Minnesota LTSS Advisory Council minutes

Date: Aug. 20, 2026
Facilitator: Michele Craig, Public Consulting Group
Approved by council vote: Oct. 21, 2026

Council members in attendance

· Alexandra Kotze: in-person

· Anna Hegland: virtual

· Barbara Weckmann Brekke: virtual

· Colin Stemper: in-person

· Darla Thompson: virtual

· Genevieve Gaboriault: virtual

· Jay Johnson: virtual

· Jillian Nelson: virtual

· Jennifer Giesen: in-person

· Lisa Vala: virtual

· Lori Schluttenhofer: in-person

· Nicole Hansen: virtual

· Patricia Wright: virtual

· Patrick Meacham: in-person

· Roxanne Portner: virtual

· Sherry Gustafson: virtual

· Sherri Pickthorn: virtual

· Tarryl Clark: virtual

· Louella Kaufer: in-person

· Zahnia Harut: virtual, joined after the June meeting vote

· Tyler Frank: virtual

DHS support staff in attendance

· Rachel Shands: in-person

PCG support staff in attendance

· Michele Craig: in-person

· Jeremy Thomas: in-person

· Ryan White: virtual

· Katie Alijewicz: virtual (partial)

· James Nyberg: virtual

· Monica Villareal: virtual

· Audrey Davis: in-person

· Jonathan Sauerschell: virtual (partial)

· Heather Fladmark: virtual

Council members not in attendance

· Addyson Carpenter

· Jennifer Ballinger

· Lance Hegland

· Lisa Antony-Thomas

· Musab Khalif

DHS staff not in attendance

· Jensina Rosen

Agenda topics

Welcome, housekeeping and introduction

· Tyler Frank, appointed by the Service Employees International Union (SEIU) Healthcare Minnesota & Iowa, was introduced as a new member of the LTSS Advisory Council.

· The council discussed moving the next meeting scheduled Oct. 15, 2026 due to the Minnesota school fall break. Ultimately, the council agreed to move the meeting to Oct. 21, from 1 to 4:30pm. The meeting invitations and website will be updated.

Council action

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

· No comments or requested edits.

· Roll-call vote responses for adoption of minutes:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Weckmann Brekke: yes

Colin Stemper: yes

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: abstained due to not being on council at previous meeting

Zahnia Harut: not present for vote

· The June 18, 2026, LTSS Advisory Council meeting minutes were approved.

Town hall and public comment feedback summary

· PCG presented the feedback received during the July 2026 town halls and related public comment period.

· Supportive feedback generally focused on simplification, consistency, and fiscal stewardship. Respondents mentioned reduced duplication, more consistent program rules, streamlined administration, improved targeting of resources, or better alignment of public spending with service use.

· Feedback not in support of recommendations spoke to the impact to people receiving services, their families/support systems, administrative responsibilities, rural community and Tribal Nations. Community partners were concerned about cost savings proposals that could reduce access to or disrupt continuity of care and was especially prominent for the transition to Elderly Waiver (EW) and eliminate Community First Services and Supports (CFSS) consultation services recommendations.

· PCG discussed the specific supporting/non-supporting themes for each cost savings recommendation presented during the town halls. This information is detailed in the report sent to the council members as well as the PowerPoint presentation for the council’s Aug. 20, 2026 meeting.

· No comments or questions were raised by council members.

Workgroup updates

· Eligibility workgroup

The workgroup had difficult conversations around cost reductions and that their current recommendations do not result in the targeted cost savings.

There was recognition that all proposals create impacts for people receiving services and they focused on identifying the "least harmful" options rather than ideal solutions.

There were ongoing concerns that proposals still fall short of required savings targets.

· Benefits workgroup

The workgroup spent time discussing the EW recommendation, trying to find a middle ground on the options.

The cost savings estimate revisions significantly reduced anticipated savings of the recommendation.

The workgroup discussed their concern over spending months developing recommendations that ultimately generated limited cost savings.

The workgroup also discussed advancing the nursing facility proposals and expressed some concern about the lack of direct nursing facility representation.

· Provider rates workgroup

The workgroup discussed the reduction or elimination of state grants, trying to determine which ones are not utilized and others that support important work. They are still exploring new ideas but it is difficult without fiscal notes.

The workgroup discussed concerns about the competitive wage factor being reduced and discomfort about nursing facility cuts without feedback from the industry.

