Minnesota Long-Term Services and Supports Advisory Council meeting transcript
June 16, 2026
Slide 1
Michele Craig (PCG): All right. Well, welcome to the June LTSS Advisory Council meeting. I'm Michele Craig with Public Consulting Group and I will be facilitating today's meeting along with my colleague Jeremy Thomas here in person and the PCG team supporting online virtually. We appreciate you all joining today. We have just a few housekeeping reminders to cover. But before I do that, I'd like to take a minute for a new Council member introduction. Jennifer Giesen is joining us today as the Minnesota Disability Law Center appointee to the seat vacated by Jonah. So, Jennifer would you take a moment. Would you like to introduce yourself to the rest of the Council?
Jennifer Giesen: Sure. I'm Jennifer. I've been at the Minnesota Disability Law Center, which is the state’s Protection and Advocacy system for people with disabilities in Minnesota for a long time, I think over 25 years now and I've done a variety of things there. I started off doing special education work and Juvenile Justice and kind of quickly moved into doing more Medicaid work. I do a lot of fee-for-service Medicaid work in our office and then some Home and Community Based waiver work. And have primarily represented clients over the years, but in the past ten years or so I've done much more policy work, for those of you who knew Ann Henry, since she retired we've had a variety of different staff kind of taking policy work, so a bit of that as well.
Michele Craig: Wonderful. Well, welcome. Thank you very much. Due to time constraints today, we won’t go around and have all council members introduce themselves to Jennifer. I imagine you might know several of the people on the Council, but for folks in the room, you may want to introduce yourselves or folks online if you want to introduce yourself in the chat and folks in the room, you can take the opportunity to meet Jennifer maybe here on break. Now for the housekeeping, so next slide please.
Slide 2:
Michele Craig: The meeting is open to the public, both in person and virtually. And it is being recorded, I should double check it is being recorded, right? Yes, I see the recording. The recording will be available to council members and the public after the meeting.
Slide 3
Michele Craig: There's a public comment period today from 4:00 to 4:30 after the meeting. We will have the sign up for public comment during the scheduled break at 2:30. If you're a member of the public joining virtually, you can sign up at that time through the chat function. If you're in person, and I don't see anybody in person right now, from the public but in person, members can see me to sign up on a sheet of paper if you're in the room. Public comment will be limited to 3 minutes per speaker, and public attendees can only access the chat function when it is enabled for public comment sign up. PCG is taking the minutes for today's meeting and they will be available to the public once they're approved by the Council for Council members. Please put any requests for accessibility or accommodation or technical issues in the chat and one of the PCG team will support you. And finally, Council members please adhere to your meeting agreements as described in the Charter, including raising your hand to be recognized or to speak, saying your name before you speak, being respectful of others and sharing space for all to contribute their perspectives.
Slide 4
Michele Craig: Okay, let's move on to the agenda. So, today's agenda includes starting with the adoption of the April 16th, 2026 minutes and reviewing the action item status. Then we'll move on to some updates about the town hall meetings. We'll have a discussion about the outcome of the 2026 legislative session. Workgroup leads and members will share updates from their May and June meetings. DHS will lead the fiscal analysis discussion for the recommendations that will be voted on later in the meeting. Then we'll take a 10-minute break. We'll resume this half of the meeting really focused on first round rating, voting on the recommendations and then we'll wrap up with summary next steps and move to the public comment period. All right.
Slide 5
Michele Craig: Adoption of the April 16th meeting minutes. Next slide.
Slide 6
Michele Craig: So, the April minutes were distributed to council members on April 30th. I'd like to ask; do any Council members have requested edits to those April minutes? None in the room. Not seeing any virtually, I don't see any hands. All right. Let's proceed then with the roll call vote for the adoption of the minutes. I'll call for each Member to vote yes or no for adoption and alphabetical order by first name. Starting with Addyson, I think Addyson is going to be late.
Addyson Carpenter: I was able to hop on because I am - we're just in a conference room waiting for the hearing.
