Waiver Reimagine FAQs

Waivers are a way to pay for home and community-based services that support you so you may live in the community, rather than an institution. They help you take part in community activities and support you at work. Currently, the four disability waivers are:

• Brain Injury (BI)
• Community Alternative Care (CAC)
• Community Access for Disability Inclusion (CADI)
• Developmental Disabilities (DD).

Advocacy is an important part of the process. For decades, people, families and advocates have worked with the state to create this system of home and community-based services and supports. That advocacy has played a big role in making the system more person-centered. It also informs the improvements we are making now.

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 you to lead a meaningful life based on your goals and what is important to you.

Waiver Reimagine is intended to address the challenges people and families have raised. We recently heard common concerns about waiver programs, including how:

• 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.

Waiver Reimagine is meant to respond to these concerns by:

• Making the waiver system easier for you to understand and use.
• Empowering you with more control over your services.
• Providing equity across waiver programs and people.

During the next several years, we will work with you, your family members, advocates, providers, tribal nations and counties to make more improvements to waiver programs. Your feedback is crucial.

There are many ways you can share your feedback. You can:

• Submit a question or provide input on the DSD Contact Form.
• Follow the Waiver Reimagine page because we will update it often.

• Watch this short video introduction to Waiver Reimagine
• Visit the Disability Hub MN website
• Subscribe to DHS Disability Services Division eList announcements.
  
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Waiver Reimagine will not change the assessment process. Lead agencies (counties and tribal nations) still will use the MnCHOICES Assessment.

Please review all the questions and answers on this page first. We will update the Waiver Reimagine website regularly with new questions, answers and other information, such as legislative reports. Submit a question on the DSD contact form.

Review our stakeholder events page, either to review past events or attend future events. You can also submit a suggestion on the DSD contact form. For ongoing projects affecting the disability community, consider joining the Virtual Insight Panel.

No. Waiver Reimagine only affects Minnesota’s disability waivers (CAC, CADI, BI or DD). It will not change the Elderly Waiver or the Alternative Care (AC) program. 

People will still need to meet current level of care eligibility requirements. This process won’t change. Once we determine they are waiver eligible, people will determine service need through:

• The assessment/informed choice process (service = living arrangement)
• Residential service need criteria.

These will in turn determine which waiver people are on:

• Individual Supports: For people who live in their own home or family home.
• Residential Supports: For people who live in provider-controlled residential settings.

Today, eligibility requirements do not align between waivers. For example, the DD waiver has a residential habilitation requirement that does not exist on the other three disability waivers. Moving forward, the waivers will use a single set of eligibility requirements. This single set of requirements is designed to be more easily understood by the people we serve. For example, everyone will need to meet one of the existing levels of care, have needs that exceed state plan services, etc.

Levels of care will still be recorded and tracked through the assessment process since level of care is an eligibility requirement. DSD is working closely with the federal government to ensure reports can be run as needed, including reports based on level of care and reports based on the new waiver types.

Habilitation is a concept developed by the Centers for Medicare & Medicaid services (CMS). Habilitation describes services that help people acquire, retain and improve self-help skills, socialization skills or adaptive skills they need to live in the community. CMS breaks habilitation into residential habilitation and day habilitation.

The requirement originates from intermediate care facility (ICF) requirements of active treatment, which is ongoing treatment to acquire, retain or improve skills. The DD waiver requires an ICF-DD level of care. The use of residential habilitation as an eligibility requirement helped to ensure residential habilitation continued and people were not put into a “care model.” A care model is when a person has their activities of daily living (ADL) and instrumental activities of daily living (IADL) needs met by someone doing for them rather than being engaged in performing ADLs and IADLs with someone.

CMS defines day habilitation as regularly scheduled activities in a non-residential setting and separate from the person’s home. Day and employment services might meet the federal requirement for habilitation. However, the DD waiver plan requirement is for residential habilitation or services provided at home to a person who lives in the community.

Day treatment and habilitation (pre-streamlined DD waiver service) used to be a required service provided to anyone eligible for Rule 185 case management. This included people on the DD waiver. As a result, all DD waiver plans were required to have DT&H service until it was challenged in court. The expansion of day and employment services became accessible to people on the DD waiver without requiring them to attend DT&H. Since the DT&H requirement was in state law and not the waiver plan, once the requirement for DT&H ended, there was no authority to require or allow for DT&H or current day and employment services to meet the residential habilitation requirement.

