WRAC raw captioner transcript, Feb. 27, 2025

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Hi, it is Adrienne. Can you all hear me? I see the chat now. Okay, great. We just currently have the mute for the background noise. I think we are able to unmute anyone at any point. As they are coming in, we have everything muted. Great. Seeing some yeses.
Good morning. Sound check. Getting really --
Can everyone see the screen I just started to share, too? Yes? Okay. Because I can't. [Laughs] I mean, I can. Sounds great.
Polly, you are unmuted.
Okay, I'm just going to talk again to see if people can hear all right. Natasha, last time you had a lot of feedback.
Is this -- just doing a sound check here. It's better for my end.
Can you hear me? I think that's a "yes."
Yes. And you're all seeing PowerPoint, as well, yes?
Yes.
If you want, I think we are a committee of 27 right now, if I did the math right yesterday. We've had two or three regrets we are saved in the last 24 hours.
So we are ready?
I think we can be ready. I will look to see if we have other people having difficulty logging on, but I think we can start.
Hello, folks. Kurt is here from the disability services division of the Department of Human Services. I think we are ready to convene this month February 27th waiver reimagined advisory committee. Again, my name is Curtis Buhman. I had light skin, brown hair, and you might see me occasionally pop my reading glasses on. I am here to walk us through the agenda, and one of the things I'm going to be doing as we move ahead is not going to put an icebreaker question in the chat that you can respond to by just saying whatever you want to say about yourself and answering the icebreaker question. Just a chance to get us talking and chatting together and getting familiarized, in lieu of a long string of introductions. I will get to that momentarily, but I think you're ready for the next slide. Agenda today, after we finish up this welcome we are going to walk through a change in the facilitation of this meeting. have been doing this meeting for -- I should have looked this up before the meeting today, but at least three years, and they're moving into facilitation change. We will walk through that momentarily. We are going to give you some project updates, and open it up for some Q&A, some questions and answers. Then you're going to move into a budget presentation and conclude with a facilitated discussion. At this point, I think we are ready for the next slide, Adrienne. I'm going to introduce our assistant commissioner, Natasha, who is going to talk us through the next several slides. Welcome, Natasha.
Thanks, Curtis, and thanks everyone for being here. Really happy to be on our February waiver reimagined committee meeting. I'm going to walk to the next two slides for all of you. As Curtis mentioned, we have determined that a change in facilitation would make a lot of sense right at this particular point in the project and in our work with you. Alliant has been with us a long time and you're grateful for the help and support they provided to DHS, but I also want to acknowledge, and I've heard loud and clear from this group, that sometimes the approach of facilitation that we were taking with Alliant wasn't aligned and supportive of all WRAC members. So we wanted to be responsive to that concern and look at a change in facilitation approach. So I did want to mention that we have Jessica and Katie from the office of dispute resolution that are here listening and going to give us a little bit of advice today. They will be facilitating a discussion with you at the end of our meeting about what you're looking for in facilitation to make sure that we have a really successful structure that incorporates all your feedback going forward. So you'll hear more from them later but I wanted to acknowledge that there on the meeting with us today to listen and hear what you all have to say and listen to the discussion we are to have. Next slide. So just a little bit of grounding in where we have been and where we are going, it's been a couple of months since we met and certainly a lot has changed in the interim time. I wanted to just walk through. You can see what's on the slide there, but 2023-2024 has been about policy development, engagement. The revision launched in 2024, so where we are headed next, we are in 2010 to five, as you all know, so looking to refine policy guidance, draft plans for two new waivers, plan amendments, and I will talk about that in more detail in the next slide. We are gathering updated data on services and supports for the MnCHOICES revision, and of course we are also working behind-the-scenes on some of our IT systems to plan and make changes we would need to implement. So 2026, looking forward, would look to be continuing to analyze MnCHOICES and MMIS data. For those who don't know, that's our Minnesota Medicaid information system. So that is the system that providers used to bill Medicaid for services and it's also the system that lead agencies used to enter service agreements, so it is the bridge between services being delivered and providers being paid for the services. And of course continued external stakeholder engagement and prep partners for implementation. And I wanted to reemphasize, I hope you all saw the announcement that went out earlier that we have pushed the implementation date of Waiver Reimagine to January 1 at 2027. So that is our date that the forecast has been updated to reflect that date, the state budget forecast. And I will walk through that in more detail on the next slide, please, Adrienne. Going to talk through a few important things here. As I mentioned before, we have gotten guidance and clarification from the governor's office but they do expect us to implement Waiver Reimagine into a 27 and implement it as -- it is currently written in state law, which is about the waiver structure. What I wanted to acknowledge for sure is that this group has raised a lot of different concerns about ATU-waiver structure. In particular, that the budget under the residential supports waiver are higher than the individual waivers, some of the sample ranges that we have shown to you and other members of the public in various reports. The other piece of context that has changed and that I think -- that I know needs to inform our work is the state budget forecast that continues to see really accelerated growth in spending under the waiver structures as they currently exist today, and that's putting a lot of pressure on the state budget overall. So one of the things, when I'm done here with my slides, we have experts from our state forecast and budget office that are going to walk through the specifics of that. And I asked them to come and said this would be an important presentation for all of you and all of us today to be on the same page about some of the different spending pressures that are occurring in our state budget, and we want to work with you to figure out how we can meet the needs of the changing fiscal realities and still implement Waiver Reimagine in a way that makes sense. So I realize that's not an easy conversation, it is a complex conversation, and it is where we are and where the state budget is today. So I will be looking to this group -- we will all be looking to this group to help us figure out, within the constraints we have with state spending, how we can implement Waiver Reimagine in a way that's really successful. I think we can and will discuss what it would look like to bring the individual supports waiver up to the same amount of spending as the residential waiver, but I think it is important to know that doesn't seem like a physical reality going forward, so we are going to have to figure out together what this looks like. But I do think it starts with a foundational conversation about what are the realities of the budget, what kind of growth we are seeing in the disability waiver, and what the future looks like. I think the last point I will make is that I know a lot of concerns you have all raised about the difference in support ranges under the two waivers. It relates to very legitimate policy concerns and homestay considerations in the sense of, why would we be paying so much more for people to live in residential settings when we want to incentivize them to be living in their own homes and community-based settings, accessing all heads of services and supports, not just waiver services? And that is our policy direction, that has been our policy direction, but we will see is that Minnesota is already paying a lot more on the residential services. Those are the primary cost drivers of the increased costs to the forecast. What that means is that the bias or the differentiation between how much Minnesota currently pays for residential services is inherently baked into how Minnesota has been doing business for really long time. That was in some ways and artifact or a result of deinstitutionalization, and building up community residential settings in group homes. I think what you're seeing the support ranges and the differences between those proposed support ranges is just reflecting reality. So if we want to make a significant change to that reality, and we feel we have done some of that in our early calculations, and we can talk through that, we have to make those changes in the context of a diminishing amount of money or a real shift in the state budget forecast. So I hope that you will hang in with us, and we have Peter Butler from -- our budget director, and Courtney Jones, who will walk through that with you, and certainly of course this is a really big, meaty, difficult point of discussion. While it's not going to be an easy conversation, I'm really looking for your feedback and your help so that we can cocreate this going forward within the existing fiscal realities that we have. In the last piece of news I want to share, we have also -- I wanted to talk about some of the things that we have done differently based on your feedback already. A couple things I want to mention, we talked about a facilitation change. You have more time in our agenda to talk through that later in the meeting. The other thing that we have really talked about, that you shared with us that we have really taken to heart, this idea that you can't separate Waiver Reimagine from other big projects or initiatives such as MnCHOICES. I think in the early days of meeting we are trying to keep those things separate because in our minds it made sense to keep them separate, and it got really complicated and we started talking about them in context for each other. But we recognize your feedback -- it was very clear we needed to incorporate that piece into how we talk about later reimagined. One of the things we have done at the Department's we have stood up what we call a complex project structure and brought in project management support from internal resources in the department to establish really clear decision-making structures, and for the scope of that complex project, we have included Waiver Reimagine, the MnCHOICES data and liability piece, and also the person portal. So as we are moving forward with each function within that project, we are all working together as a team to make sure that the decisions we are making on each component of the project are making sense together. So that complex project, you might not hear about that, it's an internal effort within DHS, that prior to the commissioner's departure, she understood how very important it was to have the right support to keep all these moving parts swimming forward together, given how complex it is. Certainly the temporary Commissioner has also expressed support for continuing with a complex project, and it's helping us manage our work a little bit better and catch interactions before we miss them. So very grateful for that. It's a big effort but I think it's really necessary for the scope and scale of this project and the ever-changing dynamics. That's what I have to share with you today, and I will be on for the rest of the meeting and anxious to hear conversation and anxious to get your feedback. What I will say is I'll handed off to Peter for the budget presentation, and hold your questions until after that. He has just a few slides to a clear, so make sure you are riding your questions or your comments down as you go so it may come back to the discussion we can do that. With that, I will hand it off to Peter.
