV confirms visit information; it does not replace the person-centered plan, accurate service documentation, or communication about changing needs.

What if the participant's needs change?

New mobility limitations, falls, hospitalization, cognitive changes, medication changes, skin concerns, swallowing difficulty, continence changes, or increased supervision needs may affect the support plan. Report important changes promptly to the service coordinator and provider.

Do not wait for the next annual meeting if the current service no longer fits. The team may need to review the assessment, risks, schedule, tasks, provider qualifications, or service authorization. In an emergency, call 911; a routine provider inquiry or website form is not an emergency service.

Can a family member become the paid caregiver?

Nebraska publishes guidance on allowable services by relatives, guardians, and legally responsible individuals. The answer depends on the service, family relationship, legal responsibility, current program rules, provider qualifications, enrollment, conflicts, and the participant's approved plan. Do not assume that every relative can be paid or that every task is compensable.

Veracity welcomes questions from families. When an arrangement is permitted, the prospective worker must still complete applicable employment or provider requirements. Veracity advertises caregiver opportunities paying $18–$21 per hour, depending on state, role, experience, assignment, authorization, and other applicable factors. This advertised range is not a guarantee of hire, hours, placement, or a particular rate.

Questions to ask a proposed provider

  • Are you approved and currently able to provide the authorized service in this county?
  • Which exact tasks are authorized, and which are outside the service?
  • How do you match, train, supervise, and back up workers?
  • How will the participant's preferences, privacy, communication, and routines be respected?
  • How are health-related tasks reviewed and assigned within legal and professional requirements?
  • What happens when needs change or a worker cannot come?
  • How are EVV, service notes, errors, complaints, and incident reporting handled?
  • Can a relative be considered, and which relationship or employment rules apply?
  • When will the provider, participant, family, and service coordinator review whether the plan is working?

How can Veracity Systems help?

Veracity Systems provides Nebraska Aged and Disabled services that may include Personal Care, LRI Personal Care, Companion, and other authorized supports when the service is within Veracity's approved scope, compatible with assessed needs, and supported by available qualified staff.

Review our Nebraska AD services, read the AD Waiver getting-started guide, or submit a service or family-caregiver inquiry. Share the participant's county, authorized service, preferred schedule, general support needs, and service-coordination contact without sending private medical or identifying records through the website.

Questions families often ask

What is the main difference between Personal Care and Companion services on Nebraska's AD Waiver?

Nebraska DHHS describes Personal Care as assistance with activities of daily living and health-related tasks, and it may also include instrumental activities of daily living. Companion provides supervision and social supports and may include listed household or community tasks, but it does not include hands-on nursing care. When ADL or health-related assistance is needed, DHHS says another service such as Personal Care should be considered.

Can Personal Care include Companion-type support?

Yes. Nebraska DHHS states that Personal Care may include Companion supports when those supports are delivered along with assistance with activities of daily living or health-related tasks. The authorized person-centered plan determines the actual service and tasks.

Who decides which Nebraska AD Waiver service is authorized?

The participant works with the assigned service coordinator and planning team. Service selection depends on assessed needs, program rules, the person-centered plan, and formal authorization. A provider inquiry cannot substitute for an eligibility or authorization decision.

Do Nebraska Personal Care and Companion visits use EVV?

Nebraska currently lists both AD Waiver Personal Care and Companion among services that require Electronic Visit Verification. EVV records information such as the date, time, service, worker, recipient, and location of a visit.

Can a family member provide Personal Care or Companion services?

Some relatives may be permitted for certain services and arrangements, but relationship, legal-responsibility, enrollment, qualification, conflict, payment, and service rules vary. Ask the service coordinator and provider to review the exact relationship before relying on a paid-family-caregiver arrangement.

Does Veracity guarantee that services will start after an inquiry?

No. Services depend on eligibility, assessment, authorization, provider enrollment and scope, staffing, schedule, location, program requirements, and Veracity's ability to safely meet the participant's needs.

Authoritative resources

General-information notice: This guide is educational and is not an eligibility decision, service authorization, guarantee, provider recommendation, or medical, nursing, legal, financial, employment, or individualized advice. Nebraska waiver definitions, assessments, authorized tasks, provider qualifications, family-relationship rules, EVV procedures, rates, and funding requirements may change and vary by participant. Confirm current information with Nebraska DHHS, the assigned service coordinator, the participant's planning team, and the selected provider.