New recommendation review and initial voting

· PCG provided background on the new recommendation ideas and process.

· The current ideas discussed at the June 2026 council meeting do not meet the savings target, so several new ideas brought forward by the workgroups are being presented for a vote to move forward for further analysis and a recommendation vote at the Oct. 2026 council meeting.

· These new ideas were not part of the town hall or written comment period, nor has analysis and cost estimates been completed. Some of the recommendations need fine tuning in order to conduct evaluation, public comment, and fiscal analysis.

Recommendation: Implement asset limit for Medical Assistance for Employed Persons with Disabilities (MA-EPD)

· Description

MA-EPD is a work incentive that promotes competitive employment and the economic self-sufficiency of people with disabilities by assuring continued access to Medical Assistance (MA) for necessary health care services. There are no asset limits in place right now.

The recommendation idea is to implement an asset limit of either $90,000 or $200,000, with exceptions being the person’s home, first vehicle, and retirement account as assets that wouldn’t be included in the limit.

DHS is working on the estimate cost savings for the two thresholds under discussion.

· Statement of support

A council member noted MA-EPD used to have a low asset limit but that changed in 2023. It is worth considering reestablishing asset limits due to the current circumstances.

· Statement of dissent

A council member stated this change was just made and a lot of work went into it, and to change it again does not seem appropriate. The member also commented that they want to encourage people to seek employment and pursue their aspirations, but this could truncate what they earn due to fear over losing their benefits.

· The council voted to move this idea forward for additional development, evaluation, and cost savings estimate; including which asset limit to include for a final recommendation. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: abstain

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: no

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: yes

· Vote tally

20 members voted

5 members were not present for vote

1 abstention

95% (19) voted yes

5% (1) voted no

Recommendation: Eliminate grant programs

· Description

DHS provided a list of 32 active grants that are in-scope for the council cost-saving considerations on July 15, 2026 and Aug. 14, 2026.

The provider rates workgroup reviewed this list and determined that more information is needed on the scope and impact of the grants in order to determine which, if any, will be included for the recommendation.

The recommendation would eliminate certain grant programs meaning people benefiting from the grant would need to find another way to have their needs met.

· Statement of support

A council member explained this was brought forward to get more information on all the grants and their impacts.

· Statement of dissent

A council member stated the need for more information.The grants support innovation and support underserved populations.

· The council voted to move this idea forward for further development, analysis, and cost savings estimate. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: abstain

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: yes

· Vote tally

20 members voted

5 members were not present for vote

1 abstention

100% (20) voted yes

Recommendation: Repeal new certified assessor team

· Description

The new certified assessor team was enacted in the 2026 legislative session to address backlogs in assessments and provide support/assistance to counites, lead agencies, and Tribal Nations in this area.

The recommendation means that this support would not be implemented and potentially backlogs would continue. The idea does have an initial cost savings estimate because of the recent enactment. The estimated cost savings is $11 million to $12 million for the state fiscal year (SFY) 28/29 biennium.

Question from council member

A council member asked if this was a total repeal or could a partial repeal be considered.

DHS clarified that if the council preferred a partial repeal that is a possibility.

· Statement of support

A council member said that program is not operational yet since it was just created and that adding more full-time equivalents (FTE) would not solve the MnCHOICES system problems. For context- they noted that Ramsey county hired 80 assessors last year. The current legislation doesn’t solve the problem of waitlists and backlogs and adds more complexity. Further, they stated that it is important to include this proposal for cost savings to help providers and counties.

· Statement of dissent

A council member said this was a Governor’s budget initiative and believe it is a strategy to address the challenges and backlogs.

· The council voted to move this idea forward for additional development, evaluation, and cost savings estimate. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: no

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: abstain

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: abstain

Zahnia Harut: yes

· Vote tally

19 members voted

5 members were not present for vote

2 abstentions

95% (18) voted yes

5% (1) voted no

Break and public comment sign-up

· No one signed up for public comment.

Continued voting on new recommendation Ideas

Recommendation: Increase Alternative Care (AC) program fees by 5%

· Description

AC provides services for people age 65 and older who need the same level of care provided in a nursing facility.

Currently, most people pay cost-sharing fees between 5% and 30% unless they are exempt. The fees are determined based on income, assets, and a person’s support plan.

