Waiver Reimagine Advisory Committee Meeting 3 summary

Committee members present: Don Barnes, Val Barnes, Kathryn Barton, Tricia Brisbine, Jennifer Drganc, Rosalie Eisenreich, Lisa Evert, Mary Fenske, Kelly Friesen, Abigail Gertken, Arbdella Hudson, Zahnia Harut, Dr. Katrina Jirik, Ali Kofiro, Susan Mackert, Meredith McKinnon, Julie Morrison, Polly Owens, Rijuta Pathre, Sherri Pickthorn, Phyllis Reller, Rosenfield, Saudade SammuelSon, Sarah Sinderbrand, Elizabeth Scheel-Keita, Lauren Thompson, Chad Wilson, Pat Wright, Wa Xiong 

Committee members not present: Annie Braun, Cathy Chavers, Lisa Harvey, Danielle Otto, Kathy Rogers 

DHS staff present: Hannah Lamb, Curtis Buhman, Meghan Lindblom, Colin Stemper, Maria Trueblood, Emmanuel Nwala 

Meeting notes

Agenda

· Welcome members 

· Member objectives 

· WRAC member input/large group discussion 

· Presentation of budget method options 

· Confirm meeting schedule, next steps review and adjourn 

Welcome members

· Facilitator welcomed members, reviewed member input and survey responses and elaborated on the meeting objective, which was to spend 75 minutes listening to input from committee members and then spend remaining time reviewing budget methodology options. 

WRAC member and DHS meeting objectives

Objectives for WRAC members include:

· Review the budget survey 

· Discuss response to the budget question 

· Learn and understand options for budgets. For those of you who need caption support use the live caption option posted in the chat.   

Objectives for DHS Staff include:

· Listen to responses 

· Answer questions and note follow-up. 

WRAC member input

Hannah Lamb covered feedback the DHS team got from members from the last official meeting in April.  

A budget survey was sent to determine about what more people are looking for.  

· Received 17 responses out of 33 members.  

· All wanted to have more meetings to learn about how budgets were decided.  

· DHS also let members know about their questions, concerns and interests they have about individual budgets.  

WRAC budget info sessions 

· DHS organized two, two-hour info sessions.  

· In the meetings we had great discussion about complex questions.  

· In the meeting went over Minnesota and Medicaid rules and what people needed to know. We asked people, "Was this what they were looking for?" and they said yes.   

· Had a second session in mid-June. Members appreciated being able to attend meetings to more fully understand the proposed changes.  

WRAC budget survey: What will we do next? 

· Plan more listening sessions and info sessions based on topics requested. 

· Slow down our meetings to allow ample time to discuss and learn.  

· Members want to learn more about MnCHOICES, rates the state and federal governments set for reimbursement. 

· All members came into our committee with different experiences and levels of system knowledge. We need to dedicate time to gaining a shared knowledge and background.  

What have WRAC members shared about budgets so far? 

Meghan Lindblom (DHS) went over what we have heard so far:

· Make sure all counties are doing the system budgeting the same way.  

· The budget range for people living independently is way too low. Assessed needs determine budget. People are interested in assuring that all people, regardless of where they live and which waiver they are on, have individual budgets they can control. 

· Slow down so people can share and the department can listen to your concerns. 

· Flexible creative approach can be tricky in bureaucratic system.

· Criteria for determining individual budgets includes health and behavioral needs. 

· How are the budget ranges determined? 

· How are they connected to MnCHOICES?  

Large group discussion

· WRAC members were given two minutes each to respond to the prompt (provided before the meeting): How would you describe an ideal budget system? What is an ideal way to distribute limited funds to people who use waiver services?

· For complete responses from each member, review the transcript link for the June 30 meeting.

Budget method options

Meghan Lindblom (DHS) presents a summary of stakeholder input about budget methods since 2018:

· Flexibility

· Personal authority

· Simplify

· Equity

· Align benefits

· Smooth transition between waivers.

