Minnesota LTSS Advisory Council meeting minutes

Date: Feb. 19, 2026
Time: 1 to 4 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 (PCG)

Council members in attendance

· Addyson Carpenter, virtual

· Alexandra Kotze, in-person

· Anna Hegland, virtual

· Barbara Weckman Brekke, virtual

· Colin Stemper, in-person

· Darla Thompson, virtual, partial meeting attendance

· Dianne Nause, delegate for Jonah Giese, virtual, partial meeting attendance

· Genevieve Gaboriault, virtual

· Janna Peterson, delegate for Jonah Giese, virtual, partial meeting attendance

· Jay Johnson, virtual

· Jennifer Ballinger, virtual

· Jillian Nelson, virtual

· Lance Hegland, virtual

· Lisa Antony-Thomas, in-person

· Lori Schluttenhofer, virtual

· Louella Kaufer, virtual

· Nicole Hansen, virtual

· Patrick Meacham, virtual, partial meeting attendance

· Richard Varco, in-person

· Sherri Pickthorn, virtual

· Sherry Gustafson, virtual

· Tarryl Clark, in person, partial meeting attendance

· Zahnia Harut, virtual

· Roxanne Portner, virtual

Council members not in attendance

· Allison Le

· Jonah Geise

· Lisa Vala

· Musab Khalif

· Patricia Wright

DHS support staff in attendance

· Jensina Rosen, virtual

PCG support staff in attendance

· Audrey Davis, in-person

· James Nyberg, virtual

· Jeremy Thomas, in-person

· Jonathan Sauerschell, virtual

· Katie Alijewicz, virtual

· Michele Craig, in-person

· Ryan White, virtual

· Sarah Harrigan, in-person

Agenda topics

1-1:15 p.m.

· Welcome, housekeeping and introduction

· Agenda review

Notes:

Introductions:

· The two recently appointed Council members, Lance Hegland and Addyson Carpenter, introduced themselves as this is their first full Council meeting.

Housekeeping:

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

· Meeting is being recorded and recording will be made available to the public and members per council request at the December 2025 meeting.

· Public comment period at the end of today’s meeting 4-4:30 p.m. and future full council meetings.

Sign up during the break at 2:30 p.m. — Virtual attendees in the chat, in-person attendees in the physical room.

· Chat function and Q&A function are disabled; chat will only be enabled for public comment sign-up.

· PCG is taking minutes, will distribute to the council.

· Minutes will be posted publicly after the council votes to adopt.

· Council members will adhere to meeting agreements as described in the charter, including raising hands to speak and sharing the space for all members to have a chance to contribute.

· The meeting facilitator will ensure the group adheres to the established agreements and, when necessary, will invite participation from members who have not yet had an opportunity to speak.

· Due to the volume of information in the meeting, timeframes for each agenda item will be strictly followed. If the time expires for the item and there are further thoughts/ideas, that will be noted that for future discussion.

1:15-1:30 p.m.

· Council action:

Review of Dec. 28, 2025, meeting minutes

Review of charter updates

Action: Adoption of Dec. 18, 2025, meeting minutes and charter

· DHS 2026 legislative updates

· County 2026 legislative updates

Notes:

Meeting minutes

· PCG shared that minutes were emailed to council members on Jan. 29, 2026, and are in the council SharePoint folder.

· PCG asked the council if there were any comments or requested edits to the meeting minutes.

No comments or requested edits to the minutes.

· Action items that are requests from the council for data or other information are being logged and reviewing by DHS & PCG. Responses will be sent to the council with the minutes from the Feb. 18, 2026, meeting no later than Mar. 5, 2026.

· Roll call vote for adoption of minutes:

Addyson Carpenter, yes

Alexandra Kotze, yes

Allison Le, not present for vote

Anna Hegland, yes

Barbara Weckman Brekke, yes

Colin Stemper, yes

Darla Thompson, yes

Genevieve Gaboriault, yes

Jay Johnson, yes

Jennifer Ballinger, yes

Jillian Nelson, yes

Jonah Giese, not present for vote

Lance Hegland, yes

Lisa Antony-Thomas, yes

Lisa Vala, not present for vote

Louella Kaufer, yes

Musab Khalif, not present for vote

Nicole Hansen, yes

Patricia Wright, not present for vote

Patick Meacham, not present for vote

Richard Varco, yes

Roxanne Portner, yes

Sherri Pickthorn yes

Sherry Gustafson, yes

Tarryl Clark, not present for vote

Zahnia Harut, yes

· Dec. 18, 2025, LTSS Advisory Council Meeting Minutes adopted by majority.