Michele Craig: There you are. Thank you, Addyson. Do you? What is your vote for adoption?
Addyson Carpenter: I vote yes.
Michele Craig: Thank you. Alex?
Alex Kotze: Approve.
Michele Craig: Barb?
Barb Weckman Brekke: Yes
Michele Craig: Thank you. Anna?
Anna Hegland: Yes.
Michele Craig: Colin?
Colin Stemper, DHS: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Thank you. Genevieve?
Genevieve Gaboriault: Yes.
Michele Craig: Jay? Okay, I think you might have said something, but we're not hearing you in the room. Okay. We'll come back or if you want to put it in your vote in the chat, maybe you already have. Sorry about that. Alright. Jennifer Ballinger? I don’t think Jennifer is on yet. Jennifer Giesen?
Jennifer Giesen: I think I should abstain, since I wasn’t at the meeting.
Michele Craig: Jillian?
Michele Craig: Lance? Let's see. Lisa Antony Thomas is likely not attending today's meeting. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Thank you. Lori?
Lori Schluttenhofer: Yes.
Michele Craig: Louella, I believe is absent. I think she is in Europe today. I’m not seeing her, so she's not joining from Europe. Musab? Don’t see him either. Nicole.
Nicole Hansen: Yes.
Michele Craig: Pat Mecham?
Patrick Mecham: Yes.
Michele Craig: Thank you. Pat Wright?
Pat Wright: Yes.
Michele Craig: Thank you. Rick?
Rick Varco: Yes.
Michele Craig: Roxanne?
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn? Let's see, Sherry Gustafson?
Sherry Gustafson: Yes.
Michele Craig: Tarryl?
Tarryl Clark: Yes.
Michele Craig: And Zahnia? I see Zahnia’s note taker, but I don't think I see Zahnia. OK.
Michele Craig: And then coming back quick. Jay, was your vote yes or no?
Jay Johnson: Can you hear me?
Michele Craig: I can hear you.
Jay Johnson: Yes.
Michele Craig: All right. Well, we'll consider the April meeting minutes approved. Now let's briefly go over the status of the action items on from that meeting, there will be two on this slide, two on the next. So first there was an action item for PCG to coordinate a small group conversation among the benefits work group to discuss exceptions and implications for the recommendation on people 65 and older to use the elderly waiver. That's complete and that that discussion was held April 28. The next was an action item for DHS to proceed with the fiscal. estimates of the recommendation ideas to eliminate state assess consultation services and reinstate tephra. That is complete and Colin will be talking about that here shortly. The next section items was for DHS to review if they have available existing data to inform the conversation about exhausting other funding sources and send it to the Council. That is complete, and that recommendation idea has since been tabled.
Audrey, if you don't mind moving to the next slide, I may have breezed over that really quick.
Slide 7
Michele Craig: The last one was an action item for DHS to prepare data on overturned service denials and send to the Council. That is complete and was sent on May 4th to the eligibility work group who was discussing that idea. Any questions or comments before we move on to the next item on the agenda?
Michele Craig: Not seeing any. Then we can move on to updates about the town hall meetings.
Slide 8:
Michele Craig: So, the town halls. A reminder that the purpose of the town halls is to gather feedback from community partners on the recommendation ideas that are under consideration by you all as the Council. In April, we talked about the schedule for the town halls, and at that time we indicated that we were looking at those to occur between June 23rd and July 15th. But after further review of sort of the state of where the recommendations are, and likely that maybe some new recommendations may emerge out of the July workgroups, we felt it would be better to push the [town halls] a couple weeks later in order to provide our your Community partners AC chance to hear a more comprehensive review or more comprehensive presentation of all the recommendations that are under consideration by the Council. So, there will be 3 meetings. They will all be virtual as was decided on in the last Council meeting. The first one will be Monday, July 20th, from 1:00 to 2:30. Then on Wednesday the 22nd from 6 to 7:30 PM, and then Friday, July 7th or excuse me, 24th from 10:00 AM to 11:30. So LTTS Advisory Council members, you are welcome to attend but not required. PCG will be facilitating the meeting. And if you would like to attend any and all of them, you are welcome. No registration is required to participate, and interested parties may just use the links that are provided here on the screen and I will be sending you the links as well in an e-mail after today's meeting so that you can share about your networks. Next slide.
