Minnesota LTSS Advisory Council meeting minutes

Date: Dec. 18, 2025
Time: 1 to 4:00 p.m.
Location: Virtual via Zoom webinar; in-person at the Elmer Andersen Building, Room 2360, 540 Cedar St., St. Paul, MN 55101
Facilitator: Michele Craig, Public Consulting Group
Approved by council vote: Feb. 19, 2026

Council members in attendance in person

· Colin Stemper, chair, commissioner of human services or designee

· Jillian Nelson, person with disabilities living independently

· Genevieve Gaboriault, advocate for older adults using long-term care services

· Lisa Antony-Thomas, advocate for people with mental illness or developmental disabilities using long-term services and supports

· Louella Kaufer, county social services worker from Twin Cities metro area

· Lori Schluttenhofer, home and community-based service provider- day services provider

· Anna Heglan, home and community-based service provider- own home service provider

Council members in attendance virtually

· Zahnia Harut, home and community-based services provider- community residential services provider

· Darla Thompson, home care service provider

· Sherry Gustafson, American Federation of State, County and Municipal Employees member

· Richard Varco III, Service Employees International Union health care member

· Patricia Wright, former Waiver Reimagine Advisory Committee member with advocacy experience and a family member who either has disabilities or is an older adult using Medical Assistance

· Sherri Pickthorn, former Waiver Reimagine Advisory Committee member with professional experience with disability waiver services and has either a family member with disabilities or who is an older adult using medical assistance

· Musab Khalif, long-term services and supports provider

· Roxanne Portner, chief executive officer of Direct Care and Treatment or designee

· Jonah Giese, advocate for people with disabilities

· Lisa Vala, advocate for people with disabilities

· Tarryl Clark, county representative from greater Minnesota

· Nicole Hansen, county representative from greater Minnesota

· Barbara Weckman Brekke, county representative from Twin Cities metro area

· Alexandra Kotze, county representative from Twin Cities metro area

· Patrick Meacham, county social services worker from greater Minnesota

· Jay Johnson, Community First Services and Supports provider

Council members not in attendance

· Allison Le, person living with serious and persistent mental illness

· Lance Hegland, person with disabilities living in community residential setting

· Jennifer Ballinger, tribal nations representative involved with administration of social services

Council support in attendance

· Rachel Shands, interim deputy assistant commissioner, Aging and Disability Services Administration

· Elyse Bailey, budget director, Department of Human Services

· Ryan White, engagement manager, Public Consulting Group

· Michele Craig, meeting facilitator, Public Consulting Group

· Sarah Harrigan, senior consultant, Public Consulting Group

· Katie Alijewicz, senior consultant, Public Consulting Group

· Audrey Davis, business analyst, Public Consulting Group

· Monica Villareal, consultant, Public Consulting Group

· Jeremy Thomas, senior consultant, Public Consulting Group

· James Nyberg, senior consultant, Public Consulting Group

· Jonathan Saureschell, senior consultant, Public Consulting Group

Council support not in attendance

· Jensina Rosen, LTSS Advisory Council coordinator

Welcome, housekeeping and introductions

Slides 3-4 of the meeting PowerPoint presentation

· Welcome

· Housekeeping

· Meeting is open to the public, both in-person and virtually.

Public comment will be included for meetings when council recommendation decisions are discussed.

Today’s meeting will not include public comment; the chat and Q&A function will not be available for public attendees.

Council member raised that public comment should be allowed at all forums to avoid tokenization of public comment.

Response: DHS and PCG had opted for this approach previously due to limited time and are open to any feedback from council members.

Another council member noted that they agree there is not a lot of time to take feedback.

Council member shared that it feels like the council is not being transparent without opening public comment more broadly.

Council member added that the public can still come in person if wanted in order to participate in the council meeting.

Council member suggested allowing 20 minutes in next meeting as a trial for public input; this was supported by others.

Meeting will not be recorded.

Council member said they want to record the meeting to enable people with disabilities or other members to revisit the conversation later.

Response from DHS: DHS is open to this, and the council will revisit this.

Meeting minutes will be taken by PCG, distributed to the council, and posted publicly after the council approves the minutes.

Council member accessibility and accommodation requests during the meeting can be put in the chat and PCG staff will provide support.

Microphones on mute when not speaking and use the “raise hand” feature when you want to speak.

· Introductions

Council members introduced themselves, their seat on the council and their organization.

PCG staff introduced the PCG team and their titles.

Agenda review

Slide 6 of the meeting PowerPoint presentation

· Reviewed the Dec. 18, 2025 agenda.

Adoption of Oct.30, 2025, meeting minutes and action item status

Slides 8-9 of the meeting PowerPoint presenation

· Discuss any requested updates to the Oct. 30, 2025, meeting minutes

· Roll call vote for adoption of minutes and any amendments to the minutes

· No amendments to the minutes requested.