The recommendation means that people’s fees would be increased by 5% and people using Consumer-Directed Community Supports (CDCS) would have to pay program fees.

· Statement of support

A council member stated that similar to other related recommendations the council is considering that include participants paying fees with a difference being that the AC fees already exist. The member said the proposal should move forward for continued discussion and feedback from other groups.

· Statement of dissent

A council member expressed concern that the federal poverty level on which the fees are based is low compared to the cost of services, which could impact individuals.

· The council voted to move this idea forward for additional development, evaluation, and cost savings estimate. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: abstain

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: no

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: not present for vote

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: no

Zahnia Harut: abstain

· Vote tally

18 members voted

6 members were not present for vote

2 abstentions

89% (16) voted yes

11% (2) voted no

Recommendation: Implement tiered case management reimbursement

· Description

This idea is to implement a tiered case management rate system based on acuity of need (for example, reduced administrative requirements for those who may have less case management needs such as those using self-direction).

It means that a two-tiered payment method (one higher and one lower) could potentially reduce administrative requirements and resulting costs- for example, one face-to-face visit annually instead of two.

· Statement of support

A council member stated there is money spent on processes that may not be necessary and this is an opportunity to right-size case management.

· Statement of dissent

None provided.

· The council voted to move this idea forward for additional development, evaluation, and cost savings estimate. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: abstain

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: abstain

· Vote tally

19 members voted

5 members were not present for vote

2 abstentions

100% (19) voted yes

Recommendation: Create a complex care review team

· Description

This idea is to create a complex care review panel. This means that work from several separate groups would be combined into one team.

This would streamline similar processes and streamline work. One group with a statewide view might better be able to provide options to people and their teams on services and providers who can best meet their needs.

In order for this to result in cost savings, it would need to include a reduction of FTEs.

· Statement of support

A council member stated this idea is attempting to take multiple layers of programs at DHS that have similar goals and align those to ensure that programs are operating efficiently and achieve cost savings.

· Statement of dissent

A council member expressed concern this would increase wait times and its impact on services.

· The council voted to move this idea forward for additional development, evaluation, and cost savings estimate. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: no

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham, yes

Roxanne Portner: abstain

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: yes

· Vote tally

20 members voted

5 members were not present for vote

1 abstention

95% (19) voted yes

5% (1) voted no

Final voting on recommendations

· PCG reviewed the voting procedure in alignment with the council’s charter.

Recommendation 1: Eliminate Community First Services and Supports (CFSS) consultative services, with opt-in

· Description

Consultation services under CFSS help people decide which services to use that will meet their needs, help them with their service delivery plans like writing the plan if needed or reviewing the plan; as well as providing ongoing support in these areas. This means that people using consultation services would no longer be able to use those services, even if they don’t have a case manager.

For some people who do have a case manager, consultation services would move to case management. For some people who don’t have a case manager, they would need to get support with navigating services another way through their county or Tribe.

The opt-in is for people who are new to Medical Assistance (MA) state plan home care services and who choose the budget model to use consultation services for one year.

The estimated cost savings estimate is $5 million to $6 million for the SFY 28/29 biennium. This estimate is based on total elimination of the service, which will be decreased with the opt-in version.

· Statement of support

A council member stated that the CFSS consultative services are not working and people are waiting too long for services. This service is not necessary.

· Statement of dissent

A council member recognized the frustrations but said this is an essential service for many people by providing neutral guidance and supporting consumers navigating complex programs.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: no

Darla Thompson: yes

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: abstain

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: no

Zahnia Harut: yes

· Vote tally

20 members voted

5 members were not present for vote

1 abstention

90% (18) voted yes

10% (2) voted no

Recommendation 2: Reinstate the Tax Equity and Fiscal Responsibility (TEFRA) fees ≥ 545% of federal poverty guidance (FPG)

· Description

TEFRA is the Tax Equity and Fiscal Responsibility Act of 1982. Under TEFRA, there is an option that helps children with disabilities qualify for MA, even when family income is too high for standard MA eligibility.

Before January 2024, TEFRA included that families would pay a monthly fee on a sliding scale tied to family income. In 2023, all parental fees were eliminated through legislation.

Recommendation would reinstate the fee requirements for families whose income is at least 545% of the FPG. The actual amount of the fees would be based on a sliding scale, increased from previous amounts by about 1% (though this has not been factored into the cost savings estimate yet).