Slide 9
Michele Craig: So, in advance of today's meeting, PCG sent Council members, the Town Hall meeting guide for you all to review, that has the additional details of the logistics and the planning for the town hall meetings and includes the questions that we're planning to use to gather feedback. As you all read through that guide, if you have any questions or suggestions for different questions to ask Community Partners, please feel free to just e-mail those to me directly. With the amount of content on today's agenda, we don't have a lot of time to talk about it, but feel free to reach out if you have any questions or comment. As we mentioned in the previous slide, we appreciate you sharing the town hall meeting dates among your networks. So, like I said, I'll be sending you the links that you can share out as well as some draft language like we did for the Community Partner Survey. You can use it or not use it, but just providing that there as a tool for you. And then as needed after the July meeting, we'll refine some of the content as needed to make sure it's aligned with all the recommendations the Council is considering. And we'll let you all know if there's going to be any substantive changes. But we really don't anticipate that. As I mentioned, we don't have a lot of time on this but briefly would like to just pause and see if anyone has any initial questions. Not hearing or seeing any in the room. I’m not seeing any virtually either. OK. Thank you. All right, well. Again, reach out to me if there's anything you would like to talk about with the Town Halls. Moving on to the next slide.
Slide 10:
Michele Craig: The next section on the or item on the agenda is the 2026 legislative session. I think most of you are aware of this, but for anyone who wasn't at the June work group meetings, the there's a lot of discussion in those work group meetings about the outcome of the 2026 Minnesota legislative session and the impact on the Council’s work. So, we've included this item on the agenda today at the request of some Council members, so that you all have an opportunity to discuss it together. Next slide please.
Slide 11:
Michele Craig: We have about 20 minutes for this topic, so I will set a timer to kind of keep us on track here, but I'll open the floor to the Council to really lead the discussion here about the outcomes next steps, the impacts to the Council's legislative mandate, and then have some discussion about how to continue to move forward. So, I'll stop and I'm not sure from the Council who would like to start.
Barb Weckman Brekke: You know, I can talk very broadly. I hope folks can hear me.
Michele Craig: This is Barb.
Barb Weckman Brekke: This is Barb. Sorry, Barb. Weckman Brekke. I think there's only one Barb. You know, as we reviewed the legislative session we reviewed. Some of the those statutes, or the laws that were put in place, we saw a lot of the work of this Council, a lot of the work that DHS did with this Council, work with the Council, we saw cuts and changes to long term services and supports program in excess of the dollar savings that we were charged to do. And so, I guess there's a few of us in work groups talking about that saying, well, that's worth some discussion if our Council has some reaction to that on a very just kind of. I don't know what the right word is. Juvenile level and juvenile or simple way of thinking. I feel like the Council's saying well, thank you. Thank you for taking the ideas and using them. We've added them since our charge was made. Even though the legislature didn't decide to attach those savings to the work of the Council. Still, it's done. We did it. Should we really be looking for more cuts to the services our most vulnerable people need? We did the work. Here you go. Thank you. Goodbye and we'll talk again. In some ways, it seems like the work of the Council is over. So, on the table for comment. Colin?
Colin Stemper: Maybe I can provide the state perspective, which I know will be universally popular.
Barb Weckman Brekke: Are you speaking as a state or as a council member?
