Nebraska care provider battles state’s costly training takeover

Josh Midgett and his team at Integrated Life Choices never expected that a simple government bulletin would threaten their entire mission of helping adults with developmental disabilities live independently across Nebraska.

For nearly two decades, ILC has provided essential services to adults with intellectual and developmental disabilities, operating statewide programs that help clients work, live in group homes, and participate meaningfully in their communities. Central to their success has been a custom-designed emergency safety intervention curriculum called Core Supports—an adult-focused training program approved by the State in 2021 that prepares staff to handle behavioral crises while prioritizing client dignity and safety.

The program worked. ILC reduced serious safety incidents and workers compensation claims while maintaining its reputation for quality, person-centered care tailored to each client’s unique needs.

But in February 2024, everything changed. The Nebraska Department of Health and Human Services (DHHS) issued Provider Bulletin 24-01 with a stark mandate: Providers must abandon their existing training programs and switch exclusively to The Mandt System, a for-profit program designed for both children and adults. Unlike ILC’s adult-focused curriculum, The Mandt System included content less suited to adults with intellectual and developmental disabilities.

The mandate carried a crushing financial burden—approximately $6,000 per trainer for each of ILC’s 10 trainers, with costs recurring every two years and as staff turnover requires new certifications.

When the bulletin took effect, enforcement was swift and punishing. The health department suspended all new client referrals to ILC until the organization demonstrated compliance. In Nebraska’s developmental disabilities system, referrals function like the doctor’s note you need before seeing a specialist—they are the formal authorization that allows a provider to begin serving a new client under the State’s waiver program. Without them, no new clients can enter ILC’s services, threatening both its financial viability and its ability to serve vulnerable Nebraskans.

Faced with losing referrals, Josh Midgett and COO Justin Solomon began partial compliance to keep a new client placement referral from falling through. They submitted revised policies and certificates from their trainers who had completed some Mandt training in hopes of satisfying DHHS’s demands so the referrals could proceed. Under the waiver program, DHHS must place a referred individual with a provider within 60 days, or the opportunity is lost. Without compliance, ILC risked forfeiting this intake entirely—an immediate loss of revenue and a missed chance to serve a person in need.

The health department issued its mandate without statutory authority or any federal requirement. No law authorized forcing providers to use a single proprietary and expensive training system. The governing regulation simply required “Division approved emergency safety intervention techniques”—language that previously allowed diverse, effective curricula.

Even more troubling, the department bypassed Nebraska’s Administrative Procedure Act, which requires notice-and-comment rulemaking procedures for binding regulations. Officials treated their “bulletin” as guidance while enforcing it with regulatory authority.

In August 2025, ILC filed a lawsuit challenging Provider Bulletin 24-01 on multiple grounds: violation of separation of powers, denial of due process, and failure to comply with the Administrative Procedure Act. Pacific Legal Foundation represents ILC in the case, with Nebraska attorney Perry Pirsch serving as local counsel.

At stake is whether state agencies can bypass legislative oversight to impose expensive mandates on organizations serving Nebraska’s most vulnerable residents—and whether constitutional guardrails protecting individual liberty from government abuse will hold firm.