CW: Institutionalization
Across Nebraska, families caring for disabled loved ones are watching the state dismantle the system that has kept their children, parents, and partners safe for decades. The League of Human Dignity has been the backbone of Nebraska’s disability services for 26 years. Now, the state plans to eliminate it and bring all service coordination into DHHS by April 1. Families aren’t just worried; they’re furious. And they have every reason to be.
Parents like Tricia Gushard, who has spent 25 years managing surgeries, emergencies, and daily care for her son Elijah, are being told that the people who know their children best will no longer be involved. Instead, they’ll be handed off to a state agency that many Nebraskans struggle to reach even on good days. The idea that DHHS, which is already stretched thin, can suddenly handle the complex, nurse-level coordination needed for medically fragile people is not just unrealistic; it’s reckless.
The truth is, this isn’t just a Nebraska problem. It’s a national issue rooted in the structure of Medicaid itself. Federal law requires Medicaid to pay for nursing home care, but Home- and Community-Based Services—the supports that keep people at home, out of institutions and nursing homes, and connected to their communities—are optional.
That is why states can cut HCBS programs whenever budgets get tight. It’s why families constantly live on the edge of crisis. It’s also why decisions like Nebraska’s keep happening: because the services that support independence are the easiest to cut, while those that place people in institutions and nursing homes must be funded.
Families know exactly what that means. When Elijah is hospitalized, someone from the League shows up within 24 hours. Will the state do the same? When Paul, who has uncontrolled seizures, needs specialized oversight, will DHHS have anyone trained enough to understand what’s going on? Parents like Randi Ross don’t think so—and they’re right to doubt. You cannot replace decades of expertise with a bureaucratic reshuffle and a promise that services will remain uninterrupted.
DHHS insists everything will be fine. They say they’ll hire League staff. They say care won’t be disrupted. They say taxpayers will save $7.4 million.
But families have heard these lines before, in Nebraska and across the country. “Savings” often means fewer people doing more work with less time. “Continuity” usually means families become the safety net when the system fails. And “uninterrupted services” generally means the opposite.
What’s happening in Nebraska is a warning to the rest of the nation. When states treat home and community-based disability services as expendable, people get pushed toward institutions or nursing homes—not because they need to be there, but because the supports that keep them home are the first to go. Families are left to pick up the pieces, often at huge personal and financial cost.
This moment requires more than quiet concern. It calls for a national reckoning with the fact that our system protects institutional care while leaving community-based care vulnerable. Until HCBS is treated as essential—not optional—states will continue to balance budgets on the backs of disabled people and their families.
Nebraska’s families are sounding the alarm. The rest of the country should pay attention. What’s happening there is not an anomaly; it’s a preview.
Sources:
Maniates, Hannah. “Why Did They Do It That Way? Home and Community-Based Services.” National Association of Medicaid Directors, National Association of Medicaid Directors, 16 Apr. 2024, medicaiddirectors.org/resource/why-did-they-do-it-that-way-home-and-community-based-services/.
Pfeifer, Andrew. “Families Fear Loss of Disability Services as Nebraska Moves to Cut League of Human Dignity.” WOWT, Gray Media Group, 18 Feb. 2026, www.wowt.com/2026/02/18/families-fear-loss-disability-services-nebraska-moves-cut-league-human-dignity/.
Stedman, Nancy. “How Medicaid Cuts Could Force Millions into Nursing Homes.” Leonard Davis Institute of Health Economics, University of Pennsylvania, 2 July 2025, ldi.upenn.edu/our-work/research-updates/how-medicaid-cuts-could-force-millions-into-nursing-homes/.