Waiver Reimagine Advisory Committee Meeting 14 Notes

Thursday, April 25, 2024

COMMITTEE ATTENDEES: Charlene Abramson, Jennifer Ballinger, Kathryn Barton, Tricia Brisbine, Rosalie Eisenreich, Lisa Evert, Mary Fenske, Kelly Friesen, Abigail Gertken, Zahnia Harut, Arbdella Hudson, Elizabeth Iddings, Meredith McKinnon, Sue Mackert, Polly Owens, Rijuta Pathre, Sherri Pickthorn, Phyllis Reller, Gretchen Spier, Chad Wilson, Gina Winter, Pat Wright, Wa Xiong

NOT PRESENT: Don Barnes, Annie Braun, Cathy Chavers, Jennifer Drganc, Katrina Jirik, Ali Kofiro, Jessica McKane, Addyson Moore, Julie Morrison, Danielle Otto, Kathy Rogers, Saudade SammuelSon, Elizabeth Scheel-Keita, Fartun Weli

DHS ATTENDEES: Curtis Buhman, Heidi Hamilton, Adrienne Hannert, Sarah Jones, Matt Knutson, Meghan Lindblom, Linda Wolford

MEETING NOTES:

· Facilitator Lea welcomed everyone to the meeting, including six new members. Noted the update to the WebEx application potentially presenting new images users haven’t previously seen.

· Meeting practices – Facilitator Lea

When speaking, re-introduce yourself (and who you represent)

Stay present giving your full attention to this discussion; let us know via chat if you need to leave the discussion and when you are back

All members have the right to share their ideas and all ideas are valuable

Be respectful of other participants - including privacy (avoid sharing private details)

Assume positive intent – embracing a mindset that will lead to something good

Advocate for all, not individual situations - stories are shared to inform the policy

Please be mindful of the distracting nature of chat messages to both presenters and other members and use chat to add to the conversation when you are unable to directly share your thoughts.

Time has been allotted throughout the meeting for questions and discussion

February recap

Matt Knutson, HCBS waiver policy supervisor, Disability Services Division

· February’s meeting reviewed the habilitation requirement to explore the option to keep or remove the requirement in the two-waiver structure.

· Stephen Horn led the discussion in February that included:

Summary of input on removal of requirement:

§ Can enhance informed choice and person-centeredness

§ Remove barriers to access services

§ Minimize biases and stigmas through program design

Summary of input on keeping requirement

§ Provides accountability for meeting planned needs

§ Promotes opportunities to explore options a person may not have previously considered

Next steps

§ DHS will prepare additional public input opportunities (e.g., survey) prior to making a final recommendation

· Information from these meetings will be brought back to the WRAC. Members were thanked for their ideas and the input.

Updates on Previous WRAC Input

Facilitator Lea

WRAC input	Next steps/outcomes
Recommended names for two waivers	Waiver Reimagine leadership discussion on next steps
Recommended services under two waivers	Other stakeholder conversations will add to DHS’s process with CMS
Recommended budget exception types	Refining exception types internally and drafting process for WRAC review in early 2024
Case management qualifications and requirements	WRAC recommendations will be included in final policy development.
Habilitation requirement input	Prepare additional public input opportunities (e.g. survey) prior to making a final policy recommendation.

Today’s meeting objectives

Facilitator Lea

· To provide information on

Implementation update

Legislative hearing

· To receive member feedback on a way forward for WRAC meetings.

Waiver Reimagine implementation timeline update

Heidi Hamilton, director of Disability Services

· DHS is currently reconsidering the timelines for waiver reimagine implementation, taking into account the delay of MnCHOICES full implementation and concerns raised from members about the Waiver Reimagine project.

· Current implementation date: January 2026.

· DHS will take time to recalibrate the individual budgets based on updated assessment information and rates that have changed since the individual budget framework was created in 2019:

· DHS needs 12 months of MnCHOICES assessment data + further time to recalibrate budgets, so 18 months minimum.

· Members have raised concerns and shared excitement about the Waiver Reimagine project. DHS heard concerns about the timeline and member feedback. We all want to ensure this is being done correctly.

· MnCHOICES tool is being rolled out for the community, county and tribes. Process is going on now and is going well. MnCHOICES will be ready by this fall.

· Giving time to collect data and reconfigure budgets, January 2026 is when aggregate budget methodology will move to an individualized budget methodology.

· Framework was created in 2019. 2019 budgets aren’t sufficient to meet current needs.

· Given time to collect and assess one year of MnCHOICES data, it will be 2 1/2 years from this October, before new budgets are determined.