Thank you, Natasha. I just want to triple check, can anybody hear me okay?
I can.
Okay, wonderful. Thank you, everybody. As Natasha said, and Peter Butler and on the budget director. My colleague is with me, as well, and they're going to walk through the slides at a high level about what kind of budget trends we're seeing. . But I thought I would start with is to try to show what the budget looks like overall for the state. You're going to see two pie charts on the screen, the first one showing the current biennium, fiscal year 2024-2025, and the second slide is showing the fiscal 28-29 biennium. What this is trying to illustrate is what the state spends general fund dollars on. You can see on the left that human services is just about 30% and education is a little over 30% there. By the time I get to the biennium in four years. We will look at health and human services to increase and be roughly 37% of the budget and education will go a little bit, as well, 36% of budget. The reason we are sharing this, when we think about decreasing cost and some of the fiscal situations for the state, we are thinking about how education and Health and Human Services combined are approximately 70% of the state budget, and that percentage is continuing to grow both for education and Health and Human Services. Everything I will note, I know we have it at the bottom of the slide, if we Zoom out and look at what all funds are, federal funds, funds we maybe get from fees, other special revenue funds, Health and Human Services is actually almost half of the entire fiscal 2024-2025 biennium, approximately 46%. Next slide, please. Part of the reason that we are here today is to talk about growth and disability waiver spending. What this chart is trying to show is what the combined cost is for the four separate waiver programs. You can see that overall CADI and DD make up the majority. What you can see here is that the starts in 2019 and goes all the way through fiscal year 2029. The reason you see asterisks for fiscal years 25-29 is these are what we are currently forecasting as of our November forecast. So the state releases two forecasts every year. A forecast comes out in November that shows the predominant amount of change across year-over-year programs like Medicaid, education formula changes, tax revenue assumptions. And then we do an updated forecast in February every year to help the legislature prepare for any sort of bills they might spend on. Just as kind of a programming note with that, the February forecast this year is coming out March 6th, a week from today, so this chart right here is going to need to get updated next week after we have the forecasts released. But this illustrates how we continue to have increased spending growth. Not only in the past few years, but we are projected continued growth over the next budget horizon. Next slide, please. One of the things we have been asked, other from the governor's office or from members of the legislature or members of the public, why do we think there are increases in waiver spending? We try to view it as three different buckets. There's people, we will talk about that in a moment, the actual services themselves, and then there's the payment methodology. We have these three buckets here with a few of the bullet points, and I will run through them quickly knowing we can talk more about it at the end with questions. When we are thinking about people, will be see in terms of trends that there are more people accessing the waivers, increase in terms of racial diversity, both younger and older adults accessing the waivers, and also the increases in disability or diagnosis nationally. Some of these trends are specific to Minnesota, but some of them certainly have a national flavor, as well. When we look at the next bucket with services, there is the increase in both the number and type of services authorized, an increase in the volume, and increase are both nonresidential and residential services, and as expected residential services continue to be a larger cost driver of the waiver program overall. Finally, when we think about payments, over the years the legislature has made different changes to the DW RS framework, increasing payments which we will talk about in a few minutes, and also an increase in use and rate of exceptions, especially residential services. The reason we like showing the three legged stool is because of the fact that we know -- I think there is an expectation that there is a one-size-fits-all approach of how we can deal with rising costs, and our approach is, no, there's multiple facets to this public policy question. Next slide, please. I mentioned in the previous slide that part of the trend we are seeing is that there are more older adults being served. On the left is just talking about baby boomers in general, retiring and how that might have a different trend in the nursing facility in the elderly space, what we see engravers is too really interesting. We are seeing that there is already some shift, especially within CADI usage, for this group. One of the things we have noticed, when you look at our data from January of 2023, is almost as many CADI enrollees and age bracket of 65-7 as there was in elderly waiverring. That's about 3700 individuals. What is also interesting, when you look at that group of age 65-70, as more folks receiving any sort of long-term care services, so that could be nursing homes, elderly waiver, CADI, and at the bottom of the slide is trying to illustrate how this has grown. In 2015, about 23% of its population in that 65-78 bracket was enrolled in CADI, but by 2023 it had increased to 43%. Next slide, please. I think another thing we wanted to emphasize is that there's more children being served, as well. What you're seeing here are two different bar charts. The one on the left from physically or 2020, and the one on the right from 2023. The section that is in blue shows people age 25 or younger versus the green which is people older than 25 or younger. You can see that the share that is 25 or older has dropped from 82% in fiscal year 2020 down to about 65% in DD, and a change for CADI is less dramatic but it's dropped from 92% to about 85% in that time. Next slide, please. So, one thing we were talking about too is that racial diversity is improving in the waivers, as well. This shows all of our different services. PCA, elderly waiver, disability waiver, nursing homes. You can see over times in fiscal year 2020 all of them have increased for the most part, that you can see for disability laborers it stands out with nearly a 6% increase in terms of the non-white versus BIPOC populations compared to some of the other programs were the changes are more modest. Next slide, please. One of the things we are really interested in is trying to understand where this cost driver is coming from. This chart again is just showing DD and CADI in terms of the cost trajectories. This is from 2013 going all the way out to projected fiscal year 2029. What I think we are seeing is that a lot of this increase in disability laborers is coming directly from average monthly cost increasing. I think if you look at forecast documents not just this year but over the last several years we would say this is a similar pattern we have noticed. It's just that, as it continues to compound year-over-year, it becomes a larger share of states funding. Next slide, please. Just to dig a little more into the weeds, we are seeing that more services are being authorized. Additionally, we see different services are being authorized with residential services still being the highest cost. We are seeing a decreasing use of lower cost state plan services, which means maybe folks are shifting to CADI again, which could have a different cost differential for the state, and I think I mentioned earlier we are seeing that rates are increasing in general. There's a little more data here on the slide, and I know sometimes going through each bullet can be a little aggravating for folks, so I can pause for a moment for folks to take this in and we can come back and talk about the side effects questions about it. Next slide, please. I think another way to illustrate what the previous slide with bullet points was trying to show, they are looking here at different types of waiver services and what their average rate was in fiscal year 2020 compared to fiscal year 2023. You can see, depending on the service, independent living skills, maybe not so much of a change to the 4% increase, but other things like family residential services are customized living services, you see 30-40% increases over about three and a half or four-year period. One thing we are continue to track is pretty considerable growth over a 4-year period and trying to anticipate what the next four years will look like for the state. We are trying to understand how to not only curb some of that growth, but understand why that growth is occurring in the first place. I believe these are the most slides. My apologies, I just saw a comment in the chat talking about reading through all the slides. If folks would like, I would like to go back to the previous slide just to read through it. My apologies there. Just reading through the slide real quick, as well, at the very top we have that more services are being authorized. On CADI and DD there's been about 167% more units billed per person compared to 2021. The authorized to build ratio remained relatively unchanged throughout that time. Matt, about 83%. Looking at the second bucket, we have the different services being authorized, and again, residential services are still the highest cost. So growth in nonresidential services continues to grow, but at the same time the residential services costs 3-4 times more than nonresidential services. So one of the things you have noticed that there is decreases and the percentage of recipients receiving residential services, but for CADI it's really not changed very much, which means that there's total growth in the total amount of services and costs necessary for that number of CADI recipients. Looking at the third bucket again, I mentioned there was a decreased use of lower cost share services. Since fiscal year 2021, there's been about 10% fewer folks are using this through the state plan, while CADI is serving about 25%. Finally, talking about rates again, the DWS inflationary adjustments came in higher than previously forecast and then exception rates are increasing. Exceptions make up approximately 22.5% of all DWR as spending an 90% of that is in residential services. I think that was the end of our slides, so I'm very happy to take questions, and I know Courtney is here for questions that I don't know the answers to. Thank you again for letting us come here to talk a little bit about the budget.