Colin Stemper: I was speaking as a Council member with knowledge of how the state approaches this topic and also appreciate your comments as well, so you know with the target that we have as a Council to hit, what the state was looking for was those savings to pass this session and then the new law adjusting the old law to reduce the target down accordingly. And they passed- the legislature passed the new laws, but they didn't adjust the target down. So, from the pure dollars and cents perspective, the task of the Council remains unchanged and unfortunately some options have now been taken off the table for us. You know, as the Council's law is written, it’s a determination that Minnesota management budget or MB makes after the 2027 session about whether that legislature hit the target based on the recommendations of the Council and we'll have a new governor at that point. We'll have a new legislature at that point and you know, we're taking votes today and in August and want to deliver a legislative report by December. So, it's- there are conversations definitely to be had with the state government leaders about the work of this Council. And those leaders don't necessarily exist yet, and we have to kind of complete our work before they before they do exist. So, it's-there's a bit of a timing issue there. And I think from the state perspective, the legislature just didn't reduce our targets, that's the challenge.
Barb Weckman Brekke: Thank you. That's again, not maybe popular, at least with me, but understandable and expected. And that being said, I do think no matter what we do, my recommendation would be that we in whatever report would make if we make it tomorrow and submit it, say we're done, or if we would do submit in December like we probably will is to talk about those, I guess the ideas that were generated from this group that the cost savings associated with them no matter what. Even though they didn't bring the target down, like that's very valid and I think it's worthy go just respect for what this group and people put in a lot more time than me did to come up with those things which helped the legislature and their role with what they did. They used all of that. It's not like it came from thin air that was out there so. I've said enough. Maybe some of my colleagues, we've talked about this, have some more to say.
Michele Craig: I have two hands that sort of went up simultaneously. So, I'll start with Anna in the room and then Tarryl online, if that's OK.
Anna Hegland: Mine will be quick; I was just going to say that we also talked in our subgroups about just making sure that those things get into the report. They didn't do it in the 2026 legislative session, but that doesn't mean they can't make a legislative change in the 2027 session. Which is where all of our recommendations are going to be considered, so I still think I have a little bit of hope that we can talk to people between now and next session and maybe still include some of those things. So, I don't know how feasible it is to attach dollars to all of those things if we could just take it out of what fiscal note was applied in 2026 to include in the reports? I know those numbers sometimes change, but I'm hoping that we can book those savings. The other question that I had just about kind of the ongoing piece of this since none of it was counted, was it talks about the competitive workforce factor being reduced and it talks about county share, but it's really just applied to that one biennium. So, is that like the fiscal note that was associated with this Council? Are we talking about an ongoing and forever, even though we don't have any dollars attached? That question making sense?
Colin Stemper: Yes, your question does make sense. This is Colin by the way, for folks online. It's a really good question. My understanding of policy perspective is that those are ongoing reductions and I need to follow up with our fiscal folks to make sure how that- if that is reflected in spreadsheets, that could be a takeaway for DHS to confirm.
Michele Craig: Thank you. Tarryl?
Tarryl Clark: Thank you, Tarryl Clark, Stearns County, here representing AMC. Colin, I really appreciate even though you are smaller than an ant on my screen. That your, your comments about a little bit of the context, I think many of us know another part of the context was it was legislative leaders that did the targets at the very end and the poor Human Services Committee had a horrible target and so many of those doesn't necessarily reflect what anybody wanted to do. It reflected how they- I'm saying this neutrally as I can- how they were getting out of the end of session. So, I think it still behooves us to put front and center here are the amounts that came out, our job was done. If we want to give them other ideas, that's not necessarily- we could, I want to separate that, but I think it is important because while we don't know who's next, we do know that they adopted much of what we were suggesting. And let's face it, it was the least painful part of almost anything. So, us declaring victory and saying hey, you need to change this part of the statute and we all know they will have a hole, because my understanding too is that this is ongoing which would be just almost unbearable for everybody if they don't accept our work or they don't make the changes. Should we recommend any others? So, I agree with Barb.
Michele Craig: Thank you. Lori?
