Minnesota LTSS Advisory Council meeting minutes

Date: Oct. 30, 2025
Facilitator: Michele Craig, Public Consulting Group
Approved by council vote: Dec. 19, 2025

Council members in attendance in person

· Colin Stemper, chair, commissioner of Human Services or designee

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

· Jillian Nelson, person with disabilities living independently

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

· Jonah Giese, advocate for people with disabilities

· Lisa Vala, advocate for people with disabilities

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

· 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

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

· Jay Johnson, community first services & supports provider

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

· Anna Hegland, home & community-based service provider- own home service provider

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

· Darla Thompson, home care service provider

· Jennifer Ballinger, Tribal Nations representative involved with administration of social services

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

· Richard Varco III, Service Employees- Internation Union Healthcare 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

Council members not in attendance

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

· Musab Khalif, long-term services and supports provider

Council support in attendance

· Jensina Rosen, LTSS Advisory Council coordinator

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

· Ryan White, engagement manager, Public Consulting Group

· Michele Craig, meeting facilitator, Public Consulting Group

· Sarah Harrigan, senior consultant, Public Consulting Group

· Kaite Alijewicz, senior consultant, Public Consulting Group

· Audrey Davis, business analyst, Public Consulting Group

· Monica Villareal, consultant, Public Consulting Group

Welcome, housekeeping and introductions

Slides 2-6 of the meeting PowerPoint presentation

· 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.

Meeting will not be recorded.

Meeting minutes will be taken, distributed to the council, and posted publicly following the meeting.

Be mindful of not sharing personal and/or private health information.

Accessibility and accommodation requests and/or technology issues that arise during meeting can be sent to Jensina Rosen.

Microphones on mute when not speaking.

· Roundtable introductions

Council members shared their name, preferred pronouns (optional), seat/role on council, organization they work for (as applicable) and what drew them to apply to be on the council.

Colin Stemper, chair of council. Colin is the chief administrative officer at the Aging & Disability Services Administration within the Department of Human Services (DHS).

Jensina Rosen,council support (she/her). Jensina is the strategic development coordinator with DHS, in the Disability Services Division.

Rachel Shands, interim deputy assistant commissioner for the Aging & Disability Services Administration with DHS. Rachel is not an official member of the council.

Roxanne Portner, nurse executive at Forensics Services. She is interested in serving on the board because a lot of patient populations have discharged into the community.

Alison Le was not present at the meeting.

Jillian Nelson, community member and policy director with Autism Society of Minnesota. Jillian is a person with a disability and wants to serve on the council. She believes this working group will be an innovative solution as the disability system is ineffective and wants to do better for and benefit the people in her community.

Genevieve Gaboriault, deputy ombudsman for long-term care services. She has served adults, including older adults; she believes services are very important.

Jonah Giese (he/him), legal advocate with the Disability Law Center. Jonah is a legal advocate representing folks who are dealing with termination of services due to funding issues, and he is excited to build a system.

Lisa Valla (she/her), disability advocate appointed by the Arc. She is a family member to two people on waiver services. She was active in the last legislative session and hopes that better ideas can be implemented in this council.

Lisa Antony-Thomas, deputy ombudsman for mental health and developmental disabilities, and substance use disorders. Current role is looking to balance as there is room for improvement and wants to serve the equity fairness and interest as well as availability of providers.

Tarryl Clark, Sterns County commissioner, greater Minnesota counties representative, and president of intercounty association. She has been on the Priority Admissions Review Panel and taskforce. She feels that the legislature can be hard to figure out things there, and she believes that any group of people can come together to grow and be innovative and find out efficiencies and not create more work for anyone.

Nicole Hansen, county administrator with Ottertail County. She has learned about this issue from the legislature and wants to consider costs and bring folks together to create creative solutions.

Barbara Weckman Brekke, county commissioner in Scott County. She serves on multiple human services committees and believes in this work and has a brother who uses many of these services and is a client.

Alexandra Kotze, chief financial officer (CFO) for Ramsey County- metro, former CFO for DHS, and has covered many human services. She feels passionate about leveraging taxpayer funding to do the best for constituents and feels strongly that everyone has a different perspective and we can work together.