Had not this is Kelly. She do just unUte ourselves and go ahead, or are we going to be called on?
I'm happy to come on folks, so please go ahead, Kelly.
Thank you. I just want clarify, there's been a significant change since 2020. I'm trying to understand what the different waivers -- are we letting people access waivers that have needs outside of disability? I'm trying to think of what has changed in the last four or five years, and I know we have a lot more undocumented citizens in our state right now, so I don't know if they are being allowed to access some of the services or if we are treating addiction services with these waivers. What else -- are we just keeping me services and these waivers to people with disabilities or are we expanding men to other populations?
Thanks for your question. This is Natasha. I can take that one. Just to address a couple of your questions directly, the eligibility requirements for waivers have not changed, so people need to meet a nursing facility level of care in order to access these waivers, and they have to meet the financial and a categorical Medical Assistance eligibility. So there are some types of immigrants and refugees that can access Medicaid services, but typically undocumented folks cannot, so that is not a driver in costs under the waiver. What I can also say is the diagnoses of people being served hasn't really made a shift over time because of the increase in costs we are seeing is attributable to that file could stool, as Peter described it before, of increasing authorizations, rates that have been increased through inflationary updates, and other things as well as rate exceptions. So I think the other piece of contextual information that maybe is part of this puzzle is that DHS doesn't have waiting lists for waivers, and counties have been spending -- the incentives for counties to not overspend or aggregate budgets have been kind of stripped away in law over time trying to prioritize getting access to services. You may remember times were counties would decide if they can afford to put someone on the waiver and they had prioritization structures, and if they couldn't afford it or if it was going to be too much for the aggregate budget, they had to figure out how to manage that the reductions in services or having people wait to access. So a lot of those requirements or incentives for counties have gone away, so counties are authorizing more services and supports for people as a major cost driver.
I appreciate that, Natasha. To clarify, then, are waivers right now are only being used for people with disabilities, not for any other diagnoses or addictions or housing for people that need housing? They don't necessarily have a disability? It is yes or no.
I can't give you a "yes" or "no" answer that is accurate. There isn't a list of disabilities that will or won't put you on the waiver. It is about the intensity of the needs that you have. So I talked before about needing to meet an institutional level of care to access the waiver. What that means is that the person has to have needs that are significant enough that they would otherwise be in a nursing home or an ICF DD or other type of institutional setting. If they didn't have services and supports in the community. They do have to have a disability diagnosis broadly through either the state medical review process over people that are of course 65 or older. At the pathway, as well. So they have to meet a broad definition of disability that is fairly broad, but it is not diagnosis-specific. Certainly the specific diagnoses like brain injury often, different diagnoses, but the issue is a general disability diagnosis, you meet eligibility requirements and you have an intensity of need that would otherwise require you to be in an institution to meet health and safety needs.
Thank you.
I have a question. I don't know if there's anyone else with her hand up, I can't see.
I have my hand up, but go ahead. This is Pat.
Tsai, Pat. Are you sure?
No worries. Go ahead.
Thank you. People receiving long-term care services to Medicaid, that in 2015, 23% were enrolled in CADI ended 2023, 43% were enrolled in CADI. So can you guys talk a little bit about what that means? Does that mean the services under elderly waiver are inadequate for older adults right now? Is that why folks are choosing to stay on the CADI labor? And the other thing that I wanted to say is that, it kind of seems like the CADI waiver is a catchall for everything, because there are folks that would probably be better suited on the other waivers that are just put on the CADI waiver by default. So is there anything -- is there any data around that? Highlighting why this is happening. It seems like the CADI waiver is being used a lot for older adults, as well. So just feedback around that.
Thanks for it I will maybe provide some answers and then I would certainly invite anyone else on the ESD team or the budget folks, if you have additional information, to round it out. Regarding your question about people that are now 65 and older accessing CADI, I think you're absolutely right, that we are seeing people that are choosing to stay on CADI after they turn 65, where they could theoretically access elderly waiver and services, but we typically see that people choose to stay on CADI because it doesn't have a budget cap. So as many of you may know, elderly waiver has budget caps with currently no ability to have an exception to that cap. So you are given -- the lead agency is given a budget to work within based on that person's assessment. So there isn't a real benefit of moving to elderly waiver if you are already on CADI. So to me I think it's just a rational choice for people to stay on CADI. As Peter said, if people are younger accessing waivers and their aging, and therefore the utilization of CADI is increasing. Related to -- I will say, on the elderly waiver, we are working on implementing a budget exception for EW. For people who don't have access to CADI or the disability waivers and they have exceptional needs, it's very challenging to find a provider to serve them, so just a note on that piece. In terms of CADI kind of being the catchall, but I would say about that is one of the things he had been working on as part of waiver reimagine phase one was aligning the service menu that is available to people across the disability waiver. Whereas before we did that, there were different types of services or name different things but functionally did the same thing, and same on BINGD, I think CADI is a catchall because you don't need a specific diagnosis. Like a brain injury waiver, you have to have traumatic brain injury and need a certain functionality there. I don't know that -- at the same time, none of the disability waivers have upper limits or budget caps, and so I don't know that moving people that maybe could be accessing the BI waiver, for example, but are on CADI, I don't know that it from a functional perspective makes any difference in terms of money in the state trends. So those are my initial responses, but I would want anyone from DHS to weigh in if there's any other trends I might be missing or any clarifications.
Hi, everybody. This is Heidi Hamilton. I just joined. I'm very sorry for being late. I was at another stakeholder meeting. Another initiative that we are launching right now, in the process of's. Anyway, just to add to what Natasha said, related to CADI versus the elderly waiver, the elderly labor was really designed for people over age 65 and might not meet the needs of people who have had lifelong disabilities or who have become disabled earlier in life. A couple of the things that are not as prevalent in the elderly waiver are those training supports that people might need in order to live independently in a community or leaving a community at all, and also they don't have employment on the elderly waiver. When these programs are created, this option as people retire at age 65, and that absolutely happens for some people, but some people do not want to retire at age 65 and want to continue working, so I think we find that it's really rare for somebody who is on the CADI waiver it if you their needs will be met under EW. So everyone is given the choice when they turn 65 whether to move to EW or stay on CADI. But it's very rare. When I first started at DHS, people had to move from the CADI waiver to the elderly waiver at age 65, and that caused a lot of problems for people, and so we have created more flexibility to allow people to remain on the CADI waiver.
It looks like Julie has her hand up.
Hi. I represent an adult child with a disability who has been on waiver services for a long time. I continue to have trouble understanding the system-wide issues, so I'm to ask my question from a person-centered approach, and feel free to let me know that someone can follow up with me afterwards. As we look at these budgets, and we are moving towards individuals being able to manage their own budget, I continue to struggle with having really no access to understanding where my daughter's budget is, what it has grown or shrunk over time, and where there is ability to perhaps be more efficient or more effective with her service providers, which in theory would enable cost savings. So there was really nowhere in that budget overview about efficiency and effectiveness, I guess it's my bigger question. And if we are still moving to individuals managing their own budgets, in order to help with the costs, where does that fit into this?