· This gives an opportunity to learn from community members. WRAC is one group to give input on this project. DHS reaches out to other community members to ensure all voices are heard.

· DHS needs to determine policy decisions.

Waiver Reimagine Legislative Hearing Update

· Hearing held on Monday, March 18, at 3 p.m.

· Link to hearing details: https://www.senate.mn/schedule/individual/18504/20240318

· Natasha Merz, assistant commissioner of Aging and Disability Services Administration, attended. Encourage members to listen to the hearing.

Implementation timeline feedback

Questions/comments about these updates?:

· Listened to the hearing. Need some clarification. So many things have changed over the year that impact waiver services. Is DHS waiting to do collection of data from county workers after the fixes are done?

Heidi Hamilton: Yes, we have funding to look at the validity of the tool. Have heard feedback on CDCS budgets and are analyzing what’s behind that. Want to be sure we are using good data for Waiver Reimagine.

· We were told moving to two waivers (based on where a person lives) was a done deal. I heard Natasha Mertz say the structure could still be looked at. What is the background on the two-waivers? Why was it structured that way? Can we revisit and understand why it was so important?

Heidi Hamilton: Yes, we can have this conversation. Current legislative authority is to create two waivers. Legislative action would have to happen to change this and DHS can’t act on its own.

· Wonder if two waivers misaligns with Olmsted and homestead law.

· Common goal is to get this right. How are we going to receive information?

· Some people are coded as being in their homes when they are in residential settings. How is DHS managing the current workarounds, and how will DHS be transparent? How will lead agency issues with new system be addressed moving forward?

Heidi: This is a policy decision. That’s a big part of this meeting today. Asking members what do you need to get behind this project? How often do you need to hear from us? What will work for you? MnCHOICES will have a phased rollout to get correct information to everyone. System fixes will take place as the rollout is happening. MnCHOICES is separate to this rollout so Lead Agencies can train their staff. Don’t want to launch tool with workarounds. Need accurate data going forward, not just MnCHOICES.

· Need to ensure member input is reflected in posted meeting notes.

Heidi Hamilton: DHS keeps track of feedback received in both public notes and in greater detail in other files.

· Concern is we’ve flipped to keep everything into the community, and that people living in corporate settings would get more money. Opportunity to look at the whole foundation.

Heidi Hamilton: What makes sense for you? Questions about why the two-waiver system was structured how it was? Individual supports couldn’t be handled in the same waiver. This group can discuss this.

· Leadership presence in these meetings is really important.

· On CADI Waiver: why are there differences in the waivers?

Heidi Hamilton: It’s resources. People in IT and many of the programs are involved in MnCHOICES. MnCHOICES is a much broader scope than Waiver Reimagine. This group can focus on Waiver Reimagine suggestions. MnCHOICES is a different project. DHS can provide input from this group on the interconnection.

Survey responses – Program simplification topics

Curtis Buhman: Sent survey to members on how to simplify the waiver. Received feedback from six members and their responses fall into these categories:

Process related

· Cross-county moving & process changes

· Available providers for waivered services

· Work services

· Who to contact for specific issues

· Making it simpler to change case management agencies with a third party.

· Discuss the appeal process: how to find guidance in making a decision to do or not, what the process involves etc. perhaps those who have done so can give examples?

Budget related

· How higher budgets going to for-profit congregate care facilities is not going to encourage institutionalization?

· Clear explanation to program participants as to how services budgets are calculated.

More general

· How were stakeholders engaged in the design of processes/procedures?

· For whom has this process been simplified?

Previous member input - Future discussion topics

Facilitator Lea: What do you want to see? Input is always being considered when planning future meetings. What does an ideal process look like? DHS will be listening. Is there is a specific aspect you want to hear more about? A process you want to try in the future? Want everyone to give input. Welcome input via chat for those who prefer to not share verbally. Here is a summary of previous input:

Process related

· Review past meetings and decisions.

· MnCHOICES and its impacts on Waiver Reimagine.

· Self-direction and Consumer-Directed Community Supports (CDCS).

· The plan to transition between waivers.

· Specific impacts on clients if we do not decide on certain issues in programs, process, and planning to better understand the needs to determine better outcomes that need progress.

· How to ensure that waiver recipients are able to receive their needed services and to better inform those receiving disability services about community organizations and programs.  

· Please include stakeholders in setting agendas. We are capable of more than providing feedback on DHS's selected topics (which are often not a priority for stakeholders.)

· Discussion about budgeting differences between the two waivers: discuss the change of traditional waivers which currently do not have set budgets to a model of all participants having a set budget.

