Nebraska’s cruel crackdown threatens vital care for adults with developmental disabilities
Injustice is lurking around the quiet corners of Lincoln, Nebraska. The Nebraska Department of Health and Human Services (DHHS) is threatening to strip away the proven and personalized care of adults with developmental disabilities, by dismantling the programs that gave them independence and hope.
For nearly two decades, Integrated Life Choices (ILC) has been a lifeline for adults with intellectual and developmental disabilities. Founded in 2006 by Joshua Midgett and William Arrants, the organization was built upon one mission: To empower their clients to live independently and make a difference in their respective communities.
COO Justin Solomon explains ILC’s mission as “helping adults with developmental disabilities live in their community each and every day.” In practice, ILC operates facilities that are essentially group homes, where their adult clients live together with round-the-clock staff. Justin describes it as a sort of “adult foster care where someone with disability is living in a home with another person and they kind of share the life of that person and their family.”
ILC also offers intermittent support, by “going into people’s apartments if they’re living independently and assisting with all sorts of activities to make sure that they’re safe and that they’re living fulfilling lives.” They help people with disabilities build the skills they need so they can be employed in the community. “Our vocational philosophy for the folks we serve is that they should be in service to themselves or others. That’s what really leads to a fulfilling life,” Justin says.
Because every one of their clients has unique needs and circumstances, the services ILC provides look different for every person they serve.
Over the past 19 years, ILC has flourished, now offering its services to thousands of clients across three different states—Nebraska, Colorado, and California. Justin and his team love the work that they do. “They’re able to give a lot of themselves to others and really help nurture and support people in a way that maybe others can’t,” Justin said of ILC staff. “And that’s really fulfilling to them. What keeps me coming back every day is doing really good work for folks who are pretty marginalized otherwise,” he added.
Rewarding as the work is, working in developmental disability services does come with its fair share of challenges. Often, behavioral issues arise that require quick and delicate responses, which is why providers like ILC are required to offer some form of Emergency Safety Intervention (ESI) training to their workers that prepare them to handle behavioral crises while prioritizing client dignity and safety.
The ILC team knows how important it is to have strong ESI in place, which is why they had concerns when their existing system was proving itself to be insufficient for their needs. The team saw this as an opportunity to solve the problem and, in 2021, developed their own groundbreaking safety-intervention curriculum, called “Core Supports.”
One of the main issues with the other ESI protocols was the complete lack of personalization. Some of the guides, for example, have the same protocols for children and for adults, even though they have very different needs. It was ILC’s mission to solve this problem.
As Justin explained, “Our curriculum took some of the best practices that we’d seen across the country, not only de-escalation, but also how to safely perform these emergency safety interventions.” He added, “A lot of the curricula exist on a national level and are tailored towards completely different populations.”
ILC also created Core Supports with employee safety in mind.
“Employee safety is one of the big reasons we were convinced we needed to develop our own curriculum because we would see workers comp claims and part of the reason we were seeing some injuries was because the curriculum we were using was causing them.”
Nebraska approved Core Supports and ILC, and the results have spoken for themselves. The curriculum slashed safety hazards and workers compensation claims, improved staff safety, and met each client’s unique needs.
Even though its success was undeniable, just four years after the State gave ILC its blessing, Nebraska bureaucrats put the kibosh on Core Supports.
Provider Bulletin 24-01
In February 2024, DHHS issued a cold edict in the form of Provider Bulletin 24-01, which mandates that ILC, and every other provider, scrap their curricula and adopt a generic, for-profit ESI called The Mandt System, designed for everyone and no one in particular.
Providers like ILC, which had previously secured DHHS approval for Core Supports, suddenly found their hard-earned innovation deemed non-compliant overnight.
By approving Core Supports, DHHS had admitted that it was effective. Yet, now they are forcing ILC to use a system that pales in comparison.
Unlike Core Supports, The Mandt System does not account for the distinct physical and behavioral needs between each patient, like adult and children. Mandt forces ILC back into the same predicament they were in before Core Supports solved this problem. Forcing providers like ILC to abandon a curriculum that has been working isn’t just a slap in the face for ILC—the State is also neglecting thousands of its own vulnerable citizens.
