Appealing a Nebraska State Waiver Decision.
Understanding DHHS InterRAI Changes & Your Right to AppealRecent implementation of the DHHS InterRAI assessment tool has resulted in some individuals being moved to different waivers and/or service tiers. While around half have stayed the same, and around 34% have gone up funding levels, around 17% have reduced funding tiers. For many families, decreases in funding come as a shock and can feel overwhelming. This page is intended to clearly explain what your options are, important timelines, and how to decide whether an appeal makes sense for your family.
If You Receive a Letter Changing Services
If DHHS sends a notice that changes your loved one’s waiver, tier, or services:
- You have 10 days from the date on the notice to request that services remain at the current level (“aid paid pending”) while the issue is reviewed.
- If you do not request this within 10 days, services may be reduced or changed during the appeal process.
Appeal Timelines
- Families generally have 60–90 days (depending on the notice) to file a formal appeal.
- Appeals must be requested in writing and ultimately involve a legal hearing.
- The hearing process can feel intimidating, but it exists to ensure decisions are fair and based on accurate information.
Understanding the Appeal Process
An appeal is not simply a request for reconsideration—it is a formal process. DHHS has shared that many appeals fail because families state they "don’t like the decision" without addressing whether the InterRAI assessment itself is accurate.
The key question in an appeal is:
Does the InterRAI assessment accurately reflect your loved one’s needs, abilities, and support requirements?
Step One:
Review the InterRAI Assessment Carefully
Before deciding to appeal, families should request and thoroughly review the completed InterRAI assessment. Look closely at:
- How behaviors are described
- Frequency and severity of support needs
- Supervision requirements
- Communication, cognitive, and adaptive skill ratings
- Are there answers that are factually incorrect?
- Were important behaviors, safety concerns, or medical needs missed or minimized?
- Were examples taken out of context or based on an unusually “good day”?
When an Appeal Makes Sense
Families should strongly consider appealing if:
- The assessment includes incorrect information
- Key needs or risks were not documented
- Support needs were misunderstood or underreported
- The assessor did not fully observe or consider real-life functioning
When an Appeal May Be Less Successful
If the InterRAI assessment accurately reflects your loved one’s abilities, behaviors, and level of independence—even if the outcome is upsetting—there may be less basis for a successful appeal.
This does not mean families are wrong to feel distressed. It does mean that appeals are most effective when they focus on errors or omissions, not disagreement with the scoring system itself.
Another Important Factor: Is the Full Budget Being Used?
One piece of this process that is often misunderstood is how much of the authorized budget your loved one is actually using.
Before deciding to appeal, families should ask:
- Is my loved one consistently using their full waiver or tier budget?
- Or has spending historically been well below the authorized amount?
This does not mean services were unnecessary. It does mean that DHHS may view the change as aligning funding with demonstrated utilization.
Why This Matters for Appeals
- If your loved one needs services but has been unable to access providers, fill shifts, or use funding due to system shortages, this context is important and should be documented.
- If under-utilization was due to barriers outside your control (staffing shortages, lack of providers, rural access issues), families should clearly explain this.
- If the reduced tier truly reflects your loved one’s needs and actual service use, an appeal based solely on funding level may be less successful.
Helpful Language Families Can Use
Families are often unsure how to explain budget use or under-utilization. The examples below may help when communicating with DHHS or preparing for an appeal.
If services were under-utilized due to system barriers:
“While our authorized budget was not fully used, this was due to factors outside our control, including provider shortages, unfilled staff shifts, and limited provider availability. The unmet need still exists and should not be interpreted as reduced support needs.”
If services match documented needs but access was inconsistent:
“The InterRAI assessment does not fully capture the impact of inconsistent service access. Reduced utilization reflects availability issues, not a reduction in need.”
If the assessment contains inaccurate information:
“The InterRAI assessment includes information that does not accurately reflect my loved one’s daily functioning and support needs. These inaccuracies directly affected the waiver/tier determination.”
Questions to Ask Your Service Coordinator
Families may find it helpful to ask:
- What was my loved one’s authorized budget for the past year?
- How much of that budget was actually used?
- Were there documented provider shortages or staffing gaps?
- How does DHHS interpret under-utilization in waiver or tier decisions?
- Can unmet needs or access barriers be formally documented?
Key Takeaways for Families
- Act quickly--the first 10 days matter
- Request and review the InterRAI assessment
- Focus appeals on accuracy, not dissatisfaction
- Be prepared that the process includes a legal hearing
- You are allowed to ask questions, request explanations, and seek advocacy support
You Are Not Alone
Changes to waivers and tiers can have real impacts on safety, independence, and quality of life. Understanding the process empowers families to make informed decisions and advocate effectively.
If you are unsure whether to appeal, start by reviewing the assessment and asking: “Does this truly reflect my loved one’s day-to-day reality?”
The resources linked here are provided for convenience and informational purposes only. DSAANE does not endorse or guarantee the accuracy of information on external sites. If you have resources that other families might find helpful, or see any errors, please contact us at [email protected].