Minnesota LTSS Advisory Council meeting minutes

Date: April 16, 2026
Facilitator: Michele Craig, Public Consulting Group

Approved by council vote: June 18, 2026

Council members in attendance

· Addyson Carpenter: in-person, partial attendance

· Alexandra Kotze: in-person

· Anna Hegland, in-person

· Barbara Weckman Brekke, in person

· Colin Stemper: in-person

· Darla Thompson: virtual

· Genevieve Gaboriault: virtual, partial attendance

· Dianne Nause, delegate for Jonah Giese: virtual

· Jay Johnson: virtual

· Jennifer Ballinger: virtual

· Jillian Nelson: virtual

· Lance Hegland: virtual

· Lisa Antony-Thomas: virtual

· Lisa Vala: virtual

· Lori Schluttenhofer: in-person

· Louella Kaufer: in-person

· Nicole Hansen: virtual

· Patricia Wright: virtual

· Patrick Meacham: in-person

· Roxanne Portner: virtual

· Sherri Pickthorn: virtual

· Sherry Gustafson: virtual

· Tarryl Clark: virtual

· Zahnia Harut: virtual

DHS support staff in attendance

· Rachel Shands: virtual

PCG support staff in attendance

· Audrey Davis: in-person

· Heather Fladmark: in-person

· Ryan White: in-person

· Katie Alijewicz: virtual

· James Nyberg: virtual

· Monical Villareal: virtual

Council members not in attendance

· Allison Le

· Musab Khalif

· Richard Varco

DHS support staff not in attendance

· Jensina Rosen

Agenda topics

Welcome, housekeeping and introduction

· Agenda review.

· Heather Fladmark introduced herself as a new member of the PCG team.

· 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 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.

Council action

· Review of Feb. 19, 2026, meeting minutes

· Action: adoption of Feb. 19, 2026, meeting minutes

· PCG asked the council if there were any comments or requested edits to the meeting minutes. No comments or edits requested.

· Roll call vote responses:

Addyson Carpenter: not present for vote

Alexandra Kotze: not present for vote

Allison Le: not present for vote

Anna Hegland: yes

Barbara Weckman Brekke: yes

Colin Stemper: yes

Darla Thompson: yes

Genevieve Gaboriault: not present for vote

Jay Johnson: yes

Jennifer Ballinger: yes

Jillian Nelson: yes

Lance Hegland: yes

Lisa Antony-Thomas: yes

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Richard Varco: not present for vote

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Zahnia Harut: yes.

· Feb. 10, 2026, Minnesota LTSS Advisory Council meeting minutes adopted by majority. [Editor's Note: This should read Feb. 19, 2026, Minnesota LTSS Advisory Council meeting minutes]

Review of February action items:

PCG and DHS to compile and distribute meeting minutes: complete.

PCG to send community partner survey link to council: complete.

PCG to clarify accessibility of survey: complete.

DHS to discuss if they are able to share any additional budget ideas: complete. No additional ideas beyond governor’s proposed budget.

DHS to conduct competitive wage factor simulation: in progress.

DHS presentation by Elyse Bailey, budget director: Governor’s budget

DHS shared the following updates from the governor’s proposed budget:

· FY26 is a supplemental budget year. There is no legal requirement to enact proposals unless there is a current budget deficit, which is not the case. However, due to long-term structural deficits, more proposals than usual were introduced this year.

· Key budget themes included:

Program integrity.

Spending growth containment.

Limited targeted investments (mental health and substance use).

Federal policy alignment.

· Primary LTSS-related proposals outlined included:

Expansion of electronic visit verification (EVV) to additional services.

Strengthening billing limits for disability, older adult, and behavioral health services.

Aligning community residential services (CRS) rates with a person’s needs, with an exceptions process.

Aligning customized living rates with a person’s need.

Sunsetting disproportionate share payments for customized living.

Reforms to integrated community supports (ICS).

Nursing facility rate add-on eliminations (to avoid double payment).

Caps on nursing facility health insurance reimbursement.

Caps on administrative fees for market- and receipt-based services (6%).

CRS absence-related billing limits and reduced day service absence factors.

Changes to the overnight staffing factor in CRS.

Elimination of several disability-related grants.

Reinstatement of parental fees for higher-income families (TEFRA).

Modifications of nursing facility level of care to Community Access for Disability Inclusion (CADI) and Brain Injury (BI) waiver eligibility criteria.

Increased county share of behavioral health fund costs.

Limiting inflationary adjustments in disability waiver rate setting (DWRS) to 2% annually.

· Council discussion:

A council member had a question about the CRS billing limits and whether the proposal gave the commissioner the authority to make the adjustments outside of the legislative session.

DHS acknowledged it does provide the authority, but this proposal might be further refined and clarified.

A council member also questioned if the overnight staffing exceptions process would be more streamlined than other exceptions processes.

DHS recognizes this and intends that the new process will be more streamlined.

Community partner survey findings

PCG presented an overview of key findings from the community partner survey.

· Survey was open: March 9–31, 2026.

· 716 complete responses.

· Respondents represented all nine in-scope LTSS programs.