Charter

· PCG identified changes made to the charter:

Impact section: Revised to include financial stability.

Responsibilities section: Modified to say, “give everyone a chance to speak,” and add that members will raise hands to be called as well as share their name before speaking.

Workgroups/decision making sections: Headings revised, included that members may choose more than one group, and added that recommendations receiving a majority yes vote will be included in the final report.

Communication: Revised to include that the meeting will be recorded and public comment will be included for meetings.

· No further questions or comments raised on the charter.

· Roll-call vote for adoption of the charter:

Addyson Carpenter, yes

Alexandra Kotze, yes

Allison Le, not present for vote

Anna Hegland, yes

Barbara Weckman Brekke, yes

Colin Stemper, yes

Darla Thompson, yes

Genevieve Gaboriault, yes

Jay Johnson, yes

Jennifer Ballinger, yes

Jillian Nelson, yes

Jonah Geise, not present for vote

Lance Hegland, yes

Lisa Antony-Thomas, yes

Lisa Vala, not present for vote

Lori Schluttenhofer, yes

Louella Kaufer, yes

Musab Khalif, not present for vote

Nicole Hansen, Yes

Patricia Wright, not present for vote

Patrick Meacham, not present for vote

Richard Varco, yes

Roxanne Portner, yes

Sherri Pickthorn, yes

Sherry Gustafson, yes

Tarryl Clark, not present for vote

Zahnia Harut, yes

· Council charter adopted by majority.

DHS shared the following 2026 legislative session updates:

· There could be bills that get passed this session that create savings in in-scope long-term services and supports. If those ideas get passed this session, and the law does not explicitly say that it reduces the council's target, it means that option may not be attributed to council recommendations.

· The alternative option is if the legislature adopts a savings measure and says that it would apply to the council’s target. Then the target would be reduced by X number of dollars as determined by the legislature. That means there would be a lower target that council needs to hit.

· There might be initiatives in bills put forward by other organizations or in the governor’s budget that may affect the council’s work.

· DHS will keep the council updated as things progress.

· Council discussion

Member offered to use software (State of Affairs) to track bills that the council is tracking to be able to report status updates to the group, she can set up a report to go out weekly (includes updates like hearings).

DHS thanked council member for the offer and council members may follow up.

Another member commented that they agree on the importance of having a way to track bills for coordination.

· The county council members presented the following 2026 legislative session updates:

Shared a statement they prepared about the work they are pursing that intersects with the council in the interest of transparency. They have been working since early 2025 to propose strategies specifically to address the concerning and unsustainable cost trajectory for the LTSS services.

For any approved changes that provide savings, those savings are applied to the LTSS Advisory Council goal.

Although by statute, the legislation says that the proposed cost share was to be split evenly between providers and counties, they are asking that anything that happens this session that counties are proposing and becomes law be applied to the total amount, so that it could equally reduce the burden for both counties and providers.

The counties will continue to bring all their ideas through the council process also, but there is a sense of urgency surrounding the timeline that necessitates work outside of the council.

As proposals are developed, they will place a high priority on evaluating and minimizing potential negative impacts on people and their families and caregivers who receive these supports and services.

· Council discussion

Member asked if the solutions/potential ideas the counties are working on have been proposed to the Council and if fiscal notes have been run on those.

County members responded that almost every idea has also been brought up through the Council, and the Council might be prioritizing some of them differently. They are not to the point of fiscal notes yet but gathering the data and the information from DHS.

For example, the benefits workgroup brought forward the idea of TEFRA parental fees or cost shares, which is something that the counties have also been looking at for a while.

The process to get the bill fiscal noted through DHS is a little different with this group versus when brought by the counties and coordination efforts should occur.

Not all ideas have been brought up yet as workgroups are in varying stages putting forward their ideas.

Member asked if DHS has recommendations for cost savings ideas that include monetary amounts.

DHS said that their position is aligned with the governor’s budget which will be released in the coming weeks. DHS will discuss internally whether they are able to share any ideas apart from the governor’s budget based on trends they see and follow-up with the council.

Member shared a link to DHS financial reports and forecasts: Financial reports and forecasts / Minnesota Department of Human Services.

1:30-2 p.m.

· Workgroup updates

Notes:

The leads for each workgroup presented updates from their first two meetings.

