Waiver Reimagine Advisory Committee meeting 16 notes

Thursday, Aug. 22, 2024

Committee attendees: Addyson Moore, Arbdella Hudson, Annie Braun, Chad Wilson, Charlene Abramson, Dr. Kate Jirik, Fartun Weli, Gina Winter, Gretchen Spier, Jennifer Drganc, Julie Morrison, Lisa Evert, Mary Fenske, Meredith McKinnon, Pat Wright, Polly Owens, Rijuta Pathre, Rosalie Eisenreich, Sue Mackert, Tricia Brisbine, Wa Xiong

Not present: Abigail Gertken, Elizabeth Iddings, Jennifer Ballinger, Jessica McKane, Kate Barton, Saudade SamuelSon, Sherri Pickthorn, Zahnia Harut

DHS attendees: Curtis Buhman, Heidi Hamilton, Meghan Lindblom, Matt Knutson, Natasha Merz, Leigh Ann Ahmad, Linda Wolford, Sara Beauchene, Darcie Thomsen, Adrienne Hannert, Anna Yesberger

Other attendees: Lea Bittner-Eddy, Lynn James, Kelly Deering (Alliant Consulting)

Meeting notes

Welcome

Facilitator Lea

· Live captions: https://www.streamtext.net/player?event=WRAC

· Facilitator Lea welcomed everyone to this 16th WRAC meeting and described herself to the attendees.

Agenda

· Facilitator Lea reviewed the meeting’s agenda – based on input from June’s meeting

· Note: Facilitator Lea acknowledges that in the previous meeting Heidi Hamilton said she would bring more information about the MnCHOICES assessment to a future meeting. That will still happen, but today’s meeting will be reserved for members to give feedback to AC Natasha Merz.

Meeting practices

· Facilitator Lea reviewed some of the meeting practices

· When speaking, re-introduce yourself (and who you represent)

· Speak slowly so the captioner can accurately capture what you share

· Please be mindful of the distracting nature of chat messages to both presenters and other members and use chat to add to the conversation when you are unable to directly share your thoughts

· Time has been allotted throughout the meeting for questions and discussion

August’s meeting objectives - Facilitator Lea

· Get to know Natasha Merz, assistant commissioner, DHS ADSA ​

· ​Review survey and focus group feedback​

· ​Hear from WRAC members about their concerns related to HCBS waivers​

· Vote: Do you want something different other than the current budget and waiver structure?

Natasha meet and greet

· Natasha Merz introduces self to attendees

· Started as elder law attorney, and worked in Ombuds Office resolving complaints and concerns about long-terms services and supports, then transitioned to policy work

· Has sister who uses services, which informs her work

· Is assistant commissioner of the Aging and Disability Services Administration​ plus Elderly Waiver and adult protective services

· In her role as assistant commissioner, Merz oversees programs and policies that serve people with disabilities and older adults.

· Looking forward to listening to group today

Waiver Reimagine community survey update

Darcie Thomsen, DHS Disability Services in Research and Evaluation

· Survey Overview: Launched in late May 2024 as an alternative feedback method due to high interest in focus groups. The survey was open for 3 weeks.​

· Survey Topics: Covered communication preferences, waiver programs, budgets, consumer-directed supports, and informed choice.​

· Participation: 404 people completed the survey:​

· 53% were family members/caregivers​

· 38% were professionals 9% were people using a disability waiver​

· Participants came from 39 counties in Minnesota​

· Majority were aged 25-64; 22% were aged 5-24 (or responded on behalf of someone in this age group)​

· Key Insight: Overall, professionals were more familiar with Waiver Reimagine (86%) compared to people using waivers (54%) or family members/caregivers (50%).

· Full results will be shared in October

· Community survey next steps:

DHS analysts are finalizing data analysis, including open-ended comments.​

Full results will be presented at the October WRAC meeting.​

Results will be compared with focus group findings.​

When possible, analysis will explore differences based on respondent type (e.g., waiver user, family member, professional) and demographics.

· Q&A

Q: Was the survey conducted in other languages?

§ A: Only in English; acknowledge other language would be beneficial

Q: How were stakeholders engaged in the design and implementation of the survey?