· Opportunity to monitor and improve programs

· Build systems to promote self-determination and independence. 

Presentation of budget method options 

· Another quote from a WRAC member. “What parts of redesigning the waiver system are currently set/non-negotiable at this time so WRAC members cannot change that aspect of the transition and will only have input into how to best implement. We know the current budget system is not perfect. The reality some of this is not set in stone.”

· Asking the budget to be changed would require DHS to go back to the Legislature for action. It would require DHS to study and propose statewide budgets.

Budget methods metaphor: Slicing up the pizza

· Hannah Lamb (DHS) presents: DHS will describe three budget method options through the metaphor of slicing up a pizza. How do you slice up the pizza?

· We came up with up 3 different options:  

o Pizza with no set budgets 

o Pizza algorithm with budget 

o Pizza with level-based budget 

Pizza with no set budget 

· How do we divide up the pizza within the current constraints? 

· Pizza has arrived! But it did not come pre-sliced.  Each group of people who sat together randomly get pizza based on the rough size of their table. We held back extra just in case, but we don’t tell anyone. Some people and tables knew you could ask for more pizza and others didn’t.  

· Strengths of not having a set budget 

o Everyone could have the funding they need  

o Potentially less complex and administratively burdensome for people and lead agencies 

· Challenges of not having a set budget 

o Is not legally or fiscally feasible 

o Could lead to greater inequities as some people may be able to access more money than others  

o More reliant on individual staff at each lead agency 

Pizza algorithm with budget 

· We attempt to distribute exactly the right amount of pizza to each person to match their hunger level. However, the rating of "how hungry?" is hard to capture.  One person skipped breakfast today and was hungrier than usual, so they got extra. The result makes us cut down to the millimeter to match precise hunger. It’s confusing and tricky and didn't match people's actual hunger. 

· Strengths of an algorithm or individual methods  

o Highly individualized and unique to each person  

o Can demonstrate high accuracy depending on the assessment it’s based on 

· Challenges of an algorithm or individual methods 

o VERY reliant on assessment 

o  A small change in one answer on the assessment can produce a large change in your budget 

o Harder to understand 

o Can limit predictability. 

Pizza with level based budgets 

· Before we ordered the pizza, we reviewed how many people were coming to determine how to divide ahead of time. We divided the pizza by many factors including age, height, love of pizza and hunger level. We let people know how many slices they could each take before we started. There was still a limited number of pizzas but there were unlimited sides.  

· Strengths of level budget 

o Can account for errors or changes in assessment by not being reliant on just a few answers 

o Can be updated without affecting the entire system  

o Offers a budget range  

o Easier to understand  

· Challenge of level budget 

o Less individualized or unique 

o Can require additional data collection  

Budget method choice: level budget 

· What does that level method look like in Minnesota? This will be explored at the following meetings. Topics will include:

o Support ranges – how are they determined?

o MnCHOICES – how are the support ranges and budgets connected to the MnCHOICES assessment?

o Living Setting – how does where a person lives affect their budget?

o Waiver choice – how does a person’s choice of which waiver they are on affect their budget?

o Budget range and service mix – how are the budget ranges and service mixes determined?

o Services inside and outside the budget – what services are in and out of the budget?

Future budget policy decisions

We may have chosen the method but there are a LOT more details, policies, procedures and decisions to be analyzed, discussed and decided. Future meetings and work include:

· Exact service mixes and budget amounts 

· MnCHOICES assessment recalibration  

· Budget exception policy and procedure  

· Self-direction updated policy and procedure  

· Budget communication – how to explain to people about their budgets before, during and after implementation   

· Training, manuals and guides for lead agencies, people and their families.

Adjourn

The meeting was adjourned. The next meeting of the WRAC will be Aug. 25, 2022. Meeting details can be found on the Waiver Reimagine Advisory Committee website under the meetings tab.