Waiver Reimagine Advisory Committee meeting minutes

Feb. 27, 2025

Summary

The session began with a welcome and sound checks, followed by introductions from Curtis Buhman, DSD manager and Natasha Merz, assistant commissioner.

Facilitation change

The there will be a change in the facilitation approach for the committee. The previous facilitator was not fully aligning with the needs of the group, prompting a shift in facilitation to better meet the committee's expectations. Jessica and Katie from the Office of Dispute Resolution were present to gather feedback on the new facilitation approach.

Project overview

Natasha provided a breakdown of the ongoing work:

· 2023-2024: Focus on policy development, engagemen and revising the waiver structure.

· 2024: The revision process has launched, including drafting plans for two new waivers and amendments, as well as updating services and data collection for the MnCHOICES system.

· 2026: Continuing analysis of data, interested party engagement and system changes for implementation.

Waiver Reimagine implementation delayed

The implementation of Waiver Reimagine has been pushed to Jan. 1, 2027, reflecting changes in the state budget forecast, which is under pressure from growing spending on disability services.

Budget and funding challenges

There are concerns over the cost of residential services under the waiver, which is higher than individual waivers. There’s pressure on the state budget because of increasing costs. The group is expected to help find ways to balance fiscal realities with the implementation of the Waiver Reimagine project. The group will discuss how to address the differences in funding between individual and residential waivers.

Integration of projects

The committee's feedback has led to the realization that Waiver Reimagine cannot be separated from other initiatives such as MnCHOICES. To better manage these interconnected projects, the department has introduced a complex project structure that includes project management support to ensure decisions are aligned across initiatives.

State budget presentation

The meeting continued with a budget presentation by Peter Butler from the State Budget Office, focusing on the financial challenges ahead.

The presentation focused on the state budget, particularly concerning spending on human services and education, which together make up around 70% of the state's general fund budget. Over the next few years, health and human services (HHS) and education are projected to grow, with HHS increasing from 30% to 37% and education slightly increasing as well. The main area of focus is the growth in disability waiver spending, particularly the CADI and DD waivers, which make up most of the costs.

Key factors driving this increase in waiver spending include:

· People: More people are using waivers, including a growing diversity of people, both younger and older adults.

· Services: There is an increase in both the number and types of services authorized, particularly residential services, which are more costly.

· Payment methodology: Payment rates have been adjusted. There has been a rise in exceptions, especially for residential services.

Specific trends include a rise in older adults using the CADI Waiver instead of the Elderly Waiver because of the absence of budget caps on CADI. Additionally, more children are being served under the waivers and there is a noted increase in racial diversity.

Also discussed was the desire for better feedback mechanisms from service users to improve the system. Some feedback loops are in place, such as case managers and the Response Center, but there is recognition that improvements are needed, especially as the state moves toward a system where people may manage their own budgets.

Finally, discussions touched on the need for more clarity and flexibility in waiver eligibility and how to ensure services are effective and accountable, particularly in managing costs. The state is working on initiatives to address these gaps, including consideration of improvements to the service authorization process and transparency.

Participants discussed issues related to waiver services for people with disabilities, particularly focusing on the differences between residential service options and the financial implications of these choices. One WRAC member shared personal experiences with her son’s care and raised concerns about the quality of food and services in his care facility. She also asked for clarification on different categories of residential care. Curtis explained the distinctions between community residential and family residential services, noting that family residential is smaller and typically non-staffed, while community residential involves larger group homes. There was also a mention of the challenges families face with staffing shortages in these settings.

Another member raised concerns about the high costs of licensed residential care compared to more affordable options such as independent living with family, suggesting that without proper funding for self-directed living, more people might be pushed into expensive institutional care. She highlighted the need to balance resources and avoid unjustified isolation, referencing the Olmstead decision, which mandates equitable service delivery.

A WRAC member echoed concerns about the disproportionate funding for licensed settings, emphasizing that families who want to live independently are being forced into institutional care because of insufficient support. She criticized the current two-waiver system, which she believes is unbalanced and unsustainable. The discussion also touched on the impact of inflation and rising costs on people who use waiver services. The meeting concluded with the facilitator acknowledging the feedback and the need for further discussions to explore solutions to these issues.

Office of Collaboration and Dispute Resolution

Katie Pratt and Jessica from the Office of Collaboration and Dispute Resolution (OCDR) introduced their office's role in assisting the group with facilitation during a transition. They explained their office, which focuses on fostering collaboration and resolving disputes in the public interest, would support the group through a process of reflecting on what has worked and how to improve the committee's effectiveness moving forward. They will be conducting small-group conversations between meetings to gather feedback and work on enhancing the process. They clarified that while they are not subject matter experts in specific areas such as health and human services, they could assist with facilitating discussions and improving collaboration.

Discussion

A WRAC member emphasized the critical need for residential services, particularly for children who are stuck in hospitals or detention centers without proper housing options, often due to a lack of in-state placements. She highlighted the balancing act between family and residential provider needs and the increasing demand for placements.

Other committee members expressed frustration with the lack of concrete progress and emphasized the need for a clearer roadmap and stronger collaboration. They suggested forming smaller subsets within the group to help shape meeting agendas, ensuring that non-DHS members have an equal say in the process. Several members stressed the importance of moving from discussion to actionable outcomes, tracking progress and ensuring that the group's voice is heard in legislative discussions.

WRAC members reiterated the need for smaller groups to meet between regular meetings and to ensure that all voices are represented in shaping the agenda and progress. The group called for a more structured and intentional approach to collaboration, following best practices and focusing on specific policies and goals rather than general updates. Some members expressed concerns about the impact of budget cuts on services and the importance of addressing these issues effectively.

One WRAC member suggested forming a peer support group for the committee, offering a space for members to share information and experiences to enhance communication and collaboration. This initiative would help gather feedback and create a more focused agenda for meetings.

Overall, there was a strong desire for more proactive collaboration, structured meetings and clearer progress tracking in order to make meaningful advancements in the committee's work.

There were discussions about the involvement and feedback of the WRAC members in the Waiver Reimagine process. A member expressed concern about not seeing how their input had been incorporated into the Waiver Reimagine plan, particularly beyond just naming the waivers. There was frustration about the lack of transparency, especially regarding the progression of unbundling and the MnCHOICES backlog, which left some feeling that changes were moving forward without meaningful input.

DHS representatives acknowledged the challenges of incorporating broad perspectives into the Waiver Reimagine process and emphasized the need for collaboration. They proposed a more structured, ongoing update process to reflect how member input is being integrated. The conversation also highlighted the desire for clearer progress tracking and better facilitation of collaboration, with suggestions for a roadmap or project plan with clear milestones.

The meeting concluded with a reminder about open WRAC seats and the need for applications to fill those positions. There was also a request for a member directory, which had been distributed a few years ago, to be considered again. The next meeting is scheduled for April 24.