Waiver Reimagine Advisory Committee Meeting 2 summary

Committee members present: Don Barnes, Kathryn Barton, Tricia Brisbine, Rosalie Eisenreich, Lisa Evert, Kelly Friesen, Abigail Gertken, Zahnia Harut, Dr. Katrina Jirik, Susan Mackert, Meredith McKinnon, Julie Morrison, Danielle Otto, Polly Owens, Rijuta Pathre, Sherri Pickthorn, Phyllis Reller, Kathy Rogers, Bud Rosenfield, Elizabeth Scheel-Keita, Lauren Thompson, Chad Wilson, Pat Wright, Dr. Arbdella Hudson, Val Barnes, Wa Xiong

Committee members not present: Annie Braun, Cathy Chavers, Jennifer Drganc, Ali Kofiro, Saudade SammuelSon, Lisa Harvey, Mary Fenske

DHS staff present: Leah Zoladkiewicz, Hannah Lamb, Curtis Buhman, Meghan Lindblom, Maria Trueblood, Stephen Horn, Matt Knutson

Meeting notes

Agenda

· Welcome, WebEx tips, meeting practices and participant roles

· WRAC meeting roadmap

· WRAC updates and charter adoption poll

· Simplified service menu

· Breakout discussions – Guiding principles feedback

· Reshaping disability waivers

· Confirm meeting schedule, next steps review, adjourn

Introductions

· Waiver Reimagine Committee members who did not have opportunity to introduce themselves at previous meetings were given the opportunity to do so

· The facilitator reminded the WRAC of practices to adhere to for meeting success

Updates

· The facilitator introduced the roadmap for planned meeting dates and topics of focus for each meeting through year-end.

· DHS staff covered summary input from meeting 1, including:

o How public meeting laws apply to WRAC meetings

§ The public is allowed to participate in the meeting via streaming on YouTube

§ All meeting notes and chat logs are available to the public to view after the meeting

o The hopes and concerns for Waiver Reimagine

o Feedback from members regarding issues that are out of scope of this committee, but are interconnected to accomplishing the goals:

§ CFSS

§ MnCHOICES project

§ Workforce issues

§ COVID

o Meeting frequency and agenda input

· DHS provided context and background for the input we are seeking

o The role of the WRAC is not to decide if Waiver Reimagine is moving forward. The committee is advising on policy and operational guidance to implement Phase 2 of Waiver Reimagine within the scope of current legislative authority

· DHS reviewed the group decision-making process for charter adoption

o The WRAC charter has been edited and updated three times based on member’s feedback. The charter is guide to how the WRAC will do their work.

o WRAC members were given an opportunity to vote in the meeting on adopting the charter in its current form. Members voted on a gradient from A to D. 25 committee members responded.

o Poll Question: “To what extent do you support the vision, objectives, guiding principles and member responsibilities described in the Charter?”

o Poll results from committee members:

A. Full endorsement – fully approve (9 in person, 2 emailed vote)

B. Support with minor reservations (9 in person, 2 emailed vote)

C. Ambivalent – mixed feelings; see pros and cons – I can live with it (5 in person, 1 emailed vote)

D. Major reservations – serious contention; don’t count on me for support – (no votes)

o DHS emailed 9 members that did not respond during the meeting or were not in attendance to email in their votes. There were four members who did not respond to these requests.

o When it comes to future policy development work, the gradients of agreement process will accommodate more options for further discussion. The WRAC will have an opportunity to go through rounds of discussion, refining and re-voting on policy proposals. The WRAC will decide as a group the scaling options for policy development and the level of agreement necessary to move the group forward.

Waiver Reimagine Phase 1

DHS staff members presented a high-level overview of Phase 1 of the Waiver Reimagine project; the simplified/common service menu:

· Simplifying or making services common and available across all waivers sets the foundation for reshaping the waivers from four waivers to two

o In 2019, the Legislature authorized DHS to simplify the service menu across all four waiver programs

o 2019-2020: Various interested parties were involved in the process of simplifying this menu

o In 2020, DHS held trainings and made updates to policy guidance, tools, resources and forms

o In 2021, simplified service menu was implemented on a rolling basis, open office hours were hosted twice a month to help people with the transition

Breakout discussion: Develop guiding principles for reshaping the waivers

WRAC members shared hopes and concerns during and after the March 3 meeting.

During the April 28 WRAC meeting, members worked in small groups to convert hopes and concerns into guiding principles for reshaping the waivers that will act as guideposts for future policy development.

DHS asked committee members before the meeting to review the draft guiding principles (taken from the WRAC member hopes and concerns) and prepare to address the following questions:

· What needs clarification/refinement? 

· What is missing?  

· How should we use these principles to inform, develop and refine policy moving forward? 

· How do these guiding principles provide an equity lens that can inform policy decision?  

Draft guiding principles:

Principle 1: Make the waiver system easier for all to understand and use

· Improve current service and expand options. Don’t oversimplify

· Create more access to services, not additional barriers

· Develop policies/programs that are easy to navigate, not too complex/intensive

· Make the waiver system simpler without losing that functionality and without losing the things people can do now. 

· Improve accessibility, usability and informed choice and help people with disabilities to understand what options they have 

· Always be person-centered and ensure service options become more simplified and easier to navigate. 

