How to Fill Out and Submit the Nebraska Medicaid Application (MC-19)

To apply for Medicaid in Nebraska, fill out the MILTC-53 form if you’re an adult under 65, a child, or pregnant, or the MLTC-64 if you’re 65 or older or applying based on a disability. Submit it online through the iServe Nebraska portal, by mail to the DHHS Document Imaging Center, by fax, or by phone to ACCESSNebraska. The state has 45 days to decide most applications and 90 days for cases involving a disability determination.

Which Form You Need

Nebraska uses two main application forms, and picking the wrong one means your paperwork gets routed back or restarted.

  • The MILTC-53 is the standard application for adults under 65, children, and pregnant women. It covers all MAGI-based Medicaid categories and the Children’s Health Insurance Program.
  • The MLTC-64 is for applicants who are 65 or older, or who are applying based on a disability and need a disability determination.1Nebraska Department of Health and Human Services. Printable Application Forms
  • The MILTC-63 is a supplement filed alongside the MILTC-53 when an aged or disabled person lives in the same household as someone applying under the standard form.1Nebraska Department of Health and Human Services. Printable Application Forms

Download any of them as PDFs from dhhs.ne.gov, or pick up paper copies at a local DHHS public assistance office.

Do You Qualify Based on Income?

Nebraska expanded Medicaid under the Affordable Care Act, so eligibility reaches more households than it used to. For most people, the state looks at your Modified Adjusted Gross Income — essentially tax-return income — against the federal poverty level. Savings accounts, vehicles, and other assets don’t count unless you’re applying under the Aged, Blind, or Disabled category.

For 2026, the federal poverty level is $15,960 for a single person and $33,000 for a family of four, with $5,680 added per additional household member.3HealthCare.gov. Federal Poverty Level (FPL) That puts the adult 138% cutoff at roughly $22,025 a year for one person. A family of four can qualify for children’s Medicaid at household income up to about $70,290, which is higher than most people assume.

What to Gather Before You Start

Having your paperwork in hand before you fill out the form keeps the state from pausing your application to request documents. You’ll want:4Nebraska Department of Health and Human Services. Medicaid and Long-Term Care Application for Medicaid and Insurance Affordability Programs

  • Social Security numbers for everyone who wants coverage. Household members who aren’t applying don’t need to supply one.
  • Recent pay stubs, W-2s, or wage statements for everyone in the household. Self-employed applicants should have their most recent federal tax return.
  • Immigration document numbers for legal immigrants who are applying. Household members who aren’t applying don’t need to disclose status.
  • Policy information for any existing health insurance, so Medicaid can coordinate as the secondary payer.
  • Records of childcare costs, medical expenses for elderly household members, and other deductible expenses that can lower countable income.

If you’re using the MLTC-64, bring more financial detail: current bank statements, information on certificates of deposit or investments, property records, and vehicle registrations. That category has resource limits, so the state needs a full picture of what you own.5Nebraska Department of Health and Human Services. Medicaid Eligibility

One thing worth checking twice: names and Social Security numbers must match exactly. A transposed digit can hold up processing for weeks while a caseworker tries to verify identity another way.

Four Ways to Submit

Nebraska accepts applications through four channels. Keep a copy of everything you send, no matter which you pick.

  • Online: iserve.nebraska.gov. The iServe portal is the fastest route and lets you upload supporting documents with the application.6Nebraska Department of Health and Human Services. The iServe Nebraska Portal
  • Mail: DHHS Document Imaging Center, P.O. Box 2992, Omaha, NE 68103-2992.7Nebraska Department of Health and Human Services. Contact Information
  • Fax: (402) 742-2351.7Nebraska Department of Health and Human Services. Contact Information
  • Phone: ACCESSNebraska at (855) 632-7633. Local lines are (402) 473-7000 in Lincoln and (402) 595-1178 in Omaha. TDD users can call (402) 471-7256.7Nebraska Department of Health and Human Services. Contact Information

You can also drop off an application at a local DHHS office, though that adds transit time before it reaches the central processing hub in Omaha. For speed, online or fax puts the application in front of a caseworker fastest.

