Every year, the services your loved one receives through Nebraska's CDD, FSW, or DDAD waiver go through a formal review. Your case manager schedules a meeting, you talk about how things are going, the service plan gets updated, and services are reauthorized for another year.

For some families, the annual review feels like a formality — a checkbox to get through so services can continue. For others, it's an opportunity to address concerns, request additional supports, or make changes that genuinely improve their loved one's quality of life.

The difference between those two experiences often comes down to preparation.

If you walk into your annual waiver review without having thought through what's working, what's not, and what you need, you'll likely leave with the same services you had before — even if those services aren't sufficient. Case managers move quickly through reviews, and if you don't raise concerns or advocate for changes, the assumption is that everything is fine.

But if you come prepared with clear observations, specific requests, and documentation of needs, the annual review becomes a powerful tool for improving your loved one's services and quality of life.

This guide walks you through how to prepare for your annual waiver review in Nebraska so you can advocate effectively and ensure the service plan actually serves your family.

What is the Annual Waiver Review?

The annual waiver review is a formal reassessment of your loved one's services that happens at least once per year. It's required by Nebraska DHHS to ensure that waiver services remain appropriate, that the individual still qualifies for the waiver, and that the Individual Service Plan (ISP) is updated based on current needs.

During the review, your case manager meets with you and your loved one to discuss how the year has gone, whether services are meeting needs, if there have been changes in health or behavior, whether goals have been achieved, and what services should continue, change, or be added for the coming year.

The outcome of the review is an updated ISP that authorizes services for the next year. This document determines what services your loved one receives and how many hours of each service are approved.

The annual review is your formal opportunity to advocate for changes, request additional supports, and ensure your loved one's needs are being met.

When and How Annual Reviews Happen

Your case manager schedules the annual review near the anniversary of when your loved one's services began or when their most recent ISP was approved.

You'll typically receive notice a few weeks in advance that the review is coming up. The case manager will work with you to find a meeting time that works for your schedule.

Reviews can happen in person at your home, at the case manager's office, by phone, or sometimes via video call depending on what works best and what your case manager offers.

Plan for the review meeting to take at least an hour, possibly longer if there are complex issues to discuss or significant changes to make.

Some case managers send paperwork ahead of time asking you to document concerns, goals, or changes since the last review. Others conduct the review more conversationally and document everything during the meeting.

What Case Managers Assess During the Review

Your case manager is evaluating several things during the annual review.

Does your loved one still qualify for the waiver? They'll reassess whether your loved one continues to meet eligibility criteria. For the CDD waiver, that means confirming they still need institutional level of care. For FSW, that they're still living with family and have support needs.

Are current services appropriate? They're looking at whether the services being provided are the right ones. Is day habilitation working or does supported employment make more sense now? Is residential habilitation still needed or has the individual developed skills for more independent living?

Are service hours sufficient? If services are the right ones, are the authorized hours adequate to meet needs? If you're getting 10 hours per week of Supported Family Living but you actually need 20, this is when you address that.

Have there been changes in health, behavior, or functioning? New medical needs, behavioral challenges, or changes in ability to perform daily tasks all affect what services are needed.

Are goals being met? The ISP includes goals for the year. The case manager reviews whether progress has been made and whether goals need to be adjusted.

What should the plan be for the coming year? Based on all of the above, what services should be authorized for the next 12 months?

Your case manager is trying to determine whether the current plan is working or whether adjustments are needed.

How to Prepare: What to Do Before the Meeting

The key to a productive annual review is preparation. Don't walk into the meeting cold and expect to remember everything important on the spot.

Review the Current ISP

Pull out your loved one's current Individual Service Plan and read through it before the meeting. What services are currently authorized? How many hours of each? What were the goals for this year?

Understanding what's already in place helps you identify what needs to change.

Document What's Working

Think about the past year and identify what's going well. Which services are genuinely helping? Which providers are doing a good job? What progress has your loved one made?

Case managers need to hear this. It tells them what to keep doing and what's worth continuing.

Document What's Not Working

Just as importantly, identify what isn't working. Which services aren't meeting needs? Where are there gaps? What frustrations have come up repeatedly?

Be specific. Don't just say "respite isn't enough." Say "we're authorized for 8 hours per week of respite, but we need at least 12 to prevent caregiver burnout. We've had multiple situations where we couldn't access medical care for ourselves because we had no coverage for our loved one."

Specifics make it harder to dismiss concerns.

Track Incidents and Concerns

If there have been significant incidents during the year — hospitalizations, behavioral crises, medication changes, falls, injuries, service disruptions — document them with dates.

These incidents demonstrate need. If you're requesting additional behavioral support services and you can point to three behavioral crises in the past year, that strengthens your case.

Identify Unmet Needs

Are there needs your loved one has that aren't currently being addressed through services? Maybe they need therapy that's not authorized. Maybe they need more hours of personal care. Maybe they need transportation support that doesn't exist.

Identify unmet needs specifically so you can request services to address them.

Gather Supporting Documentation

If you're requesting additional services or changes, supporting documentation helps. This might include letters from doctors or therapists recommending services, behavioral data showing incidents or patterns, medical records documenting new health needs, or school records if your loved one recently aged out and lost school-based supports.

You don't need a mountain of paperwork, but having documentation that backs up your requests makes it harder for case managers to deny them.

Write Down Your Questions

You'll have questions during the review. Write them down ahead of time so you don't forget to ask.

Questions might include whether certain services are available through the waiver, how to access services you've heard about, what the process is for changing providers, or how to address billing issues or service disruptions.