· Eligibility workgroup (leads Louella Kauffer and Jay Johnson):

The workgroup has not fully fleshed out any one idea yet. They are working through an initial list of ideas to talk through and determine what they would like to dig into or if it is a good idea but may not result in cost savings.

TEFRA came up in their discussions, which is also of interest in other groups.

Getting data will be helpful to inform the workgroup’s discussions.

The workgroup is mixed on how much of cost savings ideas will generate (big impact items and smaller impact).

Their upcoming meetings will include deeper dives into ideas and data to determine which ideas to pursue and bring to the council.

· Benefits workgroup (leads Alexandra Kotze and Addyson Carpenter):

The workgroup has spent a fair amount of time reviewing information requests and needs.

They are trying to flesh out ideas that have been raised.

The workgroup has mostly focused on streamlining processes, streamlining service delivery and some different modifications. They have discussed ideas, like the other group, about what makes sense to pursue what maybe is not the right time or the right fit for the group.

Members have raised some new ideas in their discussions.

One member did some work outside of workgroup and brought ideas for cost savings, which were really helpful, and will inform future meetings. Information is on the council’s SharePoint site in the “resources” tab.

Overall, they are trying to filter through ideas for possible cost savings recommendations that make sense, have savings, and align with the values of the council.

· Provider rates workgroup (leads Darla Thompson and Lori Schluttenhofer):

Their experience has been really like other groups and the same need for data.

A few things the workgroup has been talking about are the Community First Services and Supports (CFSS) and personal care assistance (PCA) models and differences in costs for providing those services. This is an area they want to dive into.

Another idea raised in their meetings was about a very nuanced project related to community employment supports provided via the Extended Employment Program. There is an amount of unspent dollars every year that is distributed back to providers under the current rule. This is example of a non-waiver program that is underutilized and there may be the ability for cost shift from waiver services.

They have discussed what it would look like if every provider took a 1 to 1.5% rate cut (if that is acceptable) and how it would impact different groups, etc.

2-2:30 p.m.

· Competitive workforce factor and county share

Notes:

DHS provided information on the implications of the competitive workforce

factor (CWF) and county share contingent spending reductions if net savings

from Council recommendations do not meet the $177,542,000 target outlined by

the Legislature per Chapter 9 - MN Laws.

· CWF

The CWF is a component within the rate algorithms for the disability waiver rate system services.

For some services like home delivered meals, it is just a set rate. It does not include the CWF.

The CWF component would reduce the overall rate itself. However, the exact percentage decrease is unknown at this point.

49.48% of the savings would need to be achieved there, which comes to about $88 million dollars. But in terms of what that factor would be after that calculation is a function of how many people are receiving these services at that point.

That would be informed by what the state budget forecast is saying about those services when that determination needs to be made. The overall dollar figure is known but the exact percent reduction in this rate component is not.

· County share

This would be about $89.5 million of the target and similarly to the CWF, exactly what the share would be depends on the amount spending on these services at that point.

Ramsey county did analysis on impact and it was going to be in the neighborhood of 2 to 3% on their levy, which is about $11 million dollars (approximately). Other counties, particularly smaller counties, had a much bigger impact, upwards of 10 to 20%.

Counties still have administrative costs and other things for services that are not listed as having a county share that the counties are responsible.

· Council discussion

Member asked if the CWF is cut by 10%, does that overall rate for each service get cut equally by 10%, or is it a bigger cut for some programs than a smaller cut for other programs? From a dollar perspective, it may be a bigger cut for more labor-intensive services like residential.

DHS responded that it is not even. It is the same adjustment factor across all services, but how it adjusts the rate the wage component in the rate is different.

Rate frameworks or algorithms make assumptions about what costs. Ultimately, it is up to the providers to determine their wage payments.

Member asked if CWF data will be made available.

DHS responded that it depends on whether the Council meets its goal and the legislature passes sufficient savings to avoid these contingent reductions. Likely variables will not be known until February 2027 to produce actual data. DHS will discuss internally to see if they can run some type of simulation to get data.

Member commented how do we know that the solutions that we are producing is something that the legislature is going to adopt? We do not want to return in three or four years to do this again.

Member asked about the variation between counties on the impact of increasing the county share (ability to cover the cost and fiscal impact).

County members responded that across MN there are differentials in percentages of the population that are using these services, and in some smaller counties, the percentage of people receiving services may be high and less people who live in the county to pay taxes.