I'm just turning to digest your question here. I think the first part was, if I am capturing it correctly, there isn't a current place for you to go and be able to see the budget or see the services or see the amount that's being spent on services. Is that -- did I get that right?
There's a piece of paper that comes every so often, but let me just give an example. My daughter gets perhaps six different annual assessments and goalsetting meetings, so that to me seems a waste right there, and she hates it. Every service provider wants to do it themselves. But then, really, there is also no way to give feedback on how you think -- so she has employment training, but they're not doing any employment training. So where's the feedback loop to determine how effective the spending on these services is? So it is a multifaceted question, but it's kind of, as you are looking top down, I'm looking at it bottom up as an efficiency, effectiveness, and ownership -- or ability to own her budget eventually over time. None of that is available. So even if we all wanted to help solve the budget challenges, we have no ability to do it person by person.
Right. Just in terms of where the feedback loop is, I think we need more of them and more tools than we currently have. We do look to the H CBS person portal as a tool or a mechanism to be able to create more transparency and then maybe start thinking about how we evaluate. What I would like to do is ask anyone from DSD the talk about what are the feedback loops that exist today, understanding that we definitely see room for improvement. And before I handed off to anyone from DSD, part of this too, in a county administered system that we are delegating a lot of those types of functions and responsibilities to a county case manager in terms of doing that service evaluation, I think that is definitely an area that we could explore as part of readiness for waiver reimagine. What are the types of information and the types of feedback loops that would actually be meaningful to people that use services? With that I will handed off off to maybe Curtis for some feedback.
I'll take a shot at this. You covered a lot of it already, Natasha, but your first stop on this is of course the case manager who authorized the services, and being sure to tell them, are you actually getting the service? If there is a billable service being provided, what was planned? So there is that lean. From a DST lane, you can contact us at the response center if you have concerns or questions about the policy and what's going on, and need clarification of, is this a service that is intended when I am authorized for X? And also we can engage our licensing staff if there is a deficiency in the provision of the service. That is what is in my head right now. I'm probably forgetting something, but there are avenues, and I'm sure we will be exploring more of these in more ways to achieve that accountability.
Curtis, not to take this group into a deep dive on my particular issue. It's more the idea to amplify that there is an efficiency, effectiveness, accountability missing link, system-wide. So that is where I am just -- I'm hoping that is getting looked at somewhere in this project implementation.
And I appreciate that, Julie. I agree with you. Some of what you're talking about, maybe not all of it, is probably present in the governor's budget proposals, and we will be looking harder at some of this as we move forward. But I think you are accurate with your comments. I appreciate that.
Thank you.
This is Natasha. I see that Pat and Lisa have a hands up. I'm sorry, it's harder when I'm dealing with Webex a little bit here.
I'll tell you the order of people. It is Pat, Tricia, Lisa, Dr. K, and those are the four people that have their hands up right now.
Okay, great. Let's see if we can work through the questions for people that have their hands raised and then I will hand it off to the office of dispute and conflict resolution to introduce themselves, and they can also facilitate the additional questions that are coming up on this topic or any other part of the agenda. Go ahead, Pat.
I am Pat Wright, a waiver user, and also I have a son who is on wavered services. I did want to just say -- I think it was Zahnia talking about the elderly waiver and the CADI waiver. When I turn 65, had the choice, but I was told my budget would probably go down. Recently, just a few months ago, my case manager, when I had my assessment, said that I would be eligible for more on elderly waiver, but I would lose her because her agency doesn't do elderly waiver. So I checked it out with the assessment guy, and it was like three times what I'm currently getting if I switched over to elderly Lavery. But I would not give up my case manager for any money paid to me she is invaluable. So I just wanted to put that out there. And she did say I would have to switch to managed care, so I don't know if this is a managed care deal, or -- anyway, there is that. Also, thank you to the woman before, I think it was Julie. Yeah, I have issues with where my son lives, serving hot pockets for dinner, and he needs a special diet. I think if there was some way to have some kind of accountability, and he has refused me getting involved, because obviously I can do that, and it's a very small place, and we have raised the issue. So somebody came in there and was stirring things up, they would probably know who it came from and what not. So I'm just putting that out there. My question is, these four categories we talked about, residential, family residential, independent, and I can't remember what the fourth one was. I think I know what these are, but the difference between the family residential, and just straight residential, could you go briefly through what those categories were?
Thanks, Pat, for both of those comments. When you say categories, are you talking about -- I think you're talking about slide 15 and what those are?
I think so, yeah.
The community residential services.
Yeah.
I will hand that off to Curtis or someone from DSD who wants to walk through what those services are.
Sure, I can take a stab at it, but I don't have the slide in front of me. I will start by differentiating between community residential service and family residential service. Family residential service occurs in a family foster care license setting. So those have a different rate framework, or those will have a new rate vehicle established starting in 2026. They tend to be -- thank you -- settings that are not shift staff they don't have actually employees for the most part, but the person who owns the home has somebody living with them and that his family residential. It's a much smaller group than the community residential settings. Customize living is a different licensing structure through the Department of Health, a different kind of setting. Again, different -- I'm sorry, I'm babbling here a little bit, but a different service definition under our waiver plan. Independent living skills with training is an hourly service that is provided to individuals who need the service. I'm going to stop there rather than continuing on to see if I'm getting close to answering your question, Pat.
Yeah, yeah. My son is in a place that they used to call foster care, so that his family. I'm sure there's a place I can probably find needs on the DHS website, too.
Pat, the community residential services are what we used to call SOS, or supported living services. That includes most of our corporate group home settings, for lack of a better expression. To differentiate them from family residential.
Thanks, Curtis. Appreciate that.
I just want to address some of the comments that you had made, Pat, related to your case manager. We are seeing a lot of turnover and case managers, which I'm sure you are all aware of, and the impact of the workforce shortage is not just direct care workforce shortage but also the case management level. So I completely understand why you would make decisions based on access to the case manager that you've developed a relationship with. And you mentioned managed care, that was one piece mentioned earlier. But the elderly waiver is primarily people on managed care, or the elderly waiver services, and that's not the case for the disability waiver program. So that is another difference that people would need to make a decision about.
Thanks, Heidi.
Let's move to Tricia next.
Thank you. I had a couple comments I wanted to point out. One thing about the residential services, when you look at the highest cost, that really gets me that it costs the most money, it is probably the most restrictive type of environment, or the most institution-like, yet the workers, the staff in those facilities, are so poorly paid. So I think that is something we need to look at, that there is a staff shortage in the pay within those facilities is not that great. Where is the money going? I sometimes wonder, is it the corporate piece that is the money suck? I think it's logical to take a look at that, maybe. Because it's really hard for families to say, I want my loved one to stay at home, they want to stay at home, but we can't afford it. So we go spend more money to put them in a facility. So that's the logic I wanted to point out, or maybe a consideration, whether that is logic. And there's also the Olmstead decision. What it basically says is that budgets don't assess or drive disability need. So while he understand we have to look at the reality, the Olmstead decision, or the realities of the budget -- I'm trying to be concise here. Emphasizing that unjustified isolation would be a form of discrimination based on disability, and the states would have to balance the resources while providing services equitably. And I think that is something we need to go back to, just because the budget is changing, the knee doesn't change. And that is a very serious thing we need to consider. Thanks.
Tricia, just to respond briefly, I think your concerns on staff wages are shared. I know our legislators have approved substantial additional funding with the intention of impacting those wages, and they have taken a couple of actions that would probably be helpful. First of all, we have cost reporting occurring from providers where we are eliciting their accounts and finding out how much they are paying to staff, among other things. And also the legislature has passed a statute setting wage thresholds where they want to know that providers are paying at least this much to staff. My understanding of that statute, it doesn't actually have a penalty or sanction imposed.