The residential habilitation requirement is an eligibility requirement for the federal 1915(c) DD Waiver. The waiver was developed by Minnesota and approved by CMS.

Every person who receives the DD waiver must have residential habilitation. The current waiver plan language says: "A participant must receive case management and have authorized and delivered a residential habilitation service as defined in Appendix B-1 (b) and as documented in the community support plan. A residential habilitation service must be in place within 90 days of a person starting on the waiver."

This means that all people on the DD waiver must:

• Have at least one residential habilitation service authorized and delivered
• Have a residential habilitation service in place within 90 days of starting the waiver.

The DD Waiver requires residential habilitation, which can be met in several different ways. A person may receive one of the following services:

• Community residential services
• Family residential services
• Individualized housing supports with training
• Individualized housing supports with family training.

People may also receive consumer directed community supports and meet the residential habilitation requirement. This is done through specific documentation in the person’s community support plan and meets the residential habilitation definition.

Finally, a person who lives in their own home with a primary caregiver or in the home of a primary caregiver (the family home, etc.) may receive residential habilitation through an unpaid caregiver. The person would be authorized for homemaker or respite, which will free up time of the primary caregiver to provide unpaid residential habilitation. The community support plan must specifically document the residential habilitation provided by the unpaid caregiver. To be considered a primary caregiver, the person must be principally responsible for the care and supervision of the participant, must maintain his/her primary residence at the same address as the participant and must be named as an owner or lessee of the primary residence.

Federal and state case management requirements will remain largely unchanged as a result of Waiver Reimagine. Transitioning from a four waivers to a two-waiver structure does not change the roles and responsibilities of waiver case managers. Waiver case managers will continue to follow requirements as outlined in the CBSM - Waiver, AC and ECS case management.

We are still working on the specific details. We anticipate the transition from one waiver to another to incorporate existing system processes to open and close waivers. We plan to incorporate feedback received from the public to minimize the number of steps where able.

No. Moving between waivers will be based upon the person’s chosen living arrangement. A person would switch between the residential waiver and individual support waiver when their living arrangement changes.

The process for moving between waivers will not result in a waitlist, unless there is legislative action to do so.

Moving between waivers will be based on the person’s chosen living arrangement. A person would switch between the residential waiver and individual support waiver when their living arrangement changes. When moving, a person’s support plan and services will change. The person’s case manager will support them to facilitate the transition and update their support plan. We are still working on the details and will seek feedback about strategies to minimize the number of steps where able.

DHS plans to maintain the current length of time a person may remain on a waiver without another waiver service in addition to waiver case management. For more information, see service requirements and exceptions section of CBSM- Waiver, AC and ECS case management.

In Phase 1 of Waiver Reimagine, we worked to align service menus between the four disability waivers in preparation for moving from four waivers to two. Current services will align to the two waivers based on existing program policies for service options when a person lives in residential settings or lives independently, including with family. The Residential Supports Waiver will serve people living in:

• A family foster care and receiving family residential services
• A foster care or community residential setting and receiving community residential services
• An assisted living facility and receiving customized living services
• An integrated community supports setting.

DHS is not adding new services to the waiver programs as we transition from four waivers to two. We will incorporate the current services in the four waivers into the two new waiver programs. Current services will align to the two waivers based on existing program policies for service options when a person lives in residential settings or lives independently, including with family.

The goals of Waiver Reimagine are:

• Provide equitable access to services, regardless of disability
• Ensure consistency and transparency in allocation of funds across the state
• Empower people with more choice and control over their services
• Create more flexibility within services and increase options to self-direct services
• Make the waiver system easier for all to understand and use
• Build systems that promote self-determination and independence.

Saving money or decreasing waiver funding is not a goal or an outcome of Waiver Reimagine. However, it is within the power of the Legislature to change the amount of funding available for disability waiver services, either to increase or decrease. This is the case in the current and future systems. Funding changes, although outside of the goals of Waiver Reimagine, can affect its implementation.

Support ranges are the level of a person’s need as measured through the MnCHOICES assessment. Service mixes set the budget amounts and differ based on support ranges, where people live and how old they are. For adults, DHS created budgets for people who live independently, with their families, in community residential services or in family residential services. For adolescents and children, DHS only developed budget ranges for those who live in the family home because children overwhelmingly live with their families. Other living settings are reserved only for the rare instances when children cannot be best supported with families.