Patrick Meacham, social services supervisor for Pine County; supervises MnCHOICES and all waiver programs. He is looking to serve as an advocate for partners, providers and participants in rural Minnesota, and wants to ensure that the programs Minnesota has are sustainable.

Louella Kaufer, senior department administrator, Hennepin County. Her work is in access, aging & disability and has worked in a variety of different roles as a social worker. Served a lot of different people and groups over 30 years. She has seen what has been working well and what has not been working well in Minnesota.

Jay Johnson, Minnesota First Provider Alliance appointee and is a quadriplegic and familiar with the services through that way. He is a chief executive officer (CEO) of a PCA organization and is here to help make changes.

Lori Schluttenhofer, appointed by MOHR (Minnesota organization for Habilitation and Rehabilitation) which is a group of 100 employment support service partners. She feels a deep connection to this work as she has two siblings with disabilities who are on waiver services. She wants to create a sustainable system to support Minnesotans.

Anna Hegland, Dungarvin Minnesota. She is the Association of Residential Resources in Minnesota (ARRM) appointee and is excited to collaborate and knows that finding this amount of money is a big lift and wants to be more efficient.

Zahnia Harut, appointed by the Residential Providers Association of Minnesota and CEO of Affinity Care Minnesota. She has previously served on the Waiver Reimagining Advisory Committee. She is passionate about improving health equity and improving outcomes for the black, indigenous, and people of color (BIPOC) communities as well as rural communities as they are often left out of the conversation.

Darla Thompson (she/her), home care provider. She has passion to help do better and being fair and equitable. She believes that Minnesota can be a leader in ideas to provide care and access to all.

Musab Khalif was not present at the meeting.

Jennifer Ballinger, Tribal Nations representative and member of a Tribal Nation in rural Minnesota. She was drawn to apply to design social services that work, as rural Minnesota is different than the metro area and wants to work towards a system that works for all the members of a waiver.

Sherri Pickthorn, supervisor at Southwest Health and Human Services. She is a guardian for a loved one using the brain injury (BI) waiver and they are in the southern corner of the state and wants to make sure they are represented.

Sherry Gustafson, representative of the American Federation of State, County, & Municipal Employees from Grand Rapids, she has a long career working in human services and works for the county in long term care for people with disabilities. She is interested in services that will make a difference and as a county employee she wants to learn and listen.

Rick Varco, political director at the Service Employees International Union Healthcare Minnesota and Iowa. He is interested in finding win-win savings and efficiencies.

Patricia Wright, state advocate who has worked in the field and is a past member of the Waiver Reimagine Advisory Committee. She has a family member with a disability and has faith in the council.

Agenda review

Slide 6 of the meeting PowerPoint presentation

· Reviewed the Oct. 30, 2025 agenda.

Send out calendar invitations for recurring council meetings.

Meeting agreements

Slides 9-10 of the meeting PowerPoint presentation

· Discussed establishing agreements for meeting conduct and participation.

The council discussed the following proposed meeting agreements:

Attend meetings.

Review pre & post meeting materials.

Facilitator sends materials timely.

Stay focused, minimized disruptions.

Share your thoughts.

Share the air.

One person speaks at a time.

Assume positive intent.

Be mindful/respectful of:

Preferred communication & learning styles.

Everyone’s unique perspective and contribution.

Differences in options, it’s important that we treat each other with respect.

Sharing confidential information.

Stay on topic.

Parking lot for items not on topic.

Follow through on action items you commit to complete.

Seek to understand, ask questions, be curious.

If you disagree with what someone says, remember that they’re talking about their own experience.

Define acronyms when used.

· Council member stated that they would like to add an agreement that states that the council will use disability positive language, avoid speaking in an ableist manner and assume competence for people with disabilities rather than assuming people with disabilities are inherently vulnerable.

· Council member proposed that information about disability justice is sent to committee members and that work should be centered around disability justice framework. This is the newest version of the disability rights movement and was built on the back of the independent living movement and centers the idea of interdependence and centering the voices of those with disabilities, especially those who are the most marginalized (for example, if systems are not focused on serving those who are living at the intersection of multiple marginalized identities, this is not a sufficient system). Principles of the disability justice movement as a whole are a phenomenal framework for building the next generation of disability services that serve the people they want to support.