Is no accountability, so it's like, we can find out what's going on, but we can't do anything about it.
Yeah, and that was a decision by the legislature. The accountability would be just to have visibility about what's going on. So it would see the light of day in terms of what is actually being paid. I hear you, and your comments are absolutely legitimate. I just wanted to point those two pieces out. That's all. Thanks.
Thanks. I don't think it makes me feel any better, but thank you. [Laughs]
I just want to add that the governor's budget this year does include funding and resources to do something about the information that we find. So there are pieces of the governor's budget that include more staff to focus on enforcement and not just collecting the data.
If I could kind of circle back a little bit of something that was said earlier about individuals feeling like there are things in their own waiver or their child's waiver that just don't make sense and might be a waste of money, I would encourage DHS to seek out that feedback and maybe not be so passive and wait for people who are already overstretched to reach out and say, hey, there is wasteful spending in my budget, and risk losing some budget. Maybe seek us out and find out how we feel about it intentionally, because you might be able to find more wasteful spending there than anywhere else.
Thanks. I appreciate both comments and questions. Let's move on to Lisa.
Good morning. Lisa, parent to an adult using the waiver services, approximately 20 years now. I have been on this committee I guess since the beginning. Lots of good discussions. When I want to point out, and it is an interesting time, how we kicked off this meeting as a step back to over. I don't know what you want to call it. Anyway, what is striking me so far in this meeting is I want to go back to the beginning comment from Natasha that you recognize that this committee has struggled with the two-waiver system, and having budget aligned that seemed unbalanced, that you are providing more budgeting for a licensed setting. So thank you for recognizing that, because you are absolutely right. We have struggled with that from the first meeting. So you are saying -- and I know this, too -- we pay more now, in the past, for those license settings, so we are going to continue to pay more, and I'm sure in part what you meant by that is, by nature, a licensed setting is going to be more expensive because of how it is structured. But we are paying more for those settings now and the artist going to keep paying more, is what you had said. And then you moved forward today to slide 14. Correct me if I'm wrong, but I'm reading slide 14 to say that those licensed settings are costing 3-4 times more than if you were in unlicensed, independent living with family. Not a surprise anybody on this call. I'm sure we know they cost more. So what I want to emphasize is that, if we don't -- if we as WRAC, we as DHS, we as Minnesota, if we don't provide appropriate funding in a budget to people who want to self-directed, live independently, live with family, in a nonlicensed setting, then the only thing we are doing is pushing with no other alternative to go to those licensed setting that our 3-more times more expensive. We have seen so far -- and I know our world is changing because of the governor budget and everything coming nationally, but where we have been at so far in two years with WRAC is that the budget numbers are so devastating to the people that currently self-direct and living a nonlicensed setting, it is not sustainable. It is devastating. That is why I'm on this committee. If we keep going down that way of thinking, and you now have slide 14 that draws out clearly these license settings are terribly expensive, it is unbelievably irresponsible for us as a committee to not find the appropriate balance, to not cut off people at the knees that are currently self-directing, have been doing it for literally decades in some examples. They need has not changed. All they wish for is to be able to get out of bed, brush their teeth, and take their medicine. That is just a perk. We have heard the stories. So I just want to emphasize -- correctly anywhere that I'm wrong, but as WRAC we just can't allow that. It is irresponsible, and putting forward proposals that just do that so blatantly -- I can't say it anymore. I been doing this for two years, and it's just wrong. I don't expect to solve this today. I guess what I'm saying is more just my comments and observation, this is kind of a breath of refreshing here that we can sort of start over. I want to recognize that, honestly, the landscape in our state with the budget cuts coming from the governor's office, the stuff coming out of the White House, this is all new to all of us, and it is devastating where our life is going, and Natasha and your team, hello. It's got to be miserable. But black and white common sense says this committee is completely a failure and irresponsible if we put forward a proposal that continues to support the most expensive option out there. I can't imagine -- if you implement it waiver reimagine with that kind of unbalanced budgeting, and it unfolds to the point that -- we have had. Say, I had no choice but to place my child. If that unfolds, and now the governor's budget has to recognize that path of what human choices were, what would that do to the bottom line budget again? We can't support it now, we can't support it then. Anyway, I hope that is clear. It is more of a comment then it is a question, but that is where I'm at, and I appreciate this fresh start over. But this is getting very frustrating, that we just keep beating down that same path of two waivers that make no sense. Especially in the budgeting. Thank you.
Thanks, Lisa. I appreciate everything that you have just shared, and I think that is a summary of the rock and a hard place that we are in. One thing I will say is the numbers that I think you are all referencing her in the legislative reports from 2019, and we need to provide some high-level updated numbers in terms of the impact of inflation and rates and things on people's budgets. So that might help us, if we are able to do that before we recalibrate, it might help us have a conversation with updated numbers and be able to work off that. Specific to the issue between the differences in cost drivers on the two waivers. As you mentioned, we are not going to be able to solve that today, but I do think that is a conversation that we need to have with the WRAC, to say, what are the solutions? If these solutions are unacceptable, what are the solutions? Understanding that we have an obligation to implement according to state law unless the state law changes. So we have to be driving towards implementation in '27, and it would take a legislative change to stop it. If we can make those recommendations and see where that takes us. But I just appreciate what you are sharing, and it is not new information, but I appreciate the way you summarized it. Dr. Kate, what did you want to say?
We have one of the most expensive models, providing care by using residential services, and you are saying we need to keep this model which is extraordinarily expensive and will increase the numbers of people in residential care because the supports are not able to be accessed by people in the community, and this will increase the total cost instead of revamping the service to a different direction, to keep more people in the community at a lesser cost. This is a huge problem which indicates a serious lack of vision about other options.
Thanks, Dr. Kate. All right. I just want to thank people for their comments and their feedback, and as I said before, I think this is a fundamental discussion that we need to have. I would, I think... Oh, I am seeing that -- I think what I'm going to do is recognize other folks have their hands up, but I would like to hand it off to the office of conflict resolution to introduce themselves and lay some facilitation groundwork, and Jessica and Katie, if we can then spend some time before the end of the meeting to make sure that everyone that has their hand up or has a comment that they want to share has an opportunity to do that before the meeting ends. Is that okay? Is at a reasonable way to move forward?
That works. Gina and P22, I see your hands up, and we will come right back to you. We will jump in and let you know who the office of collaboration and dispute resolution is. So this will just be a little interlude. My name is Katie Pratt and I am the director of the office of collaboration and dispute resolution, and I'm here with Jessica who introduced herself in in a minute, as well. But DHS reached out to us letting us know that you are going through a facilitation transition with this group, and if this was something we could be a part of helping to steward the group through this transition, making sure that you are set up for success as you continue on as a committee and in your work together, looking back at what has been effective in WRAC so far, and how you can make the most out of your time together. I understand you still have a couple years to work together, but I also know that on complex issues time can go really fast. So we will take a few minutes to explain who we are, and how we are going to be working with you in the near term, and then we will get right back to your questions. So please know that we are coming back. The office of collaboration and dispute resolution, we are a state office, located in the Department of administration, but we exist in statutes, and we have a broad mandate to help Minnesotans collaborate better to work on collaborative problem-solving and solve issues that are in the public interest. So we work on a whole range of topics, we were good state, local, tribal governments, we work across all three branches of government and any issue area. So we are not subject matter experts, Health and Human Services or education or environment or any of the other topics that come to us. That is who we are, and the next slide, please. Again, what are charge is as an office, the sustainable resolution of matters of public interest, effective collaboration and dispute resolution, in state and local government, and the broad use of community mediation throughout Minnesota. So we are part of a much larger network in Minnesota of facilitators and mediators and people who help Minnesotans work together to get needs met, and especially our office really focuses on when there are complex issues that there is no easy answer, no magic wand solution. And it really takes the creativity and collaboration of many different groups and perspectives to make the wisest decisions you can under the circumstances. So that is where we land. Just a little bit about me, I have been in this role for about two and half years. I was in state government previously in a different role working on environmental issues. I have a background in geography, and as my colleague Jessica just learned yesterday, I have an undergraduate degree in zoology. Fun fact. It was a long pathway from here to working on what I do now, but I love it and I get to interact with wonderful people. Jessica, I will turn it to you to say a couple words about yourself.