· Respondent breakdown:

76% of respondents were in the county, managed care organization (MCO), and Tribal Nation staff (majority county) category.

15% of respondents were in the “individuals receiving services and family caregivers” category.

The remaining respondents were in the “providers” and “direct care worker” categories.

· Major themes from individuals and families on what they want the Council to know:

LTSS services are essential “lifelines.”

Workforce shortages and turnover are critical concerns.

Navigation of the system is difficult.

There is fear that service reductions could force institutionalization.

Transportation challenges highlighted.

Consumer-directed community supports (CDCS) flexibility meets critical equipment and dietary needs.

Technology enables community living and prevents institutionalization.

· Findings on which area the state should focus on to find savings:

Savings should be spread across all three areas presented: eligibility, benefits and provider rates.

· Open-ended responses emphasized:

A need for coordinated, systemwide changes.

Elimination or reform of Community First Services and Supports (CFSS) consultation services.

Reducing administrative burdens.

Strengthening fraud prevention and oversight.

· Findings from providers and counties regarding ideas to reduce costs:

The most frequently cited duplication of process was the CFSS consultation services.

Streamlining the assessment processes.

Technology systems modernization (e.g., the Medicaid Management Information System [MMIS] and Social Service Information System [SSIS]).

Rate caps similar to the Elderly Waiver.

· Council discussion:

A council member raised a question about reduced agency billing referenced during the presentation and how it would affect workforce development.

PCG noted that respondents mentioned billing delays but will review the survey data and provide a more specific response.

PCG again noted the positive response rate and summarized that the consensus was that savings should come from addressing system inefficiencies and focus on “smarter spending” to mitigate the impact on people who need the services.

Town hall planning

PCG gave an overview of the purpose and structure of the town halls:

· The current plan is to conduct three virtual town halls between June 23 and July 15, 2026.

· PCG asked the council for feedback about the proposed approach, audience and timeline, especially ways to increase engagement for less-represented groups from the community partner survey and whether there should be an in-person town hall.

Council discussion:

· A council member noted that it is important to clarify the purpose of the council and its charge / constraints so that attendees who might have thoughts outside the scope of the town hall meeting purpose know how and where they can communicate those ideas.

· There was general agreement about working to support people receiving services to have more of a voice in this part of the process and exploring the use of tools such as Mentimeter to support engagement by those who might be less inclined to speak publicly or using word clouds to capture key ideas.

· Members shared suggestions to increase the participation of people using services through asking advocacy groups and case managers to share information with them about the town halls.

· The council recognized that there would be benefits to an in-person town hall and presented some ideas for locations, but they generally acknowledged that it would be difficult to have in-person meetings in an equitable manner given the size of the state.

· Meeting facilitator welcomed council members to send any additional thoughts after the meeting via email to PCG or in the workgroups.

Break & public comment sign-up

· One person, Ben HsuBorger, MEAction, signed up for public comment virtually.

Workgroup updates

Eligibility workgroup co-leads, Jay and Louella, shared the following updates:

· The co-leads noted the overlap of some ideas, including eliminating CFSS consultative services and reinstating the Tax Equity and Fiscal Responsibility Act (TEFRA) fees for parents at certain income thresholds.

· They also raised other ideas that were valid, but not under the scope of the council and established a "parking lot" for those suggestions to ensure they could be considered as a policy idea when appropriate.

· The workgroup also discussed a residency requirement of one year to access Medicaid services but learned this is not allowed under the Centers for Medicare & Medicaid Services (CMS) rules.

· The idea spreadsheet was noted as a good tool to assess the viability of ideas.

Benefits workgroup co-leads, Alex and Addyson, shared the following updates:

· The co-leads summarized several key ideas that emerged in discussion, including CFSS consultation services, people age 65 and over going on the Elderly Waiver, unspent LTSS funding going into a separate fund to support ongoing services and others that will be discussed later in the meeting.

· The workgroup moved some ideas forward for further discussion (streamline CFSS, 65 and older use Elderly Waiver, exhaust other funding sources, service limits, shared staffing), and some others were placed in a similar "parking lot" for future consideration.

Provider rates workgroup co-leads, Lori and Darla, shared the following updates:

· The co-leads acknowledged the challenge of rate reductions as an idea because of their impact on workforce, service availability and providers, especially since half of the members have already experienced rate cuts in recent years.

· The workgroup also had several ideas that were longer-term reforms outside the timeframe of the council’s charge.

· In addition to CFSS consultation services elimination idea, the workgroup highlighted the LTSS loan fund, which is estimated to have $70 million in unspent funds, as something that could be attributed to the cost savings target.

Recommendation ideas discussion

· Facilitator outlined that the next section will be a guided discussion about ideas that were generated and will be led by council chair.

· The council chair clarified that the Legislature is in the third deadline week of its session and that some of the ideas raised, if enacted, might need to be taken off the council’s list of options. For purposes of today’s discussion, the council will discuss them as is.

Idea: Eliminate CFSS consultation services

· There was broad agreement that the current system is duplicative, costly and causes delays.