§ A: Based on focus group work from independent, professional contractor

DeYoung engagement

Sara Beauchene – One Choice Policy Specialist at DSD

· Used informed choice public engagement requirements to structure the focus groups ​

· DeYoung’s purpose was to learn where people get their information (regarding waiver reimagine and informed choice) to inform DHS’ communications strategy ​

· 161 participants across 9 focus groups throughout the state including metro and outstate plus diverse communities

· Majority were waiver users, some guardians and a few advocates

· DeYoung participant recommendations:

· Informed choice should include accessible information and active decision-making.

· Supporters/caregivers should center individuality and the whole person. ​

· System redundancies should be eliminated to enhance a person-centered approach.

· Other feedback:

· Amplify advocate voices

· Improve case manager capacities

· Improve communications

· Engage all parties

· Create financial and budgeting awareness

Back to Waiver Reimagine charter – Assistant Commissioner Natasha Merz

· Guiding principles: As the need for waiver programs grows, we must respond to challenges that people and families have told us about. The waiver system should support people to lead a meaningful life based on their goals and what is important to them.

· Waiver Reimagine is intended to address the challenges people and families have raised, including:​

· Waiver programs are too complex and difficult to understand.​

· People feel like there is a lack of information.​

· There is limited flexibility, control and choice over services.

· Member asks what “informed choice” means; what about when clients say what they want but are told those services aren’t available due to lack of staff or resources?

Natasha: valid point; workforce shortage constrains resource availability and services; DHS needs to understand the realities and constraints

· Natasha Merz: recognizes this is her first meeting and work has been going on for a long time; wants to get a snapshot from members about what’s working/not to inform future direction and policies

· What is working and what isn’t working with the HCBS waivers? Facilitator Lea calls on members round robin and alphabetically by first name to hear input

· This comes from person-centered work – what’s working and what’s not working

· Start with positive – 20 mins

· Then pivot and give 20 minutes on what’s not working or not making sense

· Will do as round robin

· Please don’t respond to other’s input

· This isn’t the only opportunity to share concerns

· Giving snapshot to Natasha

· DHS will theme input

Positives

· Generally can get sufficient services and supports; knows what the services are available and has knowledge of how to get additional services

· Have more choice and options for individuals to be served than ever before

· Health care has improved and she is able to live independently with waivers; she is scared of the future after changes

· When services are in place they allow people to live in their chosen place in the community;

· Grateful for waivers, quality of life is greatly improved; without it she’d be homeless or in an institution; she has availability to programs that can help her in the future

· People are able to self-direct their services, collaborations have been a successful model;

· The cdcs manual helps guide what is covered and what is not; hears from people on the committee that cdcs is working well, and people on waivers are aspiring to have what is in cdcs;

· Waiver has a lot of flexibility within existing service categories to be creative in how to use the categories and can use most of what’s in the cdcs option

· Gets medical equipment and supplies and no longer has to struggle to pay the deductibles;

· Waivers are great when you have family members or another form of natural support or are in metro area with ample case managers, supervisors or others who understand a disability; if you’re white, waiver services work better for you; or if you have a living parent or someone else who is willing to do the staff work

· Flexibility to offer new and better choices as demographics change and people’s needs shift; escalation of grants to promote innovation have worked;

· The idea of paid family or parent caregivers are wonderful; these are the most natural means of care when budgets are sufficient to support this

· Grateful for waivers; streamlining of services; assessment process

· Battling cancer and the waiver services have helped

Not working

· Budgets are too low to meet those with higher support needs; one case manager might approve something and the next will not: case manager inconsistency;

· More complications, requirements, polices to navigate is cumbersome; the most competent case managers and others struggle with this and it creates challenges with relationship; lead agency’s systems are outdated and don’t work well with the other systems and it’s a time suck for staff

· Methodology and polices can be confusing, even for case managers and other professionals, including the assessment itself and the understanding of the budgets; inconsistencies across counties; lack of provider options in rural areas

· Issues with service provider that had a huge turnover; couldn’t get any programs to me and put the work onto targeted case manager; billed services that were not received then eob’s stopped coming; never saw her budget;

· Language barriers and lack of knowledge to navigate the system;

· Case managers are overwhelmed and are gate keepers, asking “why are you choosing this or that?”;

· There are unused funds that go into the general fund and can be used for other things;

· Staffing shortage

· Contracted case managers have a lot of turnover and people then may not have the same service as other using county case managers;

· Rates don’t always adjust to every new rule one to one;

· Different parts of the system seem to operate in silos – lack of coordination.