For each support range, the person will be able to purchase services and supports within that budget range. The budget amounts are based on the real costs of services, called service mixes. Service mixes, shown in Appendix B of the Waiver Reimagine Legislative Report (PDF), are an estimation of the type and amount of services that people in each support range, living setting and age group are likely to need. These are used to develop the budget ranges. When developing service mixes, DHS intended them to account for more than the average amount people use. DHS added employment for adults and respite for children to align with policy efforts to expand access and the use of employment services and supporting family sustainability through caregiver relief.

Currently, there is no one, consistent method for lead agencies (counties and tribal nations) to determine how much a person will have to spend on disability waiver services. Those who use the consumer directed community supports (CDCS) option are given a unique budget based on their MnCHOICES assessment. Those who do not self-direct, or those who use only “traditional” waiver services, have budgets determined by lead agencies, who often have to weigh one person’s needs against another to meet their overall budget. The support ranges will provide an individual budget to each person based on their MnCHOICES assessment alone. The methodology will be the same regardless of the county or tribal nation in which the person lives.

Support range budgets reflect the cost or the rate of services available to people living in different settings (community residential settings, living independently, etc.).

Rates for these services are set by the Legislature, including through the Disability Waiver Rate System (DWRS) statute.

According to the statutory rates, and previous analysis of waiver spending across Minnesota, providing residential services generally costs more than supporting a person who lives independently.

The proposed support ranges and budget amounts in the 2021 legislative report are not final. We will update them before we begin Waiver Reimagine. The support range method will need to be updated with the revised MnCHOICES assessment. The service mixes, which determine the amount of the budgets, will need to be updated as well based on a variety of new data including but not limited to: the updated MnCHOICES assessment, new service data and new rates.

We also will review this information with interested parties, including reviewing records and budgets with the Waiver Reimagine Advisory Committee (WRAC) and a variety of others.

Finally, there could be new directives from the Legislature before implementation that dictate changes in budget amounts as well.

Some services are “outside” the budget, meaning they will not count toward individual waiver budget spending in the future, but will be included in the state aggregate. People will be able to access those services as they need with different limitations based on current service policy. Each service that is “outside” the budget must be considered separately when developing authorization guidance for people and lead agencies.

In general, the following categories of services will not count against a person’s budget:

• Temporary or one-time services, such as a home modification
• State plan services, such as state plan PCA or state plan home care nursing
• Some priority services, such as case management services and positive (behavioral) supports.

The list of services that will not be included in a person’s budget is not finalized and needs additional work, discussion and input from interested parties, such as the WRAC.

In researching and developing budgets since 2017, DHS completed detailed and extensive analysis of what people currently spend on disability waiver services and what their future budgets would be. DHS wants to ensure the smoothest transition possible for people and their families. However, there always will be those whose needs are not met by their budget or do not fit into the budget model. Therefore, DHS is developing a budget exception process. We will continue to engage with interested parties for feedback throughout the development process.

A person’s budget is not related to how much they spent the previous year. Annual budget changes will not be based on a person’s use of their previous budgets. If a person does not spend their entire budget in a year, the amount does not roll over into the following year. Each year at their annual reassessment, the person will be assigned to a support range and a budget amount based on their needs. The budget ranges are set at the state level for people with similar support needs and considers the cost of services and how much people will use.

DHS does not anticipate that Waiver Reimagine will change the rate exception policy and procedure. Instead, we hope to streamline the rate exception processes in the future, along with a corresponding budget exception process.

Under Waiver Reimagine, self-direction options will expand. While CDCS in name will no longer exist, all people will have the option to self-direct all, some or none of their services. People will not feel they have to choose between “traditional” and self-directed services. All people, regardless of living setting, will be able to direct most of their services. Currently people who live in residential settings may not self-direct their services or use the CDCS options.

Yes, a person will have the ability to employ the caregivers of their choosing, such as a relative, parent of a minor or spouse.

Under Waiver Reimagine, a person’s budget will be based on their needs and not on how they choose to receive their services, self-directed or not. Once a person is assigned to a support range (budget), then they will get to choose whether they self-direct all, some or none of their disability waivered services. People with similar needs on the same waiver will have the same budget amount, regardless of whether or not they self-direct.