· Members voted unanimously to approve the minutes without changes. Voting record as follows:

Colin Stemper: yes

Jillian Nelson: yes

Genevieve Gaboriault: yes

Lisa Antony-Thomas: yes

Louella Kaufer: yes

Lori Schluttenhofer: yes

Anna Hegland: yes

Zahnia Harut: yes

Darla Thompson: yes

Sherry Gustafson: yes

Richard Varco III: yes

Patricia Wright: yes

Sherri Pickthorn: yes

Musab Khalif: yes

Roxanne Portner: yes

Jonah Giese: yes

Lisa Vala: yes

Tarryl Clark: yes

Nicole Hansen: yes

Barbara Weckman Brekke: yes

Alexandra Kotze: yes

Patrick Meacham: yes

Jay Johnson: yes

· Reviewed action items from the Oct. 30, 2025, meeting

The following action items are complete:

Send out calendar invitations for recurring council meetings.

Send council meeting minutes.

Update charter for December meeting, send out with meeting materials.

SharePoint access for council members.

Follow up on Disability Justice information to share with the council.

· The following action item is in progress, the financial analysis presentation by PCG will occur at the February 2026 council meeting.

Compile council feedback on data needs for financial analysis.

Charter updates & adoption

Slides 11-21 fo the meeting PowerPoint presentation

· Impact

Council discussed the impact item “Ensuring the stability of Minnesota’s LTSS.”

Members suggest a separate box should be added to specify “financial stability.” There is a desire to not revisit this in 5 years to find more savings.

Another council member agreed and added that there are multiple definitions of stability and protecting people Is still important.

The group acknowledged those aspects but still questioned whether the central charge was being captured without specifically needed calling out financial stability.

Council held further discussion about whether financial sustainability should be added or not; many agree it should be its own box.

· Responsibilities

Council member added a request to state names before speaking given hybrid is challenging.

· Timeline and activities

No concerns or changes raised by the council.

· Workgroups & Decision Making

The council will form workgroups to identify, evaluate, and select recommendations to bring back to the council; three workgroups: eligibility, benefits, and provider rates as these are the three main levers available to states to reduce Medicaid spending.

PCG shared survey link for council members to indicate their preferences on workgroup participation.

Council member asked if instead of serving on one subcommittee they could serve on more than one given for representation of people with lived experience; group agreed to this. Members will note in the survey comments if they would like to serve on more than one group.

Council member requested to revisit time frames of subgroups if needed after they are compiled.

Council member added a request for clarification on how the subgroup info gets to group before final votes.

Council member asked for a further description of three subgroups – benefits, eligibility, rates.

DHS responded that these will only be loosely defined as to assure flexibility in topics discussed.

Council member said they would be willing to support something with impact on providers if there was something with impact across the whole system – was there any consideration given to voting on a whole package?

Council member said that on another council the above approach taken there.

DHS said that this approach was based on the legislation that asks the final report to include level support on each item.

Council members put in chat that there was a mismatch between the survey and the slides’ information on times for each subgroup meeting.

PCG clarified the survey meeting days/times is the correct version.

Council member suggested to only include items that reach a certain level or threshold of support and exclude the others.

Another council member alternatively suggested publishing all ideas and clearly stating why they are not supported is better.

Council member asked if we are planning to over-solve the dollar amount cost savings target or meet the requirement only. This is unclear.

PCG said will bring back and follow up in the next meeting.

MN LTSS 101

Slides 23-41 of the meeting PowerPoint presenation

· PCG provided an overview of the nine LTSS programs in scope for council considerations for recommendations for cost savings:

Alternative Care (AC) program

Brain Injury (BI) Waiver

Community Alternative Care (CAC) Waiver

Community Access for Disability Inclusion (CADI) Waiver

Developmental Disabilities (DD) Waiver

Elderly Waiver (EW)

Community First Services and Supports (CFSS) and personal care assistance (PCA)

Essential Community Supports (ECS)

Nursing facilities.

· Following the presentation, the floor was opened for questions and discussion.

Questions from council and DHS/PCG responses:

Will there be a more detailed breakdown of spending?

PCG clarified that the council will review that level of detail at the February 2026 meeting.

What is the total spending on the applicable services?

PCG clarified that the group will discuss that later in the agenda during the DHS budget forecast presentation.

Related to the AC program, do we know how much this program saves on avoiding higher cost institutional settings?

That information is not available for this presentation. PCG will review and follow up in the next meeting.

How does Waiver Reimagine impact the council’s work?

DHS responded that Waiver Reimagine is a consolidation of waivers from four to two. There are already assumptions included in the budget forecast so cost savings recommendations the council is to identify will be in addition to those.

How do Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IDD) compare to waiver numbers.

PCG responded that this will be in DHS budget forecast presentation.

Do changes to Medical Assistance automatically change waiver eligibility or would that be independent?

PCG will review and follow up in the next meeting.

Do CFSS and CADI impact the waiver numbers on the slides because of individuals on CFSS and CADI may overlap with participation in other waivers?

As presented, if a person uses both CFSS and CADI, they will appear as recipients of both programs. But their spending will be counted in only one of the programs. If they are using CADI, both expenditures would appear in that program.