Lori Schulttenhofer: Yeah, hi, thanks. Yes, I agree with Anna, with Barb, with Tarryl. I think one of the things that really struck me with the provider rates work group during our conversation a couple of weeks ago is identifying that we were- if we sweep aside some of the ideas we've been discussing that were implemented yet aren't going to count to bring down our total. If we put that aside, we have been- and I think it we have the right people at the table to discuss long term changes that will make the end recommendations for long term changes and evolutions that will make the system more sustainable. So, I think we agree. It's like what do we do now that we have, we just have repeated cuts coming in and we know we're looking forward to some mandated cuts next summer, if we're not able to get legislative change. Do we let go of this potential that we have right now to bring together the right people to make long term changes that are going to help. I think that would- in retrospect it would have been great if we would have started this process five years ago. You know, pie in the sky. It it's too late. We aren't able to go back and do that. But it is a really frustrating time. And what I'm looking at the example of the MN Choices Advisory Group last year and the way that they were able to come together on behalf of that advisory group and really ask legislators to address some specific issues and avoid some specific harm that would have happened if they moved forward with that implementation. So, I think I'm more curious than anything about the limits of what we can do as a Council. To be united on addressing those issues ahead of -and as we get into-the next legislative session, because there will be so much riding on it.
Michele Craig: Thank you, Lori. I see in- Zahnia you had a couple comments in the chat you noted. It looks like this is the one billion savings in 2025 and 300 million in 2026. And you asked what was it reduced by and also a reminder for folks in the room to say your name. But Zahnia, do you want to? Yeah, go ahead if you want to say something more.
Zahnia Harut: Yeah. I think in the provider rates group, we were talking about. Hey, you know the budget was cut by, I think 1.3 billion in 2025 and then this 300 million cut. How much more can we cut at this point? And obviously this just goes into what everyone else is saying. But then my other question that I had was and sorry, this is Zahnia. My other question was what- I think it was Colin that I heard talking. What was it reduced by that didn't get acknowledged in the in this last legislative session. What was that amount?
Colin Stemper: This is Colin. I don't have the numbers up about what the total savings were, but the Council's target was not reduced by any of the savings.
Zahnia Harut: I think I'm more interested in and if you can get that number like it was reduced by that was not reflected. That will help us with conversations with legislators, I want to be pretty vocal about this. A lot of these legislators are having fundraisers right now. They're having fundraisers in their communities they're having lots of interactions with community members, and if we have that information, that data that really helps, you know, have these conversations in communities.
Lori Schluttenhofer: Yeah, I think if I if I can be rude, I think what Zahnia is asking for and Zahnia tell me if I'm wrong, is you know how much was spending reduced? In long term services and supports. We know that it hasn't been applied to our total but overall, how much spending has been reduced?
Zahnia Harut: Yes, because I will aggressively have those conversations with folks as they're asking for money from their constituents for their, you know, campaigns and whatnot. Like, those are conversations that, hey, you're coming to community for support, the disability services community is reeling right now. And with all of the chaos going on with payments, issues, just across the state, the disability community. The provider community and the Disability Services community is suffering and I do want to know what those numbers are so I can have conversations and say hey this was not done like how can we get to a place where this is being acknowledged next session for those who will be reelected?
Michele Craig: Thank you. Thank you, Zahnia, Thank you, Lori. Tarryl?
Tarryl Clark: We. I mean, I would need a little bit of time, but I think there's a spreadsheet that shows how much they took. It's probably not all he actual savings because they didn't have time to fully do it or they need time to figure out how much really the savings will be. But I think we should be able to find it during this meeting. Colin if you've got a friend you can phone or text, but otherwise I think one of us can go online and find what they did right, because that is something we should have for today. I'm saying with a smile. I know you could see me bigger than I could see you.
Colin Stemper: This is Colin. I will see what I can pull up during the break, but if we can't get it for this meeting, exactly, I'm sure that's something we can produce pretty quickly for the Council.
Tarryl Clark: Great. And honestly, we probably need it before the town halls anyways, but I think to the point’s already made, they're talking to us all now. It would be good- this is our best time to be helping shape people’s opinions that it does sound like. Understanding DHS and Colin, probably you are kind of being stuck in a place you know you got to be a little careful. The rest of us don't have to.
Michele Craig: Thank you. All right. We have about 4 minutes left. Pat Mecham?