Sure, sounds good. Thank you, Katie. It's good to be in this space with everyone today. I am Jessica, the assistant director of OCDR. Like Katie, I've been in my role about two and half years. Before that I was in organizational development consultant and worked with government and non-profit clients. Before that I was a quality director and I also have a degree in counseling, so that's a little bit about me.
Thank you, Jessica. We'll just continue on with this conversation today. We still have a good chunk of time left on this meeting, to help field questions, and we also have questions back for you if there's time. Another thing we want to give you a heads up about is, because this committee is going through a transition, Jessica and I are looking to connect with you outside of your typical every other month meeting space. So between now and your next meeting, which is an April. And have some small-group conversations to reflect more on the process of the committee. What has been working well? What has not been working well? What would you like to see in your next facilitator? What qualities do you hope they have? How do you hope to make the most out of your time together? So we might have some time to get into that a little bit today, will he for sure want to have some small-group conversations. After today, you will be receiving a follow-up email with sometimes when Jessica and I will be opening a call. If your schedule allows, please come and give us your feedback. If you would like to talk to us and give us some feedback about the process in those times don't line up, we will also make ourselves available to make sure we can connect with you. Keep in mind that we are not the subject matter experts, so if you have specific concerns about waiver reimagine, we don't have the content area expertise to tell you yes or no way that will work or that won't work. But we can help with the process. How is the conversation going? How is the collaboration going? How do we work together? So stay tuned for that follow-up email. In the meantime, I think we can take the slide deck back down and continue on with our questions. If you have any questions for Jessica or I about our OCDR work, too, we are happy to answer those. I will turn it next over to Gina who has her hand raised. And for all of you to know, if you have a question, use the hand raise feature next to your name and we will just call on the hands in order that we have them. So thank you.
Thank you, Katie, for that. I started to preface in our chat a little bit, and I know that on the waiver, and that's why we have the committee, because there are people both on the family side and also on the other side, the residential settings. I think that is so important. But a couple of the things I wanted to mention, especially when we are talking budgets, there's going to be a very delicate balance between both, for sure. I did say they are both at an increased need. There are people who never would have care housing if it weren't for the residential and corporate settings, as well. One of the current things that we really deal with in both crisis and CRS currently is there is a complete backup, again, because the state did stop us being able to do hotel suites and things like that. So there's another backup, especially for children that are stuck in hospitals and detention centers right now. They have nowhere to go. There are providers ready to take them, but unless we develop new houses, there's nowhere for them to go. So I want everybody on the committee just to be aware, from the residential and corporate side, that there are a lot of kids out there that their families will not even allow them to come back home even with a provider in the home with them supporting them around the clock. So there is a very high need for these children to have residential providers, and corporate come as well. And there is an increased need of children across the state that are like this. They are in the system, the state is actually their guardian, the state or county's, even under child protection. And there is nowhere for them to go unless these residential and corporate settings are increasing their developments right now and allowing them to come in. A lot of our children are sent out of state because there is such a lack of placement in the state. So I really, really wanted to make that point, for those who are also on the family provider side, so you guys really understand what it looks like on the residential and corporate side, as well, and some of the things that we are battling with, trying to get care even within the state. So these kids can't even stay in-state. Have children or maybe their family lives way up north and they have to live way down south because that's the only place in the state, or vice versa. So I just really want to make a point to say that there is absolutely going to be a need, but there is an increased need on both sides, as well. So as we are working together as a committee, I really hope we can hone in on the fact and understanding of those opposite sides of the road as we are looking at budgets and things going forward. Thank you.
I will turn it back over to DHS to see if there's any response before we move on.
I appreciate those comments, Gina, and I think that is the challenge we have in front of us today, making sure we have a service system that works for all people. And sometimes folks do need to access those residential services, and we need to have those be available. So I appreciate the point very much, and I think -- [Inaudible]
Great, okay. We will move on to Polly.
Hi. This is Polly, I have to apologize, I still have a raspy voice. I'm getting over a cold. I represent the ARC Minnesota as a volunteer and I'm an independent consumer directed community supports support planner. I have a couple things. First, Natasha, thank you for participating. Your involvement has been awesome. Heidi, if you are still on here, I want to thank you for last time. He sent a link to a site for individuals getting CDCS who had their budgets cut by over $10,000 but their needs haven't changed. I sent that out to the families I work with that I've had that happen, and they have been able to -- the majority of them have been able to have their MnCHOICES assessment relooked at and most of them have gained back the services or the budget amount that they lost. So those are two things. Thank you guys. I'm very much looking forward, Katie and Jessica, to you guys facilitating this. Like has been said before, I've been on this group since the beginning. I feel like nothing has been accomplished, really, in the last couple years. What I look forward to with you guys facilitating, because it would take it out to the realm of DHS that having to facilitate, I think that could provide an opportunity for them to come off as more equal partners. So if you're not facilitating, you are a participant and an equal partner, and I think that will be very helpful to have DHS's voice heard as an equal partner. So that is one thing I would really like to have happen as we move forward, and start fresh. So thank you.
Thanks for that comment. And DHS folks, if you have any responses are things you want to chime in with, just jump in. Otherwise I'll just keep queuing up the next questions. Trisha, it looks like you're up next.
Thank you. I think it is important to point out, we know that residential is needed in some cases. It's just that I think they're more concerned about when it is being used for people who don't need it or want to be there, but they are there because of the lack of community services. I'm going to just respond to what Gina said. I worked in child protection for three years. Looking back on, based on what I know now, the majority of the families who are encountering child protection services, a lot of it was because they had a child with extra needs or a circumstance where needs weren't being met, even close to it. There was such a stark absence of the services, the many services that exist, but they weren't accessing or weren't in place or weren't the right fit. I get that there is a need, but we need to think about how much of a need we are creating by not meeting families' needs in the first place, not meeting disability needs in the first place. Same with incarceration. Let's be a little more proactive, I guess, in looking at where we can maybe improve access to save money. Thank you.
Thanks for that comment. Polly, I don't know if you had another comment or if your hand is just raised from before.
Is there anyone else with -- I don't see any current hands raised. Is there anyone else with an immediate comment or question? If not, I have a couple questions for you all. Please jump in if you want to continue with any of these past topics that have been coming up. One of my questions asked Jessica and I are very new. We are learning what all these acronyms mean, we are learning about the complex puzzle and trade-offs that you are talking about. But thinking about, let's just take 2025. A year is a time we can wrap your head around. If you look back in your meetings together as a group, what would success you like to you? What have we accomplished? What would you feel good about looking back in 2025 and say, that was a good use of our time together? Any thoughts on that? Sue, go ahead. Sue, go ahead and unmute yourself if you are able to.
I'm so sorry, here I was talking. I represent the day and employment services provider, and I had white hair and I am a senior, and I feel the success for me -- I think you have accomplished some things just by being together and discussing various issues. Because my role as an executive director of an agency is to go back and figure out how we can do this, how we can do this. So I think it has been very valuable, and I so appreciate what Tricia said in regard to residential employees being underpaid, and Lisa's discussion regarding being frustrated and asking not to be frustrated, because we really are coming together as a group and being able to deal with what is going to happen nationally and also with the governor's budget, et cetera. We have an opportunity, DHS has opened this to us to become the solution and problem solvers rather than has, as I think on the federal side of things, we are going to have some issues that we have no control over and no input into resolution. I think that is really very important. But part of what I feel from success is taking individual responsibility for my peers to go back and say we need to change things. And we have done that. I have 98% retention of my DS Ps, and it's because of changing the culture of how we function and how we operate. So I have been very grateful for these sessions, and have listened a great deal, and I think that we are just now reaching the point of being able to have some good problem-solving. Thank you.