The estimated cost savings is $35 million to $40 million for the SFY 28/29 biennium.

· Statement of support

A council member stated that this recommendation is not made lightly, but given the current situation, asking higher-income families to share in the cost of services will avoid more individuals being hurt if across the board cuts to services are made.

· Statement of dissent

None provided.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: yes

Darla Thompson: not present for vote

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: abstain

Zahnia Harut: yes

· Vote tally

29 members voted

6 members were not present for vote

1 abstention

100 (19) voted yes

Recommendation 3: Require people age 65 and older on the Brain Injury (BI) and Community Alternatives for Disability Inclusion (CADI) waivers to transition to the Elderly Waiver (EW) (with exceptions)

· Description

Currently, for BI and CADI, a person must be under 65 to enroll in the waiver if they are new to accessing any waiver. If a person is currently enrolled on BI or CADI when they turn 65, they may stay on that waiver.

This recommendation means that people who are 65 or older now on BI or CADI, or when they turn 65, would have to transition to the EW unless they are using customized living or community residential services. This includes an option for people to return to BI or CADI if their needs change.

Because EW has a case mix budget cap and some different service offerings than BI or CADI, some people may need to switch to different services on the EW waiver.

The estimated cost savings for SFY 28/29 biennium is $1 million to $2 million.

· Statement of support

A council member stated that the EW was designed for individuals over 65, and most individuals will benefit from its services, although some might not. This was one of the more impactful recommendations despite the change in estimated savings and should still be advanced for consideration.

· Statement of dissent

A council member stated that the EW is not designed for individuals with lifelong disabilities and complex needs, and as a result they may not receive the services they need to stay in the community. It is not worth the disruption for so little savings.

· The council voted that this recommendation will not be included as a cost savings recommendation in the final legislative report. The council members agreed that it will be in the report as one of the ideas the council considered. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: no

Barbara Jean Brekke: yes

Colin Stemper: no

Darla Thompson: not present for vote

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: no

Jillian Nelson: no

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: no

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: no

Patrick Meacham: yes

Roxanne Portner: no

Sherri Pickthorn: no

Sherry Gustafson: no

Tarryl Clark: yes

Tyler Frank: no

Zahnia Harut: no

· Vote tally

20 members voted

6 members were not present for vote

45% (9) voted yes

55% (11) voted no

Recommendation 4: Eliminate the Planned Closure Rate Adjustment (PCRA) for nursing facilities

· Description

PCRA provides extra payments to nursing facilities that permanently close beds, helping offset the financial impact of reducing capacity.

The policy was created before Value-Based Reimbursement (VBR), the current payment system for nursing facilities. VBR reimburses facilities based on their actual costs, including higher per-day fixed costs when occupancy declines.

PCRA payments continue indefinitely under current law, even after the beds have been permanently closed, until the facility shuts down.

The recommendation would stop the add on PCRA payment to nursing facilities for closed beds and end the duplicative payment that is currently paid under PCRA and VBR. This would reduce the overall amount some facilities are paid.

The estimated cost savings is $6 million to $7 million for the SFY 28/29 biennium.

· Statement of support

A council member recognized the need to support nursing facilities, but this removed duplicative payments. A council member asked if the current rate adjustment for nursing facilities is a one-time adjustment or ongoing, and DHS clarified that it is ongoing.

· Statement of dissent

None provided.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: yes

Darla Thompson: not present for vote

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: not present for vote

· Vote tally

19 members voted

7 members were not present for vote

100% (19) voted yes

0% (0) voted no

Recommendation 5: eliminate the Performance-based Incentive Payment Program (PIPP) for nursing facilities

· Description

PIPP is an add on payment for nursing facilities that funds projects to improve quality and care. PIPP started before the current value-based reimbursement system and was not removed when the VBR was implemented. VBR incorporates reimbursing costs for such projects which means some facilities may get duplicate payments.

Recommendation eliminates PIPP because under VBR, rates are already adjusted to reflect costs for these quality initiatives, therefore this recommendation proposes the elimination of the PIPP as a duplicative payment. This could reduce the overall payment some nursing facilities receive.

The estimated cost savings is $5 million to $6 million for the SFY 28/29 biennium.

· Statement of support

None provided.