Member commented there is a need to find ways to minimize negative consequences and that this is the biggest challenge.

Member reiterated the need for data and that they would like the group to produce other ideas so that the legislative contingencies do not have to be used.

Member suggested a level of accountability be added for counties to hold them fiscally responsible for denials and appeals. Also, they would like to see an increase in training for case managers.

Members shared examples of how denials have impacted them, including that they have experienced variations between counties about what services are provided, interpretations, and denials.

2:30-2:40 p.m.

· Break and public comment signup

Notes:

· PCG announced that sign up would be available through the break for members of the public who wish to provide comment.

No one signed up to provide public comment.

2:40-3 p.m.

· National trends in long-term services and supports

Notes:

PCG presented research findings for cost savings trends across the country.

· Rebalancing

The Centers for Medicare and Medicaid Services (CMS) primarily recommends that states use rebalancing to reduce Medicaid LTSS costs while maintaining or improving outcomes.

The 2024 Medicaid and Children’s Health Insurance Program (CHIP) scorecard reported that in calendar year 2021 (the latest date with full data available); 82.9% of Minnesota’s LTSS expenditures were for HCBS, compared to 61.3% nationally.

Since Minnesota is already a leader in balancing its long-term care expenditures, shifting costs away from institutional settings is unlikely to provide the cost savings target.

· Technology

Ohio’s Technology First Taskforce works to expand technology solutions within service delivery and operations, reduce barriers, and align state policies.

They established benchmarks for the use of technology, such as “all counties will access Medicaid funding for at least one person for these services and [increase] the overall usage of assistive technology to 25% by 2026.”

· Value based payments (VPB)

VBP shifts reimbursement from "fee-for-service" to models that reward high-quality, person-centered outcomes.

Proven savings: The national expansion of the home health value-based purchasing (HHVBP) model resulted in a $1.38 billion reduction in Medicare spending between 2016 and 2021.

· Managed care

A number of states have worked to control costs by paying a managed care plan or managed care organization (MCO) a fixed monthly amount to manage all of a person’s LTSS.

Provided budget predictability.

Caveat that there has been a recent federal rule change that restricts the direction states can give to managed care organizations that may impact states’ ability to set up their managed care organizations in a way that drives values and reduces costs.

· State/county share

Many states either have this strategy or are looking at it.

Some states may have different models on how much the counties contribute based on local dynamics like utilization rates, property values and population.

· Spending caps

This is the most frequently leveraged strategy to reduce costs, second only to provider rate reductions.

All states already have some type of spending caps, either in the number of individuals enrolled in the waiver or specific spending limits in the waiver.

Many states are looking at implementing new types of waiver limits to control costs.

· Provider rate reductions

Many states are reducing provider rates to control spending such as rolling back previous rate increases from prior years that tie increases to state revenue growth and across the board rate reductions.

· Council discussion

Council member asked, in reference to Slide 29 of the presentation, is there data to support the chart for which states are still utilizing institutional services?

PCG responded that the data for the chart comes from the Medicaid and CHIP 2025 scorecard

https://www.medicaid.gov/state-overviews/scorecard/welcome.

The states listed as examples for county share: This may not be an apples-to-apples comparison for Minnesota (different amount of counties, size, contributions and LTSS or all Medicaid).

Member said they are interested in data about Minnesota spending on housing costs: How much is paid to providers vs individuals, also provider owned/controlled?

PCG and DHS will bring that back for discussion and follow up with the council.

Member mentioned the need to consider the timing of Waiver Reimagine in relation to cost savings recommendations.

3-3:40 p.m.

· Financial analysis

Notes:

PCG presented an analysis of MN LTSS spending for the last five years.

· Spending has consistently increased over time.

· Highest spending programs: Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD), nursing facility and personal care assistance (PCA).

· Change in program spending:

Elderly Waiver (EW) and CADI have more than doubled.

Alternative Care (AC) has grown more than 50%.

Intermediate care facility for persons with developmental disabilities (ICF/DD) and home care have been declining overall, but spending increased in the last three years.

· Highest spending services and growth:

Community residential services (CRS); noting some shifts in the category with the streamlining of foster care and supported living services (SLS) into community residential services in 2021/2022.

PCA, including PCA complex, customized living, consumer-directed community supports (CDCS), personal assistance, individualized home supports with/without training, night supervision, family residential services, case management, integrated community supports (ICS), home care nursing.