Thank you. That's great. Polly, do you have your hand up for this question?
No, I've got to take it down. I'm sorry.
No worries. We all do that. It looks like Lisa is next, then.
Okay. Like Sue was saying, true problem-solving. I like what she said there. With the assumption that today is somewhat of a fresh start, I want to recognize that last year we had lots of discussions about true collaboration. I don't think we're there yet. What I have felt -- I'm no expert here on this stuff, but what I have felt for a long time is, in order to collaborate and have the nonDHS members of this committee truly feel like we are part of this process, I think the group is very large and so if we could have been identified small subset that is the voice of the nonDHS members of this committee, the purpose of that small subset would be to be our voice, of course, but helped build the agenda for every meeting. I am assuming today's agenda had zero input from a nonDHS member. Correct me if I'm wrong. So that is one layer that I think we should consider, to keep this productive and under its initial intent of why we even exist. Other than that, I think we need a new road map. We have had that dabbled in the past two years, but I think this is a perfect time to establish what is the new road map. You kind of had that with the timeline as we go into 2025, 2026, and 2027, but something we can all have as a go to. The other thing I want to emphasize that I feel ties into what Sue was saying, too, this has gone nowhere in a lot of ways. Two years of WRAC existing. I think for all of us to feel like we are always on the same page and that we are actually making progress we need to log that progress and show it. You can take meeting minutes and things, but go deeper than that and kick off every meeting to say, okay, based on last meeting, we have now had agreement on X, Y, and Z. This is where we have suggested recommendations that we have all agreed on. There is never been clarity about what we want, what we had input on. I have said this all along, but it is in writing within our charter. This committee, the entire committee has a say and a duty to create what is presented to our legislature as the change under way for me imagine. We have never seen that document. I don't think it exists, to be honest. Now more than ever, because of extreme pressure that we are all going to see by our state budgeting and violets happening nationally, it is more important than ever to stay on the right page. So, to reiterate, I do think we have to have a small subset of us that is truly our voice to collaborate setting every meeting. We need a new road map, and we need to show every meeting our log of success, our log of progress, our log of agreement, voting, whatever that means to get there. But to show that we actually had our voice heard and it matters, and it is reaching that legislative proposal. So that is my two cents. Thank you. Seek a thank you, Lisa. As a facilitator, some very concrete feedback that I appreciate. Thank you. Pat, we will go to you next.
Hi. Pat, dark hair, hazel eyes, senior, on a waiver, son is on a waiver. I really like the two previous comments and ideas, and to expand on the comments about helping to create the agenda and meeting as nonDHS staff. Let's put it that way. Taking it to another level, being able to have possibly groups of people categorized by family members, individuals on the waiver, those could maybe be combined or separate depending on how people feel, how many people they are. And then agency people. And there might be something else. I'm not totally sure who makes up this group. In terms of what to look for, what I would like to see in 2025, those groups could possibly meet in between the regular WRAC meetings, and there could possibly be a representative from each of those smaller groups that could meet to help form the agenda. Also, they would be -- what I have noticed, I have been on the WRAC meeting since we started years ago, and it seems like over time there has been the issue of, one, going through the process, which I highly value. I am a process person. And two, people who have gotten very frustrated with, what have we achieved? Things are the same. There is so much more yet to do, and I would have to start over. Sorry about this cat to in the background, it's making a lot of noise. I think both are very valuable. I think being able to have a group process -- I think that's how we got here, and I think it is important that we got here, and where we are feels really important, where we are feeling like we have a voice and we are helping to determine the forward movement and whatnot. Hopefully that is clear. I feel like come out of that, people being able to listen to each other and ask questions and get more information, that is how things will be done or achieved, goals met, however we want to say that. All right, thank you.
That's great. Helpful. There are things coming up for me, and we'll take a couple minutes after comments to report some of the things you're hearing right now today. This is great. Chad, we will go to you next.
Sorry about that. I see my video was not working there. My name is Chad Wilson. I am an attorney with the Minnesota disability Law Center. My comments reflect a lot of what members have already said. I feel like a lot of these recent meetings -- maybe it is because it is reset, it seems like it is mostly DHS staff talking at the members. I feel like we have gone away from really talking about specific policies. I think talking so globally about this can help for a point, we have been doing it repeatedly with this group. In the past, when we first started, we had meetings talking about budgets more generally, or exception processes, things like that. So if we can have that road map to point out those specific issues we want to discuss, I think that can be helpful. A lot of this, being told about the budgets update, it is great and helpful to people to know and have that information. But we need to be more specific, I think, as far as, this is a nuance we want to talk about today, and see what the recommendations and thoughts are from members. So just to be a little more precise with the topics could be helpful.
That's great. Thank you. We will go to Tricia next.
I have said this countless times. There are best practices that exist about stakeholder engagement and how to facilitate these meetings. We as members of this group have great ideas for you, but honestly you need to just figure it out and do it the right way. You need to just really -- if you want to partner with us, follow best practices. Everything that everyone has said is outlined. Intentionally having stakeholders and members of the group be involved and partner and collaborate in setting the agenda. Allowing more people to talk. All of the things that everyone is saying, it's out there. This is new news, and we shouldn't have to be the ones to bring it up. We have already sent multiple resources on to DHS staff about this. I would really -- I'm not going to apologize for being passionate about this, because I'm really afraid for my family. So I'm just going to say, I think we need to talk budgets so we can keep moving forward, because as we speak, I see a whole bunch of things that I was hoping wouldn't happen at waiver reimagine now happening under CDCS unbundling. Suspending more time teaching you guys how partnership looks and how to do it is really frustrating to me. Thank you.
Thank you for that. And just acknowledging that frustration, I am hearing that, yeah. Charlene?
Good morning. Thank you. I have a cold, so bear with me. I am Charlene Abramson, the recipient of waivers. Younger than some, older than others but I am disabled but I'm working toward the MAEDP program. I'm also a certified peer support specialist, and what I want to do is to learn new ways to find my limits in my abilities and disability to work and find a way to contribute and be someone who can be a peer support Specialist in general, so the point of this is I am working towards volunteering on my own, to make my own groups, not just about me but as support for peers. What I'm offering here is to reach out to me personally to make a peer support group for this waiver reimagine group that we have just been talking about. A couple people expressed interest in an offshoot. My goal is simply a few things. I would be following a certified program through the state of Minnesota to have some simple guidelines and boundaries. I would like to have support where we trade notes. Maybe there are things some of us know and others don't. A warm and welcome environment that helps people that are new or don't know things. I am hoping to have information to get to DHS, because how do they know if we don't tell them? And we don't really want to have all these meetings just be of complaints. If we can get our thoughts out and share information amongst ourselves in these off meetings, like you guys had mentioned a moment ago, I would like to do that, and then maybe compile little surveys for DHS for our meetings so we can have more focused agendas that can get to the point and get further faster. I will put my information in the chat, and I welcome you to reach out to me so I can build a peer support Specialist group for the reimagine committee. Thank you.
Thank you. I don't see any other hands up at the moment. Does anybody else want to chime in? Villages reflect back, and feel free to chime in, but some themes I was hearing across these comments -- go ahead, Kelly. You go first.
Sorry about that delay. I would like to clarify, because we sort of touched on this many times in past meetings, I would actually like to see what input we have provided as WRAC members that has actually been utilized other than naming the waivers. I get it, we helped make names. I really can't put my finger on what it is that DHS has put into the waiver reimagine plan of things that were suggested by us.
That make sense. I see some thumbs up in relation to that comment.
D.C. that is a possibility? I guess that's where I'm going with this.
DHS, is that something you want to reflect on the little bit?
Hello, I will jump in and say yes, I think it seems like a reasonable thing. Depending on how we move forward having an ongoing rolling update on those things would make sense, what new agreements and new input has been incorporated. That's a great comment.
