Many Nebraskans age 65 and older with health limitations, as well as younger people living with a disability, want to remain in their own homes.

Medicaid's Home and Community Based Services Waiver programs can make it possible.

Stephanie Hoyt, who supervises the Medicaid Aged and Disabled Waiver program at the Eastern Nebraska Office on Aging, said it waives the fees for in-home support. Medicaid-eligible Nebraskans ages 18 to 64 with a disability, and those over 65 who require nursing home-level care, are eligible based on certain qualifications.

"It's a combination of personal care assistance, cognition, risk factors, and medical," Hoyt outlined. "Those are the four different areas that make up needing nursing facility-level care."

Hoyt pointed out the services used most often include a medical alert system and basic personal care assistance, such as help with bathing, dressing, eating and mobility. Some people can receive cleaning, laundry, shopping and meal prep assistance. Applications are made with the Nebraska Department of Health and Human Services, and the state's Area Agencies on Aging administer the program.

Medicaid waivers are also available for developmental disability and traumatic brain injury. Hoyt explained someone whose spouse or other family member provides support can still qualify for the waiver program.

"If the spouse is there and able to do it, but also wants to be able to go and have lunch with friends one day, or to be able to go to their doctor's appointments, then there's still a need because one person can't do everything for another person," Hoyt observed. "They still have to be able to take care of themselves, or they're no longer support."

She pointed out married couples may have to go through a spousal impoverishment process in order for the spouse needing care to qualify for Medicaid.

Hoyt added some non-spouse family members even qualify to receive pay for their caregiving.

"Sometimes they'll quit their work and get approved as an Aged and Disabled Waiver Provider," Hoyt noted. "Then they get paid to provide a certain amount of hours to supplement some of that income if they've had to leave work."

Medicaid waivers can also help people with the cost of assisted living once they qualify for Medicaid if the facility accepts the waiver. Hoyt said sometimes people improve enough while in a long-term care facility to move back home with Medicaid Waiver services.


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New York disability-rights advocates are celebrating the 34th anniversary of the passage of the Americans with Disabilities Act.

The 1990 legislation prohibits discrimination against people with physical or mental disabilities. Along with becoming a standard part of employment law, it bolsters accessibility in the public environment.

As seminal as the ADA is, said Dr. Sharon McLennon Wier, executive director of the Center for Independence of the Disabled New York, more work must be done to achieve true accessibility.

"Even though ADA has been around for many, many years," she said, "there is still ignorance regarding what is true accessibility and how new construction at times can still be put up without following the principles of ADA universal access."

Downstate New York's transportation systems lack ADA compliance. Only 31% of New York City's Subway system is accessible to people with disabilities. Funding has been allocated to make the system 95% compliant. The work would have been done by 2055, but since Gov. Kathy Hochul paused congestion pricing, these plans have been put on hold indefinitely.

A New York City Comptroller report finds only 40% of the city's disabled population is employed. Statewide reports show post-pandemic employment for people with disabilities is recovering much slower than the nation.

To change this, said McLennon Wier, classroom instructional materials need to be more accessible, "having more raised line drawings, having more Braille available, having more assistive technology that can read various types of charts and diagrams."

She said she thinks certain industries are siloed, but once they open up to better comprehend universal accessibility, more people with disabilities will join them. One place this can work is in STEM fields, as only 3% of that workforce includes people with disabilities.

July is Disability Pride Month, and today is the 34th anniversary of the signing of the Americans with Disabilities Act.

Federal data show that more than 42 million Americans have a disability affecting their cognition, mobility, hearing, vision or ability to provide self-care or live independently.

"Studies over and over demonstrate that people with disabilities are a very solid
part of our workforce," said Joe Xavier, director of the California Department of Rehabilitation, which helps people with disabilities thrive at work. "They stay in their jobs, they're committed to the work that they do, and so there's much less turnover with people with disabilities, thereby reducing the cost and all the work associated with that."

Advocates have said companies are responsible for providing accommodation in the same way they provide chairs and technology for all their workers. They encourage companies to follow principles of universal design when building new spaces, so access is not an afterthought.

Britanny Comegna, a member of the State Rehabilitation Council, runs a company called Deaf and Disability Mediation Services and said people shouldn't be shy about direct communication with disabled people.

"When you meet a new disabled person," she said, "you have to ask, 'How do you want to identify? What do you need? And what can I learn from you?' Ask those questions because we really do appreciate that you're making that effort to connect with me and understand me as a person."

The Centers for Disease Control and Prevention is working to reduce health disparities among adults with disabilities, who have higher rates of smoking, obesity, heart disease and diabetes.


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Advocates for individuals with disabilities want the state of Nevada to further embrace what is known as the "independent living" model.

Dawn Lyons, executive director of the Nevada Statewide Independent Living Council, said the philosophy is centered around people with disabilities being their own experts on their needs and the services they require. Lyons acknowledged within the state's disability community, there exists what she called "inter-conflict," leading to a lack of a unified voice and sending mixed signals to policymakers.

"Even though we have these other voices interfering, saying different things, what it comes down to is 'We don't need to fight each other,'" Lyons emphasized. "I think the reason why we end up with that inter-conflict is because we've been put down so often and we've been told that we don't matter."

Lyons has been with the council for the last eight years and pointed out progress has been made but more needs to be done. She argued education related to independent living is key to moving the needle and the council supports developing educational materials as well as consulting with a state currently employing an effective independent living approach. Lyons explained one of those states could be Colorado, which she adds even has its own independent living agency.

John Rosenlund, program director for the Nevada Assistive Technology Collaborative, said independent living boils down to empowerment. He said he recognizes the state cannot move forward with implementing a philosophy if there are those who do not agree with it or are comfortable with the status quo.

Rosenlund contends centers for independent living across the state have strayed from independent living values such as peer support, individual and systems advocacy and independent living skills training.

"Things aren't right, they've lost the meaning of what independent living is, perhaps," Rosenlund suggested. "Or they're too focused on certain things so that stability at centers for independent living is, in my mind, instrumental."

Rosenlund added the lack of awareness and adoption of independent living's core values is having real effects across the state, with some missing out on real opportunities to enhance their lives. He reminded people without any change or challenge, there will not be any growth.