· We need to base waiver reimagine on a person’s needs, not the location in which they live.

· Attitudes of ablism and power;

· Societal attitudes need to be acknowledged; a regulation doesn’t change these attitudes

· Supplements are not covered; had life-saving surgery involving digestive tract and found it upsetting that supplements are not a covered;

· Inconsistency in mnc assessment and different people using the tool come up with different things for different people;

· Transportation needs to be discussed as reimbursements are not as much as needed

Meeting wrap

Natasha Merz

· We will sort feedback by themes and bring back to you in October; this isn’t new information to her either but is helpful to hear in the context of this project; spend time in October talking about what should we be doing, what do you want us to be looking at and doing; acknowledge that you’re looking for more information on how we are doing engagement and we will bring this back to this group

· For October, ponder what you want to see from the state, DHS, legislature.

· For October, ponder the things we are doing right, and what is needed to bolster those things?

· Email any additional feedback or agenda items; we will take that and incorporate that into our analysis

WRAC recommendation – tabled due to lack of time

· Natasha Merz – shall we continue on the current path or change course?

· We will sort into themes and bring back to Oct’s meeting

· Now want to shift toward what TO DO

· Is two waiver structure focus or not?

· Acknowledge more info on engagement is needed by group; want to hear about engagement with underserved communities

· For Oct think about what this group needs to do to get where group wants to go

· For things that are working, how can we increase resources here?

· Ideas for agenda items can be emailed plus any other input

October agenda – tabled due to lack of time

Where do you want to go next?

· Waivers

· Budget

· Something else

Meeting format – OK or not?

· Waivers

Wrap-up and future meeting information - Facilitator Lea

· Future meetings:

Thursday, Oct. 24, 2024 (updated from previous slides stating 31st)​

Thursday, Dec. 12, 2024

· Look forward to seeing you in October. Thank you again for your input today

Key points/themes

· Worked well

Recipients generally knew services and how to get them

Ample options and choices for individuals

Services support independent living in chosen location (prevent homelessness) (among most popular themes)

Have improved quality of life and health (among most popular themes)

Collaboration with case managers, lead agencies, assessors, etc.

· Could be improved upon

Budgets may not meet high level needs

Inconsistent case management (among most popular themes)

Case managers acting as gatekeepers (among most popular themes)

Complex navigation

Staff turnover

Insufficient DSWs for needs

Poorer access in rural areas

Lack of language assistance and engagement of diverse communities

Ableist system

Provider training insufficient and late in the process

I think I heard at least one person say, "accurate information during life transitions, specifically turning 65..."

Full meeting chat

· You 8/22/2024 9:30 AM • If anyone needs to check cameras/mics before the meeting, go for it! The meeting will start at 10 AM.

· You 8/22/2024 9:42 AM • Good morning everyone! Please feel free to check your cameras/mics. The meeting will start at 10 AM.

· You 8/22/2024 9:53 AM • Good morning everyone! Please feel free to check your cameras/mics. The meeting will start at 10 AM.

· Realtime Services 8/22/2024 9:54 AM • Good morning! If you need captions for this meeting, you can view them here: https://www.streamtext.net/player?event=MNDHS-WRAC

· Facilitator Lea 8/22/2024 10:01 AM • We will get started shortly. Thank you for joining today!

· Fartun Weli-MN Ethnic P network 8/22/2024 10:10 AM • welcome!

· Fartun Weli-MN Ethnic P network 8/22/2024 10:18 AM • thank you

· Fartun Weli-MN Ethnic P network 8/22/2024 10:27 AM • I need to know if there were participants of immigrants who don't speak English. Representation of this group is always missed.

· Fartun Weli-MN Ethnic P network 8/22/2024 10:28 AM • Oct than

· Tricia Brisbine 8/22/2024 10:29 AM • My comment: "Feedback" is not stakeholder engagment.

· Dr. Kate Jirik 8/22/2024 10:30 AM • people have questions, please don't ignore us

· Polly Owens 8/22/2024 10:31 AM • I will need to log off and log on again in about 15 minutes. Technical issues.