· Exceptions should be discussed further especially given the financial state of current waivered services and already being over state budgets, using surplus, etc.

· Unused waivered dollars going back into the waiver budget rather than being out into the general fund as this would help offset the need for using other money such as surplus tax money.

Member feedback and questions

Member input – Future WRAC topics/process

· What does an ideal WR process look like?

· How do we get there?

· Want an authentic partnership. Start seeing WRAC to partner more. Don’t need to be informed of the policy changes. We need to be engaged in the change of those policies. How are we making these decisions and coming to the conclusions? Most of us are aligned with diverse stakeholders.

· WRAC need the data DHS sees to have a two-way conversation.

· MnCHOICES is a gateway to whether you’ll get a waiver. Propose this group meet in person. Every other month cadence is not working well. Explore the idea of taskforces meeting more often. All components need to come together so resources can come together — mainly money — so people can live their lives.

· Like seeing what DHS and legislators are doing. Case management is probably the most complicated system I’ve worked in. Others can’t understand what I’m asked to do as a case manager, and I can’t fully understand what families using waivers are going through. Case managers also meet people who aren’t honest and are using waiver funds incorrectly - breaking the laws. MnCHOICES is complicated and the waivers have services and rules. Not everyone is coming from the same angle. Appreciate DHS has to walk a fine line to get resources, watch taxpayer dollars, legislature whims and then create policies. WRAC is here to hear all people involved: legislators, case managers, DHS, waiver recipients and others.

· For planning meetings could go through a path process so we are developing an agenda together. Once decisions are made, have a work group or a task force to discuss the decisions.

· Stakeholders could co-lead or completely lead meetings. We would be compensated for our expertise.

Heidi Hamilton: Thank you for all who have shared. There is concern about an in-person meeting since a lot of people don’t live in the metro area. How do we co-create an agenda together? Small groups dig into ideas and come back to group?

· Go back to charter and our guiding principles. Why are we here, and what is our purpose?

· Collectively work to give report to the Legislature.

· Appreciated hearing the link from Legislature meeting and wished I had been there. Had some contrary ideas, but listened respectively. We are all here to do good things. Support choice and independence for those in the community. Believe the DHS professionals are seeking our input. There are individuals that disagree with the direction we are going. Heidi is in meetings with those who have concerns individually or in small groups. If there are major issues, have individuals create a task force so recommendations come back to us. Want legislature to know there has been great experience. Don’t mind the two-waiver system. Respectively bring these thoughts forward.

· Appreciate the comments about next steps for input. Make sure the system is inclusive. Roll back and look at things again. Talk about two-waiver system for an entire meeting.

· During wait period for MnCHOICES data, want updates from DHS. What are the issues they are seeing? What is DHS looking for in the data?

· Appreciate hearing the different thoughts. Amazed at depth of experience represented here - work and personal.

· If someone wanted to have services outside of where they are living, how would they get them? Person fluctuates from being very independent and needing 24/7 care.

Curtis Buhman: Shared statutory language in chat that is required. We haven’t got what is needed to have the legislative report yet. Legal concern around small group meetings doesn’t abide by open meeting laws.

· What happens when someone has to transfer between waivers? How long will he have to wait in either situation?

· Acknowledge DHS people work in requirements.

Sarah Jones: What does the group need to be able to build that unified voice or come to consensus on recommendations? Want to partner.

· Can we create a SharePoint area where we could share documents. (Idea – walk through website resources and look into alts)

Facilitator Lea: State has a strong firewall, and only those with state agency emails have access.

Upcoming survey

Curtis Buhman: DHS is sending out a broader survey (not just WRAC) next week:

· Sending out to larger community.

· Please share survey with your networks.

· Using feedback along with other community engagement and WRAC feedback to inform the Waiver Reimagine work.

Wrap-up and future meeting information

Facilitator Lea

· Future meetings:

Thursday, June 27, 2024

Thursday, Aug. 22, 2024

· Link to give feedback after the meeting: waiver.reimagine@state.mn.us

· Continue to ask for your input on future meetings. Thank you for your input today.

Full meeting chat

· Gretchen Spier 4/25/2024 10:35 AM • can you speak up

· Facilitator Lea 4/25/2024 11:08 AM •

· Today's questions are:

· What does an ideal WR process look like?

· How do we get there?

· Kelly Friesen deleted their own message. 11:08 AM

· Charlene Abramson 4/25/2024 11:08 AM • I agree with Rosalie - We need to be more than heard...

· Kelly Friesen 4/25/2024 11:09 AM • A true WRAC/DHS collaborative-partnership. 2. Base the Waivers off of People's needs, not where they live. 3. We should be a decision making, actionable committee, not just a sounding board.