How Long It Takes and What You Get

The state has 45 days to decide most applications and 90 days when a disability determination is involved.8Nebraska Legislature. LB 657 ACCESSNebraska Quarterly Report During the review, a caseworker may call to clarify household details or resolve inconsistencies between what you reported and what the state’s electronic data sources show. Pick up the phone. Unanswered questions turn into denials.

When the decision is made, DHHS mails a Notice of Action explaining whether you were approved, denied, or partially approved, and the legal basis for the decision. If approved, you’re enrolled in Heritage Health, the state’s managed care program, through one of three plans: Nebraska Total Care, Molina Healthcare, or UnitedHealthcare Community Plan. Your assigned plan covers medical, behavioral health, dental, and pharmacy benefits.9Nebraska Department of Health and Human Services. Heritage Health

Covering Medical Bills From Before You Applied

Many people only apply for Medicaid after a medical crisis, so bills can pile up before coverage starts. Nebraska will pay for medical services you received up to three calendar months before your application month, as long as you would have been eligible then and the provider accepts Medicaid. Request retroactive coverage on the application itself, or within six months of the initial application date if you didn’t check the box the first time.10Nebraska Department of Health and Human Services. Retroactive Medicaid

If You’re Denied

You have 90 days from the date on your Notice of Action to request a fair hearing in writing.11Cornell Law Institute. 403 Nebraska Administrative Code Ch 2 009 – Fair Hearing Processes A phone call to your caseworker doesn’t count. The hearing is an administrative review where you can present evidence that the decision was wrong.

Denials typically come from income above the threshold for the household size, missing documentation that wasn’t supplied after a request, or a disability determination that didn’t meet the medical criteria. The notice spells out the reason. If the problem is just missing paperwork, reapplying with a complete file is often faster than a hearing, though nothing stops you from doing both.

Keeping Coverage After You’re Approved

Medicaid eligibility is reviewed at least once a year.12eCFR. 42 CFR 435.916 Nebraska first tries to renew you automatically using electronic data. If nothing has changed, you may not have to do anything. If the state can’t verify eligibility on its own, it mails a renewal form about 60 days before your renewal date, and you have 30 days to return it.13Nebraska Department of Health and Human Services. Nebraska Medicaid Unwind Resources

Miss that deadline and you lose coverage, but Nebraska gives a 90-day grace period to complete the renewal and have coverage reinstated if you still qualify.13Nebraska Department of Health and Human Services. Nebraska Medicaid Unwind Resources The gap in the meantime can leave you uninsured for new medical bills, so treat the 30-day deadline as the real one.

Between renewals, report any change to income, household size, or address within 10 days.14Nebraska Department of Health and Human Services. iServe Nebraska Portal – Change Reporting Use iServe Nebraska online, fax (402) 742-2351, email DHHS.ANDICenter@nebraska.gov, or call ACCESSNebraska. If a change would have made you ineligible and you didn’t report it, the state can require you to repay benefits paid during that time.

Extra Rules if You’re Applying as Aged, Blind, or Disabled

If you’re filing the MLTC-64, your countable resources can’t exceed:

  • $4,000 for a one-person household
  • $6,000 for a two-person household
  • $25 for each additional household member5Nebraska Department of Health and Human Services. Medicaid Eligibility

Several things don’t count toward that limit: your primary residence, one motor vehicle, business property used in a trade or business, and an irrevocable burial fund that can’t be cashed out.5Nebraska Department of Health and Human Services. Medicaid Eligibility Everything else counts: savings and checking accounts, CDs, stocks, additional vehicles, non-business real estate. Be thorough when listing assets. Undisclosed resources discovered later can trigger denial, termination, and repayment obligations.

Resource limits do not apply to the standard Medicaid categories for adults and children. If you’re applying under one of those groups, the state looks at income only.