Pat Mecham: This is Pat, MACSSA representative. You know, I just want to piggyback off Zahnia's point too is that I wouldn't want the report to only emphasize on the numbers. The impacts to providers, to the individuals, to the counties, to the work, I mean it's across the board and I think it really fits in at the end of the legislative session fits in unfortunately through a narrative that's been going on for the last year, whether it is prepayment review and the stress that came there, revalidation, to the $300 million cuts hat's in a year that didn't have to have a budget even approved. And then we're asking ourselves or the legislators asking a group of individuals to cut themselves even more or their partners and their neighbors, the most vulnerable or themselves. And it just it when it's not even a cumulative effect, it's a compounding effect over multiple years now as Zahnia said, but there is that human aspect to it, whether it's versus the numbers of providers closing, the individuals not receiving services, etcetera, that that's part of that bigger picture. That's just not a dollars and cents. That's and you know that that's my worry, is I would not want the report to be just a dollar and cents figure, but that cumulative compounding effect on all of our different areas. But I just don't want that to be lost in the report that it's just on the dollars.
Michele Craig: Thank you. All right. We have about 2 1/2 minutes left for this agenda item. Are there any other comments that someone would like to include? Terrell noted in the chat that she agrees Pat.
Tarryl Clark: Yeah, and if and if I could just really quickly, Michelle, what I was saying was in response to us not having the numbers that are being booked, that doesn't mean we shouldn't talk about that compounding in a report, but it would be helpful to have those numbers.
Michele Craig: Thank you for that. All right, I think there probably will be more conversation in this as we continue into the work groups, but I think we'll go ahead and move on to the next agenda item.
Slide 12:
Michele Craig: So now for the work group updates. Let's see. Here we have about 10 minutes total for the work group leads, all three of you to share a summary updates from your May and June meeting. So that'll be about 3 minutes for each work group and if you want to just give a brief overview and we've talked a little bit already about the budget especially, but any other updates you'd like to share about the recommendations you have been considering, you'll have 3 minutes to share that. And so, to start with Jay, I believe you will be sharing since Louella is not here today.
Jay Johnson: Can you pull up? All right, maybe I can find it. Michele, do I have that in my in one of the emails that we've got?
Michele Craig: Yeah. I mean, you'll have the meeting minutes. I think you would just be shared a couple of updates about your conversations around the, the recommendation ideas the eligibility work group is considering.
Jay Johnson: Pull that up so I can at least look at it if you can’t have it in our presentation here.
Michele Craig: Maybe if I if it's OK, I'll move on to the benefits work group and then I can come, I can quickly.
Jay Johnson: I’ll pull it up
Michele Craig: Oh, you'll pull it up.
Jay Johnson: Yeah, please. I'm gonna open up another screen here.
Michele Craig: Yeah. We'll come back to you, Jay We'll move the benefits work group and Audrey, can you against the slides please?
Slide 12
Jay Johnson: Move on and come back to me.
Michele Craig: Let's see. So, benefits workgroup. Alex and Addyson, do you want to share a brief update?
Alex Kotze: Yeah. Can everybody hear me? This is Alex.
Michele Craig: Yes.
Alex Kotze: Great. OK. Hi everybody, and Addyson jump in. And Nicole, also hop in. We spent most of our time on looking at the elderly waiver adjustments that that our group has been looking at that almost the entire time we've been meeting through the work group and looking at requiring that for people over age 65, we've asked for two different versions of the fiscal note and have wanted to bring that forward to this group at our next meeting, that's what we spent the majority of our time looking into and Colin joined us to help answer some questions. There is still some reservations, but we're still moving it forward. Addyson or Nicole? Is there anything else we want to highlight from our conversation?
Addyson Carpenter: I honestly don't remember our conversation because I was still on a bunch of meds.