Involve Your Loved One If Possible

If your loved one can participate in planning and express preferences, involve them in preparation. What do they want for the coming year? Are there activities they want to do? Skills they want to work on? Things they don't like about current services?

Their voice matters and should be included in the plan.

What to Bring to the Review Meeting

Come to the meeting with your preparation organized:

• A copy of the current ISP

• Your notes on what's working and what's not

• Documentation of incidents or concerns

• Supporting documentation for requested changes

• Your list of questions

• Any forms or paperwork your case manager asked you to complete

Having everything in one place keeps the meeting focused and productive.

How to Advocate Effectively During the Meeting

When the meeting happens, your goal is to ensure your loved one's needs are heard and that the updated ISP reflects those needs accurately.

Be Honest About What's Not Working

Don't sugarcoat or minimize problems because you're worried about sounding demanding or difficult. If services aren't sufficient, say so. If a provider isn't meeting expectations, speak up.

Case managers can't address problems they don't know about.

Be Specific in Your Requests

Vague requests get vague responses. "We need more support" is less effective than "we need Supported Family Living hours increased from 10 to 15 per week because current hours don't provide enough skill-building time to address meal preparation and money management goals."

Specific requests tied to specific needs are harder to dismiss.

Explain the "Why" Behind Requests

Don't just ask for more services — explain why they're needed and what will happen if needs aren't met.

"We need additional respite hours because I'm the only caregiver, I haven't been to my own medical appointments in six months due to lack of coverage, and my health is declining. If I can't maintain my own health, I won't be able to continue providing care at home."

That explanation makes the need real and urgent.

Reference Your Loved One's Goals

Frame requests around your loved one's goals and what they're working toward. "One of the goals in the current ISP is developing greater independence in meal preparation. We're not making progress on that goal because we don't have enough hours of Independent Living Services to practice cooking skills consistently. We need those hours increased to make progress toward this goal."

Tying requests to existing goals shows that you're not asking for extras — you're asking for what's needed to achieve the plan's stated objectives.

Don't Accept "No" Without Understanding Why

If your case manager denies a request, ask why. What's the specific reason? Is it a funding issue? A regulation? A judgment about appropriateness?

Understanding the reason helps you determine whether to push back, whether to appeal, or whether you need to approach the request differently.

Take Notes During the Meeting

Write down what's discussed, what's agreed to, and what actions will be taken. You'll want this documentation later if there are disagreements about what was decided.

Confirm Next Steps Before Leaving

Before the meeting ends, confirm what happens next. When will the updated ISP be completed? When will new service authorizations go through? If providers need to be contacted, when will that happen?

Clarity about next steps ensures follow-through.

What Happens After the Review

After the meeting, your case manager updates the Individual Service Plan based on what was discussed and agreed upon. You should receive a copy of the updated ISP, usually within a few weeks.

Review it carefully when you receive it. Make sure everything discussed is accurately documented, that service hours match what was agreed to, and that goals reflect the conversation.

If anything is incorrect or missing, contact your case manager immediately to get it corrected. The ISP is the legal document authorizing services, so accuracy matters.

Once the ISP is finalized, updated authorizations go to provider agencies so services can continue or new services can begin.

What If You Don't Get What You Requested?

Sometimes case managers deny requests for additional services or changes. This doesn't mean you're out of options.

Ask for clarification. Understand specifically why the request was denied and what would need to change for it to be approved.

Request reassessment. If your loved one's needs have changed significantly since the last assessment, request a new assessment to document current needs.

Provide additional documentation. If the denial is based on insufficient documentation of need, gather more evidence and resubmit the request.

Involve providers. If therapists, doctors, or other providers agree that services are needed, ask them to write letters or make recommendations supporting your request.

File a grievance or appeal. If you believe services were wrongly denied, you have the right to file a grievance with the case management agency or appeal the decision through DHHS.

Don't assume that a "no" is final. Persistence and documentation often result in approvals after initial denials.

Red Flags During Annual Reviews

Pay attention to warning signs during the review that suggest your case manager isn't serving your family well:

• They rush through the meeting and don't give you time to fully discuss concerns

• They dismiss your concerns without genuine consideration

• They make decisions without involving you or your loved one

• They don't document things you specifically ask to be included in the ISP

• They can't answer basic questions about services or eligibility

• They promise things during the meeting but don't follow through afterward

If you see these red flags consistently, it may be time to request a different case manager.

How Often Can Services Be Adjusted?

While formal reviews happen annually, services can be adjusted between annual reviews if circumstances change significantly.

If your loved one is hospitalized, if behavioral challenges escalate, if a caregiver has a health crisis, or if other urgent changes occur, contact your case manager immediately. Don't wait for the annual review to request needed changes.

Emergency reassessments can be conducted when warranted, and service plans can be modified mid-year if circumstances justify it.

The Bottom Line

The annual waiver review is your formal opportunity to ensure your loved one's services match their actual needs. It's not just a formality to get through — it's a chance to advocate for changes, request additional supports, and improve your loved one's quality of life.

Preparation makes all the difference. Come to the meeting with clear documentation of what's working, what's not, and what you need. Be specific in your requests. Tie requests to goals and documented needs. And don't accept denials without understanding why and exploring options for appeal.

Your case manager has many families on their caseload. If you don't advocate clearly and persistently for your loved one's needs, those needs may not be met. The annual review is where you make sure your loved one's voice — and yours — is heard.

Navigating waiver services in Nebraska and want to make the most of your annual review? Connect with Alora Supports to talk through what services might be appropriate and how to advocate effectively for your loved one's needs.