Mandt also sets unrealistic standards. Workers, for example, are required to say “pardon my touch” before they lay their hands on another person. As Justin explains, “While I understand what they’re trying to get at, for adults with developmental disabilities, oftentimes things are happening fast and you don’t have that amount of space to be able to say that.” He continues, “But then you get into the cascading impacts of if we don’t follow the curriculum to the T, there’s all sorts of recourse the State can take against us for doing what they would call a prohibited practice.”
As if the stress of implementing Mandt wasn’t bad enough, the DHHS rule also forces providers to pay for the new ESI training.
To train all staff members under the Mandt curriculum, ILC would need to spend upward of $6,000 on each individual’s training. The annual recurring costs significantly increase that number.
“We have to bring all of our trainers across into Lincoln or Omaha in order to get trained,” Justin explained. “The total annual reoccurring costs are somewhere in the neighborhood of $150,000; the upfront costs to get everyone trained are somewhere in the neighborhood of $300,000.”
This crushing financial burden also means there are fewer funds to be applied to other areas of the organization’s crucial operations.
There also appears to be a disconnect between DHHS’ sudden admiration of The Mandt System and its longstanding guidance in a previous bulletin. In Bulletin 20-07, DHHS sensibly admitted that providers needed different ESI approaches that suited their different clientele. By issuing Bulletin 24-07, DHHS is going against its own guidance and establishing a one-size-fits-all standard.
ILC did not immediately comply with the order, and DHHS retaliated by suspending all its new client referrals. To make matters worse, DHHS also has the power to shut down ILC’s business entirely. There are a precious few organizations that provide what ILC can in terms of personalized care. If ILC’s work is not allowed to continue, it’s not just their own livelihoods at risk, but those of thousands of Nebraskans who need their services.
This injustice runs deeper than just bad policy. It is also illegal.
The fight is on
The Department bypassed significant legal safeguards when it issued the bulletin. The Nebraska Administrative Procedure Act requires agencies to file the proposed rules with the Secretary of State, hold public hearings, and provide the opportunity for public comment before a new rule becomes binding.
These checks all ensure transparency and accountability on the agency’s part and give the affected parties a voice in matters that directly impact their work. By arbitrarily issuing this guidance bulletin that essentially functions like a law, DHHS sidestepped the procedural requirements for rulemaking. Bulletin 24-01 may call itself a “guidance document”, but it wields the force of law—without the consent of the governed.
The State’s attempt to bypass legislative and procedural checks and balances is nothing new.
The Nebraska Association of Service Providers—of which ILC is a part—had previously fought similar overreach in 2024. The Department was demanding the GPS location of caregivers at the cost of their entire paycheck. The association argued that DHHS imposed regulation without first meeting rules required of them. While the case was voluntarily dismissed, the group plans to refile soon on behalf of themselves and a provider. But the pattern is clear: These “guidance documents” erode the separation of powers.
The Nebraska Constitution grants lawmaking power exclusively to the State’s legislative branch. When an agency like DHHS unilaterally imposes binding mandates, it usurps the state legislature. Hence, when the Department mandated exclusive use of The Mandt System, revoked prior approvals of curricula, and slapped new obligations onto dozens of providers without following due process, its actions were unconstitutional.
ILC has joined forces with Pacific Legal Foundation to challenge the Department’s actions and hold it accountable to the rule of law.
If the Department’s actions stand, it would open the floodgates for countless unelected bureaucrats to draft unchecked regulations as they please, without hearings, oversight, or accountability. Thousands of businesses, nonprofits, and other organizations could eventually find themselves trapped in a tight web of red tape. Worse still, many Nebraskans might lose access to services on which they rely.
“If you keep adding regulation on top of layers of regulation, you eventually get to the point where people are just babysitting because there’s too much liability to do anything else. And I refuse to be in an industry that just babysits adults,” Justin said.
For the ILC team, surrender is not an option.
“You can’t let them just keep rolling over you, because we’ve seen what happens when every action gets a little bolder… people give up if you don’t give them something to fight for.”
And that fight is on.
