OMAHA, Neb. — Nebraska Department of Health and Human Services officials have discovered a billing problem that could cost the state up to $32 million.

The issue stemmed from changes made two years ago in how providers are paid for serving residents with developmental disabilities.

The changes put Nebraska at odds with federal Medicaid regulations, meaning the state could have to repay millions of dollars. The exact total isn’t known yet.

“It’s more instability to a system that’s struggling to begin with,” said State Sen. Colby Coash of Lincoln, chairman of the Legislature’s developmental disabilities oversight committee. “We really can’t afford to lose any providers.”

State Health and Human Services spokeswoman Leah Bucco-White said it’s working closely with developmental disabilities service providers and the federal Centers for Medicare and Medicaid Services to review claims since July 1, 2014, for people receiving services from residential and day service providers.

Those claims total about $32 million and reflect day programming for about 1,865 people.

Courtney Miller, director of the HHS developmental disabilities division, said it will take a couple of months to complete the review and figure out how much the state will have to repay the federal government for past claims.

The discrepancy came to light as state HHS and federal officials were working on revisions to the procedure from 2014.

Any potential penalty for this issue would be in addition to the $13 million that Nebraska already had to repay the federal government for two previous problems with developmental disability payments.

“Our focus is to ensure continued health and safety and quality services in a supportive environment for the people we serve,” Miller said.

She said the agency is committed to exploring options that will help providers continue to operate and maintain services for the people they care for.

State Sen. Kate Bolz of Lincoln, who works as the executive director of the Nebraska Association of Service Providers, said it is too early to know what the financial impact will be on providers. She said some have talked about tapping their cash reserves but others may be forced to make cuts in services.