· Charlene Abramson 4/25/2024 11:09 AM • ... and with MN Choices....

· Kayte 4/25/2024 11:14 AM • I need to log off, and wanted to put my feedback in. We I agree with everyone! We are the group tasked with creating this new system that will impact so many. We should be more involved with this, and take a look at everything and slow down the rollout. We are going to need to educate so many people about how Waiver Reimagine will work. How it will impact them.

· Charlene Abramson 4/25/2024 11:15 AM • Re. Kayte's comment / I agree and want to emphasize the importance of training and being on the same page.

· Tricia Brisbine 4/25/2024 11:25 AM • I don't think the in-person meeting idea was a collaborative suggestion. Meeting format should be determined collaboratively.

· Rosalie Eisenreich (SEMCIL) 4/25/2024 11:25 AM • We were told we can't do small groups because it violates open meeting law

· Facilitator Lea 4/25/2024 11:26 AM • Apologies to those whose hands were up. I'm going to take Arbdella's comment and return to raised hands afterward.

· Rosalie Eisenreich (SEMCIL) 4/25/2024 11:28 AM • Arbdella, I'm so sorry to hear about your health. You deserve better.

· Tricia Brisbine 4/25/2024 11:31 AM • Tool for assessing engagement: https://familyvoices.org/fesat/

· Facilitator Lea 4/25/2024 11:32 AM • Thank you for sharing, Tricia.

· Tricia Brisbine 4/25/2024 11:33 AM • Just because someone is frustrated doesn't mean they can't contribute to this process.

· Phyllis Reller 4/25/2024 11:35 AM • I just could not get my point across - unfortunately i get emotional a lot lately (retirement and sons health). At some point we really need to share how the initial group came up with the 2 waivers. And how do we ensure there is a service for those who do not have wonderful families like these families.

· Zahnia 4/25/2024 11:40 AM • Is there any way the WRAC committee could have a share point site?

· Facilitator Lea 4/25/2024 11:42 AM • Thank you for that extra detail, Phyllis.

· Curtis Buhman 4/25/2024 11:44 AM • In case helpful, here's the statute language on the legislative report: Subd. 4. Required report. Prior to seeking federal approval for any aspect of waiver reimagine phase II and in consultation with the Waiver Reimagine Advisory Committee, the commissioner must submit to the chairs and ranking minority members of the legislative committees and divisions with jurisdiction over health and human services a report on plans for waiver reimagine phase II. The report must also include any plans to adjust or modify the streamlined menu of services or the existing rate exemption criteria or process.

· Jennifer Ballinger 4/25/2024 11:45 AM • Why have any waiver options... just approved or not! Then al a carta for services, supports, housing, etc. needed for that individual to live their best life! Expand service availability - not working right now - how to Band-Aid these barriers until the roll out?

· Lisa Evert 4/25/2024 11:45 AM • Chad, you are right. ALL of our notes are on the website, but what are we doing with that input and feedback? It should tie to the legislative report that is being built along the way. We aren't documenting any vote or consensus being taken. For the new members sake, could we present our WRAC history and what has been decided and what is still in the works?

· Lisa Evert 4/25/2024 11:52 AM • Kelly F. you are making a good point. Those self-directing today are happy for the most part. I have heard that from non-WRAC members several times. Are we trying to fix parts that are not broken? SHOULD WE RE-SURVEY ALL WAIVER USERS, ARE WE USING OLD DATA? DEYOUNG CONSULTING has been conducting work this past year, what is the status of their work? We are headed for unintended consequences and even violation of law if we continue on this track.

· Kelly Friesen 4/25/2024 11:57 AM • Future Questions to consider: How will we assure that we are meeting the Olmstead mission? We should consider having an Olmstead representative on this Committee.

· Sarah Jones (She/Her) 4/25/2024 11:58 AM • Just in case it is helpful to see my question in writing. Are their actions steps Alliant (Lea/Kelly) or DHS can take to support the group to build a unified voice on recommendations, concerns etc.

· Facilitator Lea 4/25/2024 11:59 AM • Thank you everyone for your input!

· Heidi Hamilton, DHS 4/25/2024 11:59 AM • Kelly, are you thinking someone from the Olmstead Implementation Office?

· Kelly Friesen 4/25/2024 12:00 PM • Yes Heidi. ￿

· Phyllis Reller 4/25/2024 12:00 PM • thank you.

· Charlene Abramson 4/25/2024 12:00 PM • Thank you!!!

· Kelly Friesen 4/25/2024 12:00 PM • Thank you.