Council member expressed that she is involved because of her awareness of innovative mental health practices. She is wondering if she should not be on the council. Another council member offered support and encouraged participation.

DHS budget forecast presenation

DHS PowerPoint presentation, LTSS spending and fiscal notes

· DHS presented data and information on the DHS budget overview, spending trends in LTSS, fiscal notes and LTSS council financial objective.

The fiscal year (FY) 28-29 $3 billion deficit already includes the $177,542,000 cost savings identified in the legislation.

Questions from council and DHS/PCG responses:

How does the percent of the state budget spent on Medicaid LTSS compare to other states’ percentages?

PCG will review and follow up in the next meeting.

What are the federally required benefits and optional benefits in LTSS?

PCG will review and follow up in the next meeting.

Why would there be an increase in disability waiver?

DHS responded that there are a few dynamics that affect this: increase in the prevalence of disability or diagnosis of disability; older adults enroll in MA before 65 and then stay on disability side; and there has been more individuals who are Black, Indigenous and people of color enrolling than who have done so historically.

Are there numbers how diversity has changed since the waiver caps have been removed?

PCG will review and follow up in the next meeting.

Can we have data on kids being served under the Tax Equity and Fiscal Responsibility Act (TEFRA) above 500% of the federal poverty level and people on disability programs?

PCG will review and follow up in the next meeting.

Does DHS track relative costs from directly provisioned services (by county agency) vs. contracted services?

DHS responded that it isn’t tracked that way but maybe through provider type. DHS clarified this makes sense for case management.

Council member added in the chat: “But I will add - harkening back to the anti-capitalist politic principle from sins invalid - that I have questions/concerns about our systems' instinct to subcontract all services (and thereby create a market to profit off of disability services) rather than simply provide the service directly.”

Request for quality-of-life surveys from peer states. Minnesota has higher quality of life for people with disabilities than other states and so we shouldn’t just copy other states’ approaches without insight into quality of life.

PCG will review and follow up in the next meeting.

How will HSS being terminated and new moratoriums change the forecast? Were they already removed from the forecast?

PCG will review and follow up in the next meeting.

Is there a way to find out how many people on the CADI waiver have mental health diagnoses?

PCG will review and follow up in the next meeting.

Can we see how many people over 65 are on the CADI Waiver instead of the Elderly Waiver?

PCG will review and follow up in the next meeting.

What is the threshold for sufficient evidence?

PCG will review and follow up in the next meeting.

Requested clarity on the budget picture for FY 28-29.

The legislative report with recommendations will be due next legislative session and which means the earliest implementation is Jan. 1, 2028. This is well into the biennium and means we will need more ideas for future savings.

Fiscal notes and report will have different values because they change the data and there will be interactive effects.

Competitive workforce factor and county share

DHS PowerPoint presentation, LTSS spending and fiscal notes

· This item was not covered during the meeting as meeting time elapsed. Item will be included in the February 2026 council meeting.

Community partner survey

Slides 47-50 of the meeting PowerPoint presentation

· This item was not covered during the meeting as meeting time elapsed.

· PCG will email the survey questions to the council for review and feedback.

Summary and next steps

Slides 51-52 of the meeting PowerPoint presenation

· This item was not covered during the meeting as meeting time elapsed.

Action items identified during meeting

· DHS will consider council feedback on public comment periods and recordings for each meeting.

Due date: Feb. 13, 2026

· PCG will update the council charter sections:

Impact to reflect financial stability.

Responsibilities to include raising hands (in room and virtual) and saying name before speaking (in room and virtual).

Workgroup and decision making to clarify decision-making process.

Due date: Feb. 13, 2026

· DHS will clarify if the council target for cost savings just the amount in the legislation or over the amount.

Due date: Feb. 13, 2026

· PCG/DHS will review and provide follow-up information during the February 2026 council meeting on questions raised during the MN LTSS 101 and DHS budget forecast presentations:

AC program: How much does this program save on avoiding higher cost institutional settings?

How does ICF-IDD spending compare to waiver numbers?

How does Minnesota’s percentage of budget spending on LTSS compare to other states?

What are the federally required benefits and optional benefits in LTSS?

Numbers on how diversity has changed since the caps have been removed.

Data on children served under TEFRA.

Quality of life survey data from peer states.

How will HSS being terminated and new moratoriums change the forecast? Were they already removed?

How many people on the CADI Waiver have mental health diagnoses?

How many people over 65 are on the CADI Waiver instead of the Elderly Waiver?

Do changes to Medical Assistance automatically change waiver eligibility or would that be independent?

What is the threshold for sufficient evidence?

Due date: Feb. 19, 2026

· PCG will email the community partner survey questions to council members for review and feedback.

Due date: Feb. 13, 2026

· Council members will complete the LTSS Advisory Council workgroup selection survey.

Due date: Dec. 31, 2025

· PCG to schedule workgroup meetings and send out meeting invitations.

Due Date: Jan. 2, 2026