· A council member agreed with this and proposed a question to create ground rules for the group asking how the group would plan to deal with the project if the solution created is no longer feasible. Will the group create something less than perfect if time/budget constraints exist?

Another council member agreed with this approach and stated that on the Advisory Task Force for Ending Subminimum Wage in Minnesota, the advisory task force had recommendations that were the absolute need to occur, the best case scenarios, and the ideal.

Another council member agreed and said that consensus may be difficult to achieve, as well as the perfect end option. Conversation earlier than later to decide the group’s decision making model is necessary.

Facilitator thanked each council member for their input and added that we will discuss these topics when it comes to the charter later in the meeting. Facilitator also added that if the council agrees, the council can prioritize the decision-making process for the December meeting and also what will happen if perfect consensus is not possible. The council informally agreed to this by putting thumbs up in the chat.

· Facilitator reminded council that the meeting agreements will be included in all slide decks.

Council resources

Slide 12 of the meeting PowerPoint presenation

· Board support: Jensina Rosen

Jensina added that for those council members who want to request per diem for participation on the board, they will be hearing from Jensina or Toni Gillen, who is supporting invoicing for the council. Jensina is the person to contact for absence, late arrivals, and accommodations for meetings.

· Briefing Document

The council new member briefing document was sent to council members along with the other meeting materials. The document is designed to provide an overview of the background of why and how the council was formed, the expectations of the council through their work, communication expectations, and the role of PCG in supporting the work.

The facilitator asked the council if they had any questions or comments about the document, none were raised.

· Board/commission details

Webpage on the Office of the Minnesota Secretary of State website.

· Long-Term Services and Supports Advisory Council / Minnesota Department of Human Services

Webpage hosts information on the council and meeting scheduled.

· SharePoint site for council materials

PCG has created an external Sharepoint site for the council to use to share and collaborate.

PCG is setting up access for members.

Members will receive emails with instructions on setting up their account and accessing the site.

Council members can contact micraig@pcgus.com for any issues.

Summary of responses from the LTSS Advisory Council Oct. 2025 initial meeting survey

Slides 13-19 of the meeting PowerPoint presentation

· Reviewed and group discussion on survey responses received thus far.

What is most important as the LTSS Advisory Council begins its work?

Council member asked if the council could add on to the third bullet point “promote and improve access” because there are already not enough services in rural areas.

Council member asked if the council could add the timeline it takes from applying to obtaining services.

Council member added that when people do not have access to services or have delayed access to services, that doesn’t mean that those service needs are not being met, often those needs are being met in a more costly way. For example, if the MnCHOICES Assessment has an 18-month wait, the person is often spending those 18 months using crisis services which are a lot more costly than community based services. Crisis is expensive, stabilization is not.

Council member added that when we are starting this work, we are focusing on accessibility. Council member stated that the system is the most inaccessible despite it being the service where 100% of people who are receiving services are people with disabilities.

Council member agreed and emphasized the need for designing programs that don’t add administrative burden to the service participant, as lawyers can get involved and another burden is created for the participant.

Council member added that another lens to look through is the taxpayer accountability for all residents.

Other states that have reduced costs while improving outcomes for people in innovative ways?

Council member asked if we could add data to the cost saving analysis about the quality of life of the individuals with disabilities in each of these states. Just because the state has a more cost-effective program doesn’t mean it is actually serving the people well. Solutions in other states can lead to institutionalization.

PCG added that these states may not be the states that will be included for analysis, just what was reported in the survey by respondents. More factors will be taken into account to determine the states to include.

Largest hurdle for the council to overcome

Council member asked how the group will make sure that whatever costs are discussed will actually count towards the cost savings needed. There could be unintended consequences.

Council member asked who will be providing the data on expenditures and look at the projection to coincide with the charge of reducing the budget by $177 million. Who is the data gathering individual?

Response: This will be discussed in the financial analysis section of the presentation.

Council member asked if there is data that members will specifically want to focus on (e.g. data on costs of DHS appeal hearings) how will we make sure we ask for the specific information?