· It was mentioned that concerns were raised by a council member that SEIU opposes elimination of consultation services.

· It was discussed that DHS has authority to make consultation services optional under a 2025 bill, but legislative action is required for savings attribution.

· There was consensus among council members to move this idea ahead for a fiscal estimate.

Idea: Policy requirement that participants age 65 and older go on the Elderly Waiver

· There was discussion of exceptions that would be needed (e.g., people using CRS, employment supports, not forcing people onto the waiver, etc.), concerns about differences in benefits and budgets between EW and other waivers/programs; and potential impacts on people receiving services need to be further considered.

· There were questions about how the timeline of this process could work (e.g., assess people when they turn 65, explore during a reassessment, etc.).

· It was noted that the EW waiver does not include employment supports and some of these people might want to work.

· There is additional work to be done to define exceptions before fiscal modeling, which should be done through a smaller workgroup.

· Meeting facilitator will connect with the benefits workgroup to identify who would like to participate in further discussion.

Idea: Exhaust other funding sources

· The council discussed various nuances of how the process would work in terms of screening people, having an objective process, other variables such creating a lot of steps for a person to go through before they get the needed service or item and administrative burden.

· Other funding sources mentioned were Early and Periodic Screening, Diagnostic, and Testing (EPSDT), state plan Medical Assistance before waiver, vocational rehabilitation, children’s mental health, insurance, etc.

· A member shared a suggestion for the creation of a flow chart for use of other funds before waiver services.

· A member shared their perspective that the need for education for case managers and providers is critical to help with this potential process and avoid unanticipated barriers (e.g., accessing durable medical equipment).

· A member raised a question about what further conversation on this idea is needed for a fiscal analysis.

· DHS will review whether a prior analysis exists and report back to the council.

Idea: Service authorization unit limits

· Council chair noted that there is a similar proposal in the governor’s budget.

· Concerns were expressed that people with limited service times would be adversely affected, so some sort of baseline threshold before reductions are implemented needs to be considered.

· It was mentioned that the eligibility workgroup discussed this idea primarily in the context of CFSS, such as reducing each plan by one 15-minute unit.

· DHS agreed to provide additional data and analysis if possible.

Idea: Increase shared staffing options

· Discussion that shared staffing could be less expensive than 1:1 services, although the current level of spending is low so this would not have a notable impact on savings.

· Members noted that for people transitioning to shared services it could be sensitive based on individual needs and further evaluation of potential impact is needed to avoid unintended consequences.

· Further discussion that this idea might warrant consideration as a long-term proposal as the amount of cost savings might not have a large contribution to the council’s savings target.

Idea: Reinstate TEFRA fees

· Council chair noted this idea is included in the governor’s proposed budget.

· The consensus of the members was to proceed with recommendation if it isn’t enacted in this legislative session and with a fiscal estimate with a different implementation date than what is currently in the estimate for the current governor’s budget.

Idea: Counties cover the administrative cost of appeals where county decisions are overturned

· There was extensive discussion about some members’ perspectives on the need for accountability regarding service denials, inconsistency of decisions across counties and the need to avoid being punitive (which could lead to more approvals and increased cost of services, thereby not producing overall savings).

· One challenge noted was quantifying the cost of appeals, how this would be attributed to counties and the labor-intensive nature of pursuing this option.

· Group agreed that further data collection and discussion is needed. DHS will look into getting data on the number of overturned denials.

Idea: DHS loan program reversion

· Council chair noted this is idea is included in the governor’s proposed budget and a fiscal estimate has already been produced.

Summary and next steps

· PCG will:

Contact people about the smaller groups focused on specific items discussed today while the larger workgroups will continue to meet.

Draft a town hall facilitation guide for council review.

Distribute meeting minutes.

Meeting facilitator noted the next Advisory Council meeting is June 18, 2026, and will include first round voting on cost savings recommendation ideas.

· DHS will prepare fiscal estimates for eliminating CFSS consultation services and reinstatement of TEFRA fees; review if they have data to inform the conversation about the recommendation to exhaust other funding sources for services; and gather data on overturned service denials.

Public comment period

Speaker: Ben HsuBorger, MEAction / MN Home Help Navigation Program:

· Raised concerns about tightening nursing facility level-of-care eligibility.

· Highlighted risks to people with fluctuating or non-apparent disabilities.

· Warned that delaying services can increase long-term costs and worsen outcomes.

Action Items

· PCG will coordinate a small group conversation among benefits workgroup members to discuss exceptions and implications of the recommendation idea to require people over age 65 to use the Elderly Waiver.

Assigned to: Michele Craig, PCG

Due date: April 20, 2026

· DHS will proceed with the fiscal estimates for the recommendation ideas to eliminate CFSS consultation services and reinstate TEFRA parental fees.

Assigned to: DHS

Due date: June 1, 2026

· DHS will review if they have available existing data to inform the conversations about the recommendation to require exhausting other funding sources and send to the council.

Assigned to: DHS

Due date: May 5, 2026, tentatively

· DHS will prepare data on overturned service denials and send to the Council.

Assigned to: DHS

Due date: April 24, 2026.