interRAI Assessment Nebraska: How It Determines Your DD Waiver Budget

On July 1, 2025, Nebraska replaced the Inventory for Client and Agency Planning (ICAP) with the interRAI needs assessment tool for all developmental disability waiver participants. The switch changed how the state calculates individual budgets — and over 800 families reported significant funding reductions in the first year.

What the interRAI Assessment Measures

The interRAI is a standardized clinical assessment used internationally to evaluate an individual's level of care needs. In Nebraska, it determines two things: which DD waiver the individual qualifies for (Comprehensive DD or Adult Day) and how much funding they receive within that waiver.

The assessment evaluates domains including:

• Cognitive function — decision-making, memory, communication
• Physical function — mobility, activities of daily living, medical complexity
• Behavioral needs — frequency and severity of behaviors requiring intervention
• Supervision requirements — hours of oversight needed for safety
• Social participation — community integration, relationship support needs
• Informal supports — what family and unpaid caregivers currently provide

Four clinical indicators guide CDD Waiver eligibility over the Adult Day Waiver: limited informal supports, residential instability, high supervision needs, and high respite needs. The combination of scores across these factors determines the individual budget allocation.

Why Budgets Changed After the Switch

The old ICAP tool measured adaptive behavior and functional limitations but didn't directly tie scores to dollar amounts the same way. The interRAI creates a more granular scoring system that maps clinical indicators to specific funding tiers.

The problem: assessors evaluate what they observe and what documentation supports. Many families described their child's abilities based on good days — how well they perform with full support in place. The interRAI interprets that as lower need.

State officials reported that approximately 80% of participants saw budgets stay the same or increase. But advocacy organizations documented that the remaining 20% — over 800 families — experienced cuts significant enough to eliminate or reduce critical services. Some families lost residential placement funding entirely.

In response, the Nebraska Legislature and DHHS hired Alvarez & Marsal Public Sector in August 2026 for $420,000 to conduct a four-month independent evaluation of the interRAI tool's validity, resource allocation methodology, and impact on families. Results are expected by early 2027.

How to Prepare for the Assessment

The assessor conducts the interRAI evaluation annually, usually with the individual present along with caregivers and the Service Coordinator. Preparation directly affects the outcome:

Document worst-case days, not average days. The assessment should capture the support level needed when things are difficult — behavioral episodes, medical emergencies, nights requiring supervision. A log of incidents over 30-60 days provides concrete data the assessor can reference.

Bring current clinical documentation. Updated psychological evaluations, functional behavior assessments, IEP records, and safety reports from day programs or residential providers all support the assessment. Use the most current records available.

Describe support needs in specific terms. Instead of saying "he needs help getting dressed," specify: "He requires physical prompting for each step of dressing — selecting clothes, putting on shirt, fastening buttons — and verbal redirection 3-4 times during the process. Without a caregiver present, he will not initiate or complete dressing independently."

Account for all supervision hours. Include overnight supervision if the individual wanders, has seizures, or needs positional changes. Include transportation time, medication administration, and behavioral de-escalation. Every hour of real support that goes undocumented translates to underfunding.

What to Do If Your Budget Is Cut

If the interRAI assessment results in a budget reduction that eliminates or significantly reduces services:

1. Request a written copy of the completed assessment — review how each domain was scored.
2. Review the scores against your documentation — identify any areas where the assessed need level doesn't match documented support requirements.
3. File a formal appeal within 90 days through the Nebraska DHHS administrative hearing process. Provide the incident logs, clinical records, and specific examples that contradict the assessment scores.
4. Contact Disability Rights Nebraska (disabilityrightsnebraska.org) for advocacy support during the appeal.

Until the Alvarez & Marsal evaluation is complete, the current interRAI methodology remains in effect. If the assessment understates support needs, a documented appeal can request review of the scores and budget determination.

The Nebraska SSI at 18 & Adult Disability Benefits Guide includes an interRAI preparation log template designed specifically for tracking the daily support data that drives assessment scores.

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