Response: We will want to make sure we have a clear process for data requests, and this will be covered later in the conversation.

Council member put in chat, “data on the cost of CFSS [Community First Services And Supports] consultation providers would be interesting. Thank you.”

Survey will remain open for the next couple of weeks if council members who haven’t had a chance to participate would like to submit a response.

Break

LTSS Advisory Council charter development

Slides 21-32 of the meeting PowerPoint presentation

· Purpose, goal, impact

Council member stated that they would like to propose that we look at the new CFSS program and how it is being run because it is not serving and mis-serving people with disabilities. A lot of people with disabilities are getting lost in this system and lots of extra expenses are being added to the state. Council member would like to see the numbers on this.

Council member asked in chat if the competitive workforce factor applies just to the disability waiver rate system (DWRS), or is it broader?

It primarily applies to DWRS, there is a competitive workforce factor in personal care assistance and supports rate framework, but this framework isn’t fully phased in. The factor is in the rate formula, but the rate formula has a discount applied at the end to it.

Council member followed up to ask if the contingent reduction goes into effect, would it apply just to DWRS or other programs?

It will only apply to DWRS.

Council member asked in chat what the reductions to competitive workforce factor mean?

The competitive workforce factor is one component in the rate calculations for a number of services under disability waiver programs, it would be a broad reduction for a number of these services.

Council member asked what specific services these are.

It is about 15 or 16 services that represent often the most used services on the disability waivers and a lot of disability waiver spending.

Council member stated that perhaps instead of reducing the reimbursement rates, a partial freeze in rate increases would be an option for those two years.

Council member stated that a concern in reducing the competitive workforce factor is that we will restrict the pay for some direct care professionals, and Minnesota already struggles with finding adequate care professionals. If there is a limit on what their pay will be, it may be more difficult to find good quality staff.

Council member followed up and agreed that Minnesota cannot go backwards in their rates. There is already a fraud, waste and abuse problem because people were not in it for the right reasons. However, this legislation states that if the Council is unable to identify recommendations meeting cost savings, then that is what will happen.

Council member agreed and stated that part of what is needed to discuss is exactly these factors, and this is something we need to consider.

Council member stated that something to consider is that is there a way to cap a profit a provider can have so when they’re asking for rate exceptions to pay staff higher, they are ensuring staff is receiving 100% of what the extra request for the rate exception is. It is important to assure accountability for providers.

Council member said that this may be hard, because there is such a hard time to get qualified employees as the profit margin for this industry is already incredibly low. When limiting the profit margins then we are limiting growth.

Council member agreed, but when there are rate exceptions, is there accountability to ensure those dollars are going to the staff?

Council member said as a business owner, they are required through statute through Minnesota law to pay out the state of Minnesota between 72-80% of reimbursement rates to employees, and that does not include payroll taxes or work comp. The reality is the margins are very small, and revenue and profits are based on billable hours.

Council member added that because of this we are losing culturally competent providers. Small businesses that can provide care to marginalized communities are closing because there are not enough clients to meet this critical mass. Only larger providers are left to provide these things.

Council member stated that they were not trying to say that, rather there are larger corporations that reap more than others.

Council member asked what providers are reaping more profit than others?

Council member responded that there is some grayness with rate exception.

Council member said in chat, “just a reminder that providers will need to start providing wage data for rate exceptions based on language that was already passed in 2025.”

Council member said in chat, “amen. There are million-dollar corporations running residential services. There are rate exceptions of $4,500.”

Council member said is there a possibility to limit yearly assessments that need to be done for those whose disability status will not change?

Council member responded that Senator Abeler has passed a bill to make the MnCHOICES assessment change from once a year to once every 3 years unless requested by a client. This is still awaiting CMS approval – if it goes into approval, it will begin Jan. 1, 2026.

Council member said in chat, “Identifying the commonalities in LTSS services between metro and rural could be helpful towards our purpose and goal.”

Council member said in chat, “I agree that looking at further efficiencies in the assessment process makes sense.”

· Scope

Council member asked if the council should start emailing to start submitting future ideas.

Facilitator responded that we could save these ideas for future meetings but if the council members come up with ideas in the meantime, we can add them to a parking lot list of items.