Alex Kotze: Oh, that's true. Sorry, Addyson. I'm glad to see you're back. Nicole, anything I missed? Right. Oh, wait. No one more thing. Sorry. We actually are also bringing forward. So, DHS had three separate proposals regarding nursing facilities and that had savings but were not passed by the legislature and we are also bringing those forward as part of the what we want to bring to this group in August. So that was also great for us to look through those. We got a presentation from Colin on those. So, we'll have those three that are packaged plus the EW for consideration by the larger group. Now I think I got everything. We looked at other things, but those were major items that have been brought forward from our group, from the benefits workgroup.
Nicole Hansen: Yeah. Thanks, Alex. Sorry, I had trouble getting my phone to unmute for a while there, but no, I agree. Yeah, you caught everything.
Alex Kotze: Great. Thank you.
Michele Craig: All right. Thank you, Alex, Addison, Nicole and benefits work group. Let's move to provider rates, Lori and Darla, and then we'll come back to the eligibility workgroup.
Lori Schluttenhofer: All right. Thank you. Our preceding conversation represented a lot of our last meeting, just talking about the frustration and I think one of the things I want to make really clear on behalf of the provider rates work group, is everybody in that group is very, very committed and wants to be helpful and wants to participate in a meaningful way. And we're finding it very difficult to bring ideas up. Pat summed it up better than I can bringing forward ideas to continue to compound the effects of the decreases we've already seen. With that being said, we want to be helpful and are really open to talking with the broader Council on how we can be of assistance with other work that's being done if we're If we're stagnated in coming up with rate reduction ideas. Some new ideas that were brought forward and again we haven't gotten much research on them yet, but those are and we have we have we have mixed support within the subgroup on these, but those ideas are around any cost savings we can have with rolling back the certified assessor team that was mandated and aim to address the backlog. In the 28 and 29 biennium, limiting look at some limitations or guard rails around spousal or parental hours in CFSS keeping them closer to the assessed need and looking at the nursing hardship. Waiver hours limit for unskilled care. That is, that is pretty much the summary of where we were at. I think we want to, we're really committed to trying to be good stewards of communication and ask for the assistance we need with fiscal analysis and feasibility research and we would really love to be able to focus on some long term solutions. Darla, did you want to add anything?
Darla Thompson: No, I think that that sums it up and just really looking at where can our time be best spent knowing that there's been a lot of cuts in regards to rates and a lot of changes in the environment just as far as like gas prices and everything else, so promoting access. And looking at alternatives to some of these rate decreases to ensure that you know with here they're a rate, an extra rate decrease doesn't than cost even more with facility more facility based care especially when it comes to complex. So yeah, thank you.
Michele Craig: Thank you, Lori and Darla and Jay we’ll come back to eligibility. Work groups were you were, were you able to find your notes?
Jay Johnson: Yup they were squared away. So, the five items that we talked about and we're looking for fiscal analysis today was to reinstate TEFRA fees so we're looking for some information on that. We're looking at eliminating the CFSS consultation services we have five of these, five of these that we talked about and a couple of new ones that I will mention. We tabled one to reduce CFSS authorizations by a unit or 15 minutes. Let's see. We talked about moving forward on transferring all the services and case management when a person moves from one county to the next to have those services and case management follow the client as opposed to being administered by a county that they're, I guess, the lead county or the county that they're not living in or that they moved from. So, I think those so the three that we that that I believe we all agreed that we would like to move forward on would be to transfer all services and case management when a person moves to a new county to that to that county of residence. The third one or the second one, was to reinstate TEFRA fees. The third one was to eliminate CFSS consultation services. And then a couple of the new ideas that came up. One of them was to take a look at MAEPD, so medical assistance for employed persons with disabilities and to have perhaps set some limits around that if a person if a person earning or making under a certain amount to eliminate any type of fee for them. If a person has assets or an asset limit exceeding some exceeding an amount and they don't know we never really came up with an amount but to either increase their premium or perhaps remove them from program. That was one of them. The other one was- let's see. We talked about a paid parent to explore where the paid parent program if we could, if there were any limits that would impact cost savings. So again, another fiscal analysis on the paid parent program. So those were the those were the primary areas or agenda items that we selected or discussed about moving forward. If anybody has any questions, I think I can answer them. I'm looking at our minutes and kind of going over some of our notes. Sherry. You have a question?