· Statement of dissent

None provided.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: yes

Darla Thompson: not present for vote

Genevieve Gaboriault: no

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: not present for vote

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: abstain

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: yes

Zahnia Harut: not present for vote

· Vote tally

17 members voted

8 members were not present for vote

1 abstention

94% (16) voted yes

6% (1) voted no

Recommendation 6: Cap the health insurance reimbursement for nursing facilities at $15,000 per enrollee

· Description

Prior to cost-based payment rates established under the VBR, payments to nursing facilities for employee health insurance were included in the operating rates and thus subject to limits.  VBR removed this reimbursement limit nine years ago, and since then health insurance costs have increased by 69 percent. Some facilities with self-funded health insurance plans were reimbursed more than $30,000 per employee enrollee per year in the 2024 calendar year, more than triple the state contribution in the current plan year for state employees.

Recommendation sets a cap on the allowable health insurance costs for nursing facilities at $15,000 per enrollee and increases annually to account for assumed inflation. This could reduce the overall payment to some nursing facilities.

The estimated cost savings is less than $1 million for the SFY 27/28 biennium.

· Statement of support

None provided.

· Statement of dissent

None provided.

· Council member question

A member asked why the estimated savings for the four nursing facility recommendations are now much lower than when the governor proposed them.

DHS explained that the new timeframe and process for CMS approval of a state plan amendment will delay implementation, that savings for the next biennium will be lower but full savings achieved after that.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: yes

Darla Thompson: not present for vote

Genevieve Gaboriault: yes

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: yes

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: no

Zahnia Harut: not present for vote

· Vote tally

19 members voted

7 members were not present for vote

95% (18) voted yes

5% (1) voted no

Recommendation 7: Increase quality in nursing facility care

· Description

VBR methodology reimburses based on a provider’s costs and ties payment limits to a nursing home’s quality scores. 

An independent evaluation of VBR by a team from Purdue University and the University of Minnesota in 2021 found no evidence that VBR’s quality incentives led to higher facility quality. They concluded that a change in the formula is needed for the VBR to meet the intended goals of increasing quality for Minnesotans accessing nursing home care.

Recommendation would change the calculation of the reimbursement limit for care-related costs within the VBR rate setting formula to create a stronger quality incentive while at the same time reward cost efficiencies. Some nursing facilities could see a reduced payment.

The estimated cost savings is $5 million to $6 million for the SFY 28/29 biennium.

· Statement of support

None provided.

· Statement of dissent

None provided.

· The council voted to include this as a cost savings recommendation in the final legislative report. Vote record:

Addyson Carpenter: not present for vote

Alexandra Kotze: yes

Anna Hegland: yes

Barbara Jean Brekke: yes

Colin Stemper: yes

Darla Thompson: not present for vote

Genevieve Gaboriault: abstain

Jay Johnson: yes

Jennifer Ballinger: not present for vote

Jennifer Giesen: yes

Jillian Nelson: yes

Lance Hegland: not present for vote

Lisa Antony-Thomas: not present for vote

Lisa Vala: yes

Lori Schluttenhofer: yes

Louella Kaufer: yes

Musab M Khalif: not present for vote

Nicole Hansen: yes

Patricia Wright: yes

Patrick Meacham: yes

Roxanne Portner: abstain

Sherri Pickthorn: yes

Sherry Gustafson: yes

Tarryl Clark: yes

Tyler Frank: abstain

Zahnia Harut: not present for vote

· Vote tally

16 members voted

7 members were not present for vote

3 abstentions

100% (16) yes

Summary and next steps

· The six new recommendations that were brought forward for a first vote will be advanced for further refinement/development as well as impact and cost estimate analyses by the workgroups. A public comment period will also be established for these new recommendations.

· The October 2026 council meeting will include a vote on including the new recommendations ideas in the legislative report.

· The initial draft legislative report will be distributed to the council and workgroups for review and feedback in late August 2026.

The report will also be updated after the October 2026 meeting to capture any new recommendations.

· A question was raised if the EW recommendation with a different option can be brought back for consideration.

The council chair responded yes, and there was no disagreement from other council members.

· A question was raised about including the fiscal notes when full implementation of some proposals occurs, since the current cost savings for proposals in the next biennium are lower.

· DHS clarified that this could be noted in the legislative report (e.g. future savings would be larger).

Public comment period

· No public comment was provided.