Minnesota Waiver Reimagine

Reconfiguring Waivers

In Minnesota, roughly 43,000 people with disabilities have access to needed long-term services and supports (LTSS) through four separate Medicaid Waivers:

• Brain Injury Waiver
• Community Alternative Care Waiver
• Community Access for Disability Inclusion Waiver
• Developmental Disabilities Waiver

Minnesota’s Disability Services Division has been working to transform its system and is looking to reconfigure its waivers to provide simpler, more streamlined access to services for individuals with comparable needs. Working with our longtime partners the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and Burns & Associates—and informed by people who receive services, county staff, and providers (thanks to focus groups conducted by the University of Minnesota)—our cross-disciplinary team is evaluating the feasibility of options to reconfigure or consolidate waivers and proposing a transition plan for the state.

As part of this effort, we’re researching the efforts that other states have taken to reconfigure Medicaid LTSS services, and analyzing federal authority requirements that would impact reconfiguration.

Working with Stakeholders to Gauge Impact and Achieve Project Goals

Stakeholder input will be instrumental in helping the state achieve its goals for the project, which center around the development of individually responsive programs. The overarching goals are to:

• Provide equal access and benefits across disability waiver programs. The programs will be responsive to a person’s needs, circumstances and preferences.
• Align benefits across waiver programs for people with disabilities, including consistent limits and allowable services.
• Facilitate flexible and predictable benefit changes that recognize life changes and an increased use of technology.
• Simplify administration to make waivers easier to understand for people receiving services, county and tribal administrators, and service providers.

To engage stakeholders, we’ve reached out to the University of Minnesota. UMN is conducting focus groups to hear about people’s experiences with these waivers and to help us better understand needed changes. Through Waiver Reimagine Conversations held in a variety of locations and languages, UMN is seeking input from individuals served by Minnesota’s four disability waivers, family members, individuals from culturally and linguistically diverse backgrounds, and members of tribal nations–as well as county staff and service providers.  

Individual Budgets

Members from our intellectual and developmental disabilities, aging and disabilities, and behavioral health research teams are also advising the state on how it can promote self-direction and flexibility of funds through an individual budgeting model.

Minnesotans with disabilities currently have the option to self-direct their funding or to choose traditional services and service delivery. In the Consumer Directed Community Supports (CDCS) option to self-direct services, individuals are provided with an individual budget. This project will propose changes to those budgets as well as propose a methodology and implementation strategy for budgets for individuals who do not currently self-direct.

We’re analyzing results from the assessment tool MnCHOICES, as well as the services used by individuals in Minnesota coupled with the amount of funding  they have spent on those services. HSRI will propose a methodology, and will test the individual budget methodology on real service recipient cases to determine that the budgets are adequate to meet needs before DSD proposes any changes to the system. Burns & Associates will conduct a fiscal analysis to determine the impact of implementing the new methodology. HSRI will consider any policy or infrastructure adjustments. Throughout the project, HSRI will work with a core group of stakeholders to discuss project findings and to gain feedback about the work.