Bureaucrats can’t skip the rules. A disability care provider’s lawsuit shows why.
When Integrated Life Choices was founded in 2006, it had a clear mission: to help adults with intellectual and developmental disabilities live independently and engage meaningfully in their communities. Nearly two decades later, the Nebraska-based organization operates a statewide network serving vulnerable adults through 24-hour residential care, supported employment programs, and behavioral health services.
But in February 2024, a single government edict threatened to upend everything the organization had built. CEO Josh Midgett and COO Justin Solomon watched as state regulators demanded they abandon a training system that had proven effective for their clients.
That’s when the Nebraska Department of Health and Human Services (DHHS) issued Provider Bulletin 24-01, a mandate that all certified developmental disability service providers use one specific private training program for Emergency Safety Intervention training. The bulletin gave providers just over a year to comply, regardless of whether they already had effective, state-approved training programs in place.
For ILC, this wasn’t just bureaucratic inconvenience. Since 2021, the organization had used a custom-designed curriculum called “Core Supports,” specifically tailored for adults in community-based settings and approved by the very same state agency now demanding its abandonment. The program emphasized person-centered responses—interventions tailored to each client’s unique behavioral patterns and personal history.
The new mandate would force ILC to spend an estimated $60,000 training its staff in a generalized program designed for both children and adults, with annual recurring costs in the tens of thousands, potentially compromising the quality of crisis interventions for their adult clients. When ILC didn’t immediately comply, the state suspended all new client referrals— the process by which individuals are directed into ILC’s services—threatening the organization’s ability to serve the community and maintain financial viability.
ILC’s experience highlights a fundamental problem in government regulation: agencies bypassing proper procedures to impose costly mandates on the people and organizations they regulate.
When guidance becomes gospel
The Nebraska Administrative Procedure Act exists for good reason. When state agencies want to create new rules that bind the public, they must follow specific procedures: file proposed rules with the Secretary of State, hold public hearings, and provide opportunities for stakeholder input. These requirements ensure transparency and give affected parties a voice before new regulations take effect.
But agencies sometimes try to sidestep these safeguards by issuing “guidance documents” or “bulletins” that function like rules but avoid the procedural requirements. That’s exactly what happened here.
Provider Bulletin 24-01 didn’t just offer guidance—it imposed binding requirements with real consequences.
The irony is stark: While agencies claim they’re just exercising discretionary authority under existing regulations, their enforcement actions tell a different story. In July 2025, the Department suspended all new client referrals to ILC—cutting off the steady flow of placements essential to the organization’s business model. One residential placement that had undergone a 60-day intake process was nearly derailed by the suspension. Under this pressure, ILC felt compelled to begin compliance with the bulletin, submitting trainer certifications and revised policies to avoid immediate financial harm.
But even ILC’s good-faith effort wasn’t enough. The agency approved only two of seven trainer certificates, rejecting the others for missing certain components. When an agency threatens to decertify providers and cut off Medicaid funding for non-compliance with a “guidance document,” that document has crossed the line into rulemaking territory.
No amount of agency spin can disguise the fact that this bulletin created new legal obligations for providers across Nebraska. As the Nebraska Supreme Court explained in McAllister v. Nebraska Department of Correctional Services, an agency policy that imposes enforceable consequences affecting private rights is a rule requiring formal rulemaking, regardless of what the agency calls it.
A broader pattern
This isn’t an isolated incident. Nebraska providers are increasingly challenging the Department of Health and Human Services’ practice of imposing regulatory requirements through informal bulletins rather than proper rulemaking. The pattern became so concerning that State Senator Dan Quick introduced legislation in 2025 to pause new agency bulletins and require fiscal impact assessments—although the bill stalled in committee.
In 2024, the Nebraska Association of Service Providers (NASP)—of which ILC is a member—filed a lawsuit challenging a separate DHHS bulletin that would have required disability care providers to log their GPS locations to get paid. Although NASP later dismissed the case for procedural reasons, its filing underscored the same concern raised here: The Department is reshaping the rules of the game through “guidance” documents that sidestep the safeguards of Nebraska’s Administrative Procedure Act.
Fighting for procedural fairness
Pacific Legal Foundation is representing ILC in challenging Provider Bulletin 24-01 on multiple grounds: that it exceeds the agency’s statutory authority, violates separation of powers by imposing legislative-type requirements without legislative authorization, and deprives providers of due process by enforcing mandates without proper notice and hearing.
The lawsuit seeks to restore the flexibility that previously allowed providers like ILC to use state-approved alternatives to serve their clients effectively. More broadly, it aims to ensure that when Nebraska agencies want to impose new requirements on regulated parties, they follow the transparent, accountable procedures the law requires.
Government agencies may serve important functions, but they must operate within constitutional and statutory bounds. Rulemaking procedures aren’t bureaucratic obstacles—they’re essential safeguards that protect both individual rights and democratic governance. ILC’s fight reminds us why these procedures matter and why they’re worth defending.