Summary of WRAC input:

· The language used to describe waiver programs and policies is not understandable to people and families that use services

o Recommended solution: Create resources for people receiving services that describe waiver programs, services and related policy in a simple way, so they can make more informed choices when planning their services and supports

· Waiver programs and operational policy is administered inconsistently across the state.

o Recommended solution: Train/educate case managers on waiver programs, services and related policy as a result of Waiver Reimagine changes to assure more consistency with implementation

o Recommended solution: Allow a person’s service and support plan to move with them if they move to a different county.

Principle #2: Empower people with more choice and control over their services

· To make sure that there are as many choices available to people as possible. And make sure, as we move into a two-waiver system, we really do protect people living in their community as independently as possible by their choice 

· That this process will maximize individual choices in all directions 

· Make the choices clearer not only for service providers but for the people we serve so they can make educated decisions on services they want and use 

· Shift power from lead agencies to people on waivers. Make things more crystal clear to create better empowerment for us who are on the waivers so we can have a greater autonomy 

· The new waiver service system focuses on full integration into the community, informed choice and self- determination 

· Establish a partnership that will address the concern that things are being done “for us” and “to us” 

· Advocate for independence while valuing services including independence vs. the dependent. 

· Bring in the focus of interdependence as well. People are pushed to be independent when people really need support.

Summary of WRAC input:

· Case managers are unable to spend time getting to know people because of high caseloads

· It is hard to empower people receiving services when there is so much to understand. The way services are defined is open to interpretation; no two situations are the same. Recommended solutions:

· Build case manager capacity; reduce caseload sizes

· Maintain Consumer Directed Community Supports (CDCS)

· Streamline paperwork.

Principle #3: Provide equitable access to services, regardless of disability and in which county or tribal nation a person lives

· Make the waivers more equitable, both in terms of accessing the waivers and in accessing specific types of waiver services

· Build a statewide equitable process for all

· Recognize the impact that the workforce shortage has on people's access to authorized waiver services and the structure both of the waiver programs and how they are used by people. 

· To create a process that will enable lead agencies and residential providers to respond effectively to change in need and change in demographics.

Summary of WRAC input:

· There is inequity in assessments between mental health and other types of assessment tools

· A person’s needs shouldn’t change based on where they live. Recommended solutions:

o Identify barriers (through a gaps assessment) to accessing waiver services and define what equity means. There are many different aspects including demographics, geography, service availability that can affect equity.

o Increase cultural awareness and capacity to support people with different cultural backgrounds/needs.

Guiding principle #4: Create more flexibility within services and increase options to self-directed services, use technology and remote supports as alternative support options

· Create a process that will lead to more service options, more varied service options, including expanding self-direction, opportunities to everyone who's on the waivers regardless of setting type.

· Create flexibility in the waiver services

· Assure CDCS is individualized, not requiring people to fit into a specific category of service 

· Overcome institutional bias related to congregate living by shifting the emphasis on where a person lives and creating flexibility to self-direct/self-determine

Summary of WRAC input:

· There are barriers to finding sufficient help, including rules and red tape

· Finding people to deliver services is an issue regardless of how big their budget is

· Flexible service use is needed in lesser populated areas. Recommended solutions:

o Create a process that will flexibly meet everyone’s needs especially changing from residential services to home-based services.

o Create a liaison position in each county to work between case managers and client

o Provide equal access to technology funding and training

o Create more services that allow for interdependence

o Ensure funding continuity with waivers and CDCS budgets working together in tandem.

Waiver Reimagine Phase 2: Reshaping the disability waivers

· DHS staff presented information about the start of a two-waiver system in accordance with Minnesota Session Laws, 2021 1st Special Session, Chapter 7 Article 13 Section 73, paragraph (a)​.

o In 2017, the Legislature directed DHS to study consolidation of the waivers. After researching other states, reviewing the existing systems and policies in Minnesota and soliciting extensive feedback, DHS decided to move to the two-waiver system, which the Minnesota Legislature approved.

o 2017-2018 waiver reconfiguration studies:

§ Analysis of Federal Authorities & Research Into Other State Activities: a comparison of waiver authorities and structure, and how they are used in other states (PDF) (4/13/18)

§ Stakeholder Focused Discussions: a summary of the stakeholder engagement effort (PDF) (6/4/18)

§ Feasibility & Recommendation Report: reconfiguration options and preliminary recommendation (PDF) (9/14/18)

§ Waiver Transition Report: a plan and additional considerations for waiver implementation (PDF) (10/19/18)

o The WRAC recommends policy on several topics related to the transition to two waivers, including services by waiver, future of habilitation (for people on the DD waiver), expanding self-directed services and moving between waivers.

Summary of WRAC input:

· Access to waiver services should be based solely on a person’s needs regardless of where they live. A person's assessed needs do not change based on living situation

· There are biased, foundational issues that affect where a person lives. Equity and self-direction are not achievable by basing waiver access on living arrangement

· DHS must consider budget consequences and limitations associated with the transition from four to two waivers

· One waiver could further reduce administrative complexities and equity concerns

· We could certainly recommend something different/better than a two-waiver system based on living arrangement

· Make sure changes don’t result in any unintended service disruptions.

Adjourn

The meeting was adjourned. The next meeting of the WRAC will be Thursday, June 30, 2022. Meeting details can be found on the Waiver Reimagine Advisory Committee website under the meetings tab.