· Sara Beauchêne 8/22/2024 10:32 AM •

· Informed Choice Statute

· Sara Beauchêne 8/22/2024 10:34 AM • https://www.revisor.mn.gov/statutes/cite/256B.4905#:~:text=Informed%20choice.,or%20children's%20needs%20and%20preferences.

· Sara Beauchêne 8/22/2024 10:34 AM • MN Statute 256B.4905

· Some weren't able to open the link. There is another link and the statute citation.

· Fartun Weli-MN Ethnic P network 8/22/2024 10:37 AM • thank you

· New messages

· Tricia Brisbine 8/22/2024 10:52 AM • sorry have to step away

· Adrienne Hannert 8/22/2024 10:58 AM • from Kelly Friesen: 1. I appreciate having WRAC. It provides an opportunity for DHS to get meaningful input from stakeholders.

· 2. With that being said, we need DHS leadership to not only “hear” our considerations and suggestions, but we need to have the suggestions put into action as WR evolves. I am glad Ms. Merz will be attending this month. I wish I could attend, but I am unable to get out of a work commitment.

· 3. I have said this multiple times, but we need to base Waiver Reimagine on a persons needs, not the location in which they live.

· 4. We should consider only having one waiver that looks at the person’s needs and gives them the services they need based upon the assessment of their needs. All services should be available to all individuals, based upon need.

· 5. We should make an agreement to have the final plan, no matter what it looks like, be presented to WRAC for input and the Legislature before it is presented to CMS.

· 6. MnChoice 2.0 should be audited to see how many people have had their budget go down, stay the same, or go up in comparison to the 1.0 assessment. This is relevant to the WRAC discussions.

· 7. As we discuss Waiver Reimagine, we need to keep the Olmstead plan and living in the least restricted environment, that will meet a persons needs, a top priority.

· 8. CDCS should not go away. It is working very well for people who choose to use it.

· 9. Nursing Services should be kept in the CDCS option.

· 10. We need to discuss what self direction is, and if people are still going to have the option to have traditional waivers that are managed by the case manager.

· Gina Winter 8/22/2024 11:36 AM • We appreciate that Natasha.

· Heidi Hamilton 8/22/2024 11:37 AM • We really appreciate hearing all of this feedback. Thank you all for sharing your perspectives!

· Fartun Weli-MN Ethnic P network 8/22/2024 11:39 AM • I know - thank you

· Fartun Weli-MN Ethnic P network 8/22/2024 11:42 AM • Thank you Lisa

· Rosalie Eisenreich (SEMCIL) 8/22/2024 11:45 AM • Thank you, Mary.

· Meredith McKinnon 8/22/2024 11:46 AM • I am ready to come off mute.

· Tricia Brisbine 8/22/2024 11:50 AM • Respectfully, I request that the remaining members prepare their info to share and move along so everyone can speak

· Thank you

· Gretchen Spier 8/22/2024 11:59 AM • Thank you for the discussion today. I need to step away for a meeting.

· Fartun Weli-MN Ethnic P network 8/22/2024 11:59 AM • Immigrants are the victims of scammers because they are uninformed and rely on the wrong people. the government is to blame by taking the short cut. Our families are the victims here.

· Mary Fenske 8/22/2024 12:00 PM • I do have to leave at noon. Please email out any last issues or instructions that are discussed.

· Lisa Evert 8/22/2024 12:03 PM • good point Rosalie "who has the most to gain?" DeYoung says only 54% of waiver users KNOW that waiver reimagine exists! (54% of the 404 polled, which is a small fraction of the big picture) That leaves a large group that don't even know that these changes are being proposed. YIKES Those with weak advocacy are the most at risk and have the most to gain, right?

· Fartun Weli-MN Ethnic P network 8/22/2024 12:04 PM • DeYoung responded my question about who was included the survey. Here is the answer:

· "We did gather insights for Waiver Reimagine but we did not do any language-specific groups. The individuals who participated offered many critiques of the Waiver Imagine system, but they were not specific to the immigrant experience."

· As usual, Immigrants are missed agian

· Tricia Brisbine 8/22/2024 12:05 PM • Is the meet and greet another link?

· Adrienne Hannert 8/22/2024 12:05 PM • yes I will send an email with the link again now