Just to clarify, I will give you an example, we have sort of heard that waiver reimagine was on pause. We missed the December meeting, because we were on pause, but yet things are still moving forward just like other people have talked about. The CDCS unbundling. Things are moving forward even though we are on a pause, which doesn't really feel good. Things are going to roll out whether or not we have meaningful input or not. Again, I would also collaborate with everybody else to say that, really, if we want to make this the best program for Minnesota, you've got to listen to the people that are utilizing the services, because we have a lot of ideas for how to save money. Again, like we talked about, keeping people in the community that are able and willing and have a desire to stay in the community would be step one. I understand we need the residential services, absolutely, but we haven't even talked about the fluidity of how people are going to go back and forth between these waivers. Am I going to have my son stuck in a residential setting when he needs that kind of high-level care, because the MnCHOICES backlog is so long? We haven't even addressed how he's going to get back into the community part of the waiver. There are so many concerns that I think a lot of us are nervous and would really like a lot more transparency. Two things, we would love to see what input has actually been used from this WRAC committee for input, and I totally agree that we need to have better partnership and collaboration like we talked about last April when we were in front of the human services committee and had some really great testimony from people in the community that had very valid and similar concerns. Thank you.
Kelly, I want to reply briefly to say thank you so much for your comments. One of the challenges that we have been working through over the "pause," if you will, is how to incorporate the broader perspective of the whole waiver system beyond just waiver reimagine, and how to have that engagement. Because, yeah, unbundling is happening. That's not tied directly to waiver reimagine, but from your perspective, how do you differentiate? I appreciate that. MnCHOICES, same thing. So that is part of what we are working through on our end, how to enable a conversation that is inclusive of all of the topics that touch on waiver reimagine. I hope that makes sense, and please push back if it doesn't.
I don't want to push back. I want to work with you on this. CDCS is such a big part of waiver reimagine. I heard from many sessions that it's going away and we are going to get self-directed, but we really don't know what that is or what it looks like. That puts fear into people, because he had a fear of the unknown, and yet things are moving along. So I appreciate your feedback, Curtis, but again, we all want to work with you. This is not a us versus them thing. Let's make this as positive as we can possibly make it be.
Got it. Thanks, Kelly.
That's great. We maybe have -- from Polly, there is a comment in the chat, if you're not tracking the chat. There's a comment about agreeing with chat and the focus on policy and how to weave that in. Great comments and good discussion. As a facilitator stepping in new to this group, this is great information that Jessica and I can take back and think about what to do with it. Some themes that I'm hearing, one is using collaboration best practices. There's a lot of opportunity -- Kate, I see your hand. I look at for my little outline and then jump to your comment. A lot of opportunity to use those times between meetings to cocreate agendas, potentially there could be a steering team type structure, there could be many other structures facilitationwise that can be used to really support collaboration best practices. So that is one theme I'm hearing. A second theme I am hearing is that there needs to be a better job of demonstrating progress. Where are we getting, meeting over meeting? How is feedback being integrated can actually know where we are going and be clear about that. The other thing I have heard is that folks would like to be more in the problem-solving space, or what we call in our office collaborative problem-solving space. That means you are really wrestling with different issues, talking budgets, talking specific policies and working through them together. So that is one thing I'm hearing. And reflecting come from the tone I have heard, there is some frustration or things are at, and certainly isn't perfect by any means. There still seems to be a willingness to show up and work in this group and be collaborative and not be us and then, and to come to wise decisions and share solutions. Just reflecting back to you all, that is amazing. Not all groups we work with have that spirit, and I think that is a great foundation to build on. So that is my little report out of themes. Jessica, anything to add to that?
You may have mentioned this -- I was looking through my notes -- someone use the word "road map," I think others concurred having a project plan with clear milestones seems really important.
Absolutely. That's great. Let's take Dr. Kate's comment and then we need a few minutes to close up the meeting. There are some final logistical comments. So we will go to Dr. Kate and go from there.
This is Barb, I am Kate's mom. If you're going to reference things that are said in the chat, you need to read them. Kate can't see them, and it is very distracting to hear you talking and have me try to read them to her at the same time.
Thank you for that awareness. I am learning here in this space of how chat is accessible or not accessible to folks. DHS team, maybe you could give me some guidance with the chat. Does this get printed out later? What is the best way to handle it at this juncture?
We will be including it in our notes. This is Adrienne. We will have the transcription and we will also have the chat. That is what I know at this point. So that can be something we can send out as a follow-up.
Dr. Kate, yes, go ahead.
That's not really an accessible option to send out the chat after the meeting, because then she can't participate in what somebody else has said, and it is extraordinarily frustrating. Because she talks with the computer, it takes too long for her to type out this response, which is why I'm saying it. Best practice is, if you are using chat and you are saying something was in the chat, you need to read it.
Excellent. Okay. That is really important learning for me, and I think that is also really important going forward, that there is some consideration about how the chat is used productively in this space. I don't know if this has come up before or what the background is. Okay. I will just read the comment that I referenced in the chat to make sure that is there. Polly said, I agree, we need to focus on policy rather than individual issues. The issues in the visuals are having that are not the scope of this group can be addressed with them outside of this group. There are valuable issues, but this isn't always the space for it. Once you have the policies determined, we can have small groups on individual policy decisions that have been made. That is how other DHS work I had been part of over the last years had worked. As I said before, if DHS is able to act as a partner in discussions, it will help move things forward. I've suggested using an outside facilitator before, so I am happy that we have some more neutral facilitation. I have done a ton of person-centered planning and facilitation and it is almost impossible to facilitate if you really need to be part of the discussion or the decision-making team or to have a stake in the outcome. That is a great comment and a great reflection on facilitation, as well. Making sure we have got that comment into the discussion here. Okay, any final comments? Before we turn it over -- I think we'll turn it over. As a reminder, you will be hearing more from our office via email about continuing some of this feedback in this discussion outside of the large group space. It sounds like there is some interest, so that's great. I will turn it back over to Curtis for some closeout and logistics. I think there was a slide to come back up?
All right, folks. Hi, Curtis here again. To start closing at the meeting, just a reminder that our next meeting is set for -- I didn't have the calendar page upgrade here. I believe it is April 24th. Oh, there it is on the slide. I also want to point out that we have some open committee seats. Adrienne, if I could have you come off of mute to talk about what's going on with those?
For sure. We currently have seven open WRAC seats. Nobody's term is expiring this year in 2025 or 2024. But through resignations, et cetera, the website shows that we have four seats, but I will update it this week. We will have to kill advocate seats, four seats for people who use waiver services, two of those are general and then one is specific to greater Minnesota, and one specific to the Metro, and then I believe we will have one open spot, for a parent with a child under 21. Typically we have done these open seats kind of at the end of the calendar year, so December time. We wanted to have this meeting just to connect and have the existing WRAC members come back together after the announcement of the timeline change and having this discussion. Following this meeting, we will be sending an announcement out and we ask that you are reach out to your networks, as well, and share these opportunities. We try to test the application process is always open, but we will be reviewing these applications to make recommendations to the Commissioner as to how it goes. Hopefully the end of March is when I hope to start reviewing the applications, so we will leave it open for at least 2-3 weeks after we announce the opportunity on the E-list. So let anyone no, they can feel free to apply and reach out to me if there's questions. I think that is my update on the WRAC open seats.
Thanks, Adrienne. I think that wraps us up. Did I forget anything out of the closeout? Otherwise we will close out the meeting. I appreciate everyone's attendance today. Fantastic feedback, and we will plan on seeing you all in April, April 24th. Thanks, everyone.
Can I say one thing really quickly?
Please.
This is Pat. We haven't had a member directory, a member contact list in a long time. Is that something that we can do again sometime?
Sure. Is that something that was sent out in the past?
A couple years ago.
Great suggestion.
Thank you.
Again, I will close us out, last call, otherwise we are going. Thanks, everybody. Take care.
Thanks. Bye.