Council member asked if there will be any community outreach or community listening sessions as a part of this work.

Council facilitator responded that in December and February, there will be a survey developed.

Council member asked if there was a way to be directly involved in the survey planning process to assure accessibility.

Facilitator responded that yes, there will be opportunities.

Council member asked if there could be a creation of a google doc in the sharepoint where people can add ideas and have a repository for all ideas.

Council member added in the chat, “for example the HSS termination public comment had zero accessibility.”

· Members, roles, & responsibilities

Council member put in chat that a facilitator can encourage members to raise their hands.

Council member asked what ECS stands for (essential community support).

DHS responded that this is a program age 65 or older who have relatively low needs and it’s a state funded program.

Council member asked what the difference between the ECS program and the elderly waiver was

The difference is that the elderly waiver does not fund institutions but assisted living and in home services. ECS is for folks who may not qualify for the elderly waiver.

Elderly waiver / Minnesota Department of Human Services

Essential community supports / Minnesota Department of Human Services

· Council member put in chat, “I appreciate the ability to respond to questions (the survey) prior to the meetings. It gives time for thought and offers input from the majority of the team members.” 

Financial analysis for December meeting

Slides 33-34 of the meeting PowerPoint presenation

· Discussed data council is interested in reviewing to understand current fiscal landscape.

Council member put in chat, “can we please have a breakdown per category of how much was spent per year for the last 10 years so we can chart growth patterns.”

Council member asked how much more time is needed to put together the data.

Facilitator responded that this is understood and the urgency for the data is important due to the quick amount of time. The DHS/PCG team will put heads together to determine what other options could be if some of this was not ready by December meeting.

Council member followed up that this will be pertinent information that would be important to include.

Council member put in chat, “appeal cost, case manager cost and rate structure and billable activities,” “current level of spending, per a category” and “MnCHOICES criteria for budget determination” in chat.

Council member put in chat, “We need confirmation that HSS closure and any savings forecast as a result of fraud investigations in LTSS can be included in the $178M. Assuming it will be included since this has come up post-session when this was passed, I'd like to see what is being forecast for savings for these areas.”

Council member put in chat, “DHS and county cost for mailing.”

Council member put in chat, “cost reporting data for non-wage related cost drivers.” 

Future meeting scheduling

· Discussed preferences for on-going meetings.

No concerns with time, third Thursday was a preference

· Next meeting, Dec. 18, 2025, 1 to 4 p.m.

· In-person meetings

Council member stated that it is a two-hour drive so they will not want to do mornings.

Facilitator confirmed that meetings will be from 1 to 4 p.m. as of right now.

Council member stated in chat that meetings need to be at least hybrid to be inclusive to all.

Council member stated in chat “for us rural folk, winter is better in virtually.” 

Council member added that if we are interested in an in-person meeting, it may be better suited for the end of this work, as data will be easier to look at on a computer screen.

Council member stated that meeting in-person early on would be good so we can get to know each other; this can make a big difference. In previous councils, waiting until later to meet in person did not work, as council members are not as familiar later on.

DHS added that there will always be an in-person office due to open meeting laws. People can join the December 2025 meeting in person.

Summary and next steps

· DHS/PCG will send the initial survey again, as well as the draft version of the charter and the meeting notes.

· DHS/PCG will take back any data requests for the December meeting financial analysis discussion.

· PCG will send out meeting invites for the third Thursday of each month, from 1 to 4 p.m.

Action items

New (identified during this meeting)

· Send out calendar invitations for recurring council meetings.

PCG- Michele Craig

Due: Oct. 31, 2025

· Send Council meeting minutes.

PCG- Michele Craig

Due: Nov. 17, 2025

· Update charter in preparation for December council meeting, send out with December meeting materials.

PCG- Michele Craig

Due: Dec. 12, 2025

· Compile council feedback on data needs for financial analysis.

PCG/DHS

Due: Dec. 12, 2025

· Complete sharepoint access requests for council members.

PCG- Michele Craig

Due: Nov. 7, 2025

· Follow up on disability justice information to share with the council.

PCG- Michele Craig

Due: Dec. 12, 2025