· Service categories with spending under $150 million trends

Most have increased over the last five years and accounted for less than $500 million. $242 million in fiscal year 24-25, which accounts for about 1/3 of the five-year growth amount.

· Council discussion

Member asked what the drivers are for the number of people versus the cost per person, and what is driving increases over 50%.

PCG responded that they are analyzing per capita data and would like feedback on categories of interest.

Member commented regarding the growth in ICS expenditures that this may be due the more programs functioning under an ICS model than was previously considered and they were transitioned into ICS.

Member commented that reducing service spending in one program will not necessarily reach target because people still need those services and may get them through another program.

Member noted he has completed his own analysis and report that he will share with other members.

Member commented that for ideas that change rates or service limits, the council will need to consider how that will impact all programs as some programs have the same services.

Member suggested overlaying trends in cost services with timing of legislative changes (i.e., rate changes).

Member raised discussion about DHS data prior to 2020, data is auto deleted on a five year rolling basis. Member requested more information about why this data is deleted.

DHS responded that they would take this back and follow up with the council.

Member said it is important to keep in mind availability of services in rural areas and that it is different from the metro area. Sufficient transportation options and number of service provides is a challenge in rural areas.

Member shared their data interest points:

People moving between waivers, how many people were in a waiver at various points.

Clarification around integrated community supports.

How CWF increases affected spending increases.

CADI, DD, Brain Injury (BI) spending breakdown by service.

Causes of the increases for the fastest three growing programs.

National comparison data with state with comparable costs of living, per person spending.

Adult day services, day support services, crisis respite and respite (member hears consistently that these services have waitlists).

Why is data deleted prior to 2020?

Effect of rate decreases that lower staff wages on the state’s tax revenue (this was raised in an anchor discussion; member will try to find which state brought this up and the data points they use).

3:40-4 p.m.

· Community partner survey update

· Legislative progress report update

· Summary and next steps

Notes:

PCG presented a status update on the progress of the survey:

· In the final stages of preparing the survey for release.

· The survey includes the option for the respondent to complete the survey in English, Spanish, Somali, Russian and Hmong.

· Council members will receive the link for the survey next week; please share with your networks.

· DHS will share the survey as well with all lead agencies, providers and the Disability Hub Virtual Insight Panel network.

· PCG and DHS will monitor survey results to target any additional promotion needs.

· Council discussion

Member asked if the survey been reviewed for accessibility, not just American Disability Act (ADA) basics but accessibility for intellectual disability/executive function.

PCG responded that the survey questions were developed and reviewed with these in mind, PCG will follow up on the type of accessibility review completed.

Member noted to make sure to send survey out to all Tribal Nations.

PCG shared the status of the legislative progress report:

· The March 2026 legislative progress report is being finalized within DHS to submit to the Legislature by March 15, 2026.

· The report includes an overview of the work of the council to date, including the formation of the council, meetings conducted (as well as workgroups), highlights from the research on the national trends in LTSS cost savings, and the work being done for the financial analysis to inform the council’s recommendations.

· The final report will be distributed to the council.

PCG shared the meeting summary and next steps

· PCG will send the council the community partner survey link, the minutes from today’s meeting, the data/information request tracking log with responses and the final legislative progress report.

· Workgroups will continue monthly meetings to determine ideas for cost savings to bring to the April meeting.

· Council discussion

Member asked what the vision is to get the advisory council and workgroups to a package of things for consideration given the timeline for decision making and amount of data requests?

PCG and DHS responded that through the next two workgroups in particular, streamlining conversations to flush out ideas to focus on and to bring to the April full council meeting.

PCG will support looking at the financial estimates for ideas.

4-4:30 p.m.

· Public comment period

Notes:

· No public comment was provided.

Action items

· PCG/DHS compile meeting minutes and data requests with follow-up to send to the council.

Due date: March 5, 2026

· PCG send out community partner survey to council.

Due date: Feb. 27, 2026

· Council members distribute community partner survey link through their networks.

Due date: March 6, 2026, ongoing through survey period as needed.

· PCG will follow up on the type of accessibility review completed for the community partner survey.

Due date: Feb. 27, 2026

· DHS will discuss internally whether they are able to share any ideas apart from the governor’s budget based on trends they see and follow up with the council.

Due date: March 15, 2026

· DHS will discuss internally if they are able to run a CWF simulation and follow up with the council.

Due date: March 15, 2026