Nebraska InterRAI tiers draw backlash

Nebraska has shifted to using the InterRAI functional assessment to determine funding tiers for people with developmental disabilities. Advocates and providers report that the change is reclassifying many individuals who previously qualified for the highest-need tier into an intermediate tier, triggering steep funding cuts tied to those tier changes. The reported impact is reaching multiple service models, including shared living arrangements, where provider compensation and staffing decisions can depend heavily on tier based reimbursement levels.

Funding tiers shift downward

Providers and advocates say the new assessment driven tiering is moving people down even when support needs remain significant. One example cited is Abby Woods, a shared-living provider for a youth who uses a wheelchair. Woods faces a $30,000 pay cut after the youth was moved to a lower tier despite needing 24-hour care. These tier changes can translate quickly into reduced provider revenue, raising concerns about whether some services can remain financially viable if more individuals continue to be placed outside the highest-need tier.

Complaints question assessment accuracy

Concerns about the InterRAI process are also being raised by families and advocacy organizations. The Arc of Nebraska reports it has received more than 200 complaints about the assessment process. Some families say the tool mislabels abilities. One example described involves a person on the autism spectrum who was deemed non-verbal even though he answered questions. Service providers also report worries about inconsistent assessments, and about the potential loss of critical supports when an individual’s tier changes.

Operational and policy implications

The shift to InterRAI-based tiering is creating a set of immediate issues for IDD agency leaders, particularly in three areas:

• Financial viability of services: Moving individuals from the high-need tier to an intermediate tier significantly reduces funding to providers. Providers report that this can threaten the stability of shared-living arrangements and other services. Agencies may need to reevaluate budgets and staffing if funding tiers continue to shift downward.

• Assessment reliability: Reports of inconsistent or inaccurate assessments can undermine confidence in the system and leave people without necessary supports. Agencies are advised to collect data on assessment experiences and advocate for independent review or recalibration of the tool.

• Advocacy and legal risk: A wave of complaints may prompt litigation or legislative intervention. Providers are advised to document impacts and engage policymakers to support fairness in tier determinations.

For IDD agency leaders, the main takeaway is that Nebraska’s adoption of the InterRAI tool is being linked to significant funding cuts and appears to misclassify some individuals. Agencies are facing the dual pressure of supporting affected families while also engaging state officials on assessment accuracy, with financial planning that accounts for possible continued reductions in reimbursements.