Sherry Gustafson: Yes, hi. I'm on the eligibility committee. I just wanted to clarify a little bit and I know that we might be talking about this and voting on it later about the CFS consult consultation part of the CFSS, I think we also talked about the possibility of modifying that. So, in other words, folks that are CFSS only may be able to choose to have a consultation provider, or maybe they have consultation providers, but those who are on the waiver who have case managers maybe have the option to not have a consultation provider. We also discussed that option or potential as well. So not black and white, not one or the other, but they have the option to choose.
Jay Johnson: Sure. Anything else, Sherry, that, that you can think of that we discussed.
Sherry Gustafson: I think that you got it quite well there, yes.
Jay Johnson: Thank you. And I think we have another hand up, Tarryl.
Tarryl Clark: Yeah. Thanks, Jay, for that. We talked about so many different things just for clarification for the broader group on tephra, we had talked about the proposal at the level that. The state that the governor brought forward at 625% of poverty not going below that, but so that one we know we already had the data for. There was both some question part of the reason why we need some fiscal analysis is the movement between counties. There was some question about savings. And then very much appreciated the clarification on part of the CFSS. One of the questions at least brought up from a few of us is how much would that really save because somebody would still have to do the work. So, we just we're looking for we're all trying to find money. And we, we just need to figure out what the savings really are before we can fully bring it forward.
Michele Craig: Thank you. And we are going a little bit over here, but I realized Pat, you raised your hand and you haven't spoken up yet. So Pat, if you'd like to make the final comment and then we'll move on to the fiscal analysis.
Pat Wright: Yeah, hi, thanks. Pat Wright, person with lived experience, advocate. I had a clarifying question so people, everybody has in terms of the CFSS, everybody has a case manager that they could, you know, choose consultation, or at the case manager is that I think that's right, but I'm just clarifying. Thanks.
Jay Johnson: Everybody that receives MA services is being moved to the CFSS program. One of CFSS requirements is that you now use a, an intermediary kind of called a consultation provider. So, everybody that's receiving benefits has to have this consultation provider. They're somehow in in the mix. The consultation provider services- they're basically taking the role of the consultation that a person would receive from their county case manager or a waivered services case manager.
Pat Wright: OK. Yeah. Thank you. I hadn't heard that everybody was moving to that. It seemed like it was specific groups of people, but maybe.
Jay Johnson: This is for the CFSS program.
Pat Wright: Yeah, but didn't you just say everybody in on MA services is going to move there unless they're on a waiver? Is that maybe I'm getting into the weeds too much?
Sherry Gustafson: It's PCA is changing to CFSS, so any PCA services will change to that new CFFS program.
Pat Wright: OK. Yeah, that's what I think. That's what sounds familiar from what I heard.
Jay Johnson: Yeah. Thank you. I appreciate that.
Michele Craig: Are we good to move on, does that answer your question?
Pat Wright: I'm sorry, maybe I'm just having a confusing day. Som the people that are moving on to CFSS from PCA program, they already have a case manager. So, this is an additional service because I thought the-
Sherry Gustafson: No. Yeah, people that are on the waiver, they can get PCA slash CFSS services. If you're on the waiver, you have a case manager. Some folks that get MA are not on the waiver and can get PCH/ CFSS. If that's the case, they don't have a case manager. If they're not on the waiver. They don't have a case manager.
Pat Wright: OK. So, they are kind of forced to do the CFSS unless-
Sherry Gustafson: Everybody at this point is forced to do it- it's mandated at this point, it's not optional.
Pat Wright: Yeah. So, if we both voted not to have it, then those people, well, I guess we don't know what would happen there, OK, because if they, you know don't have anybody. So, OK, that's what I'm thinking. But maybe I'm too much in the weeds for this conversation. And I know we're running out of time. Yeah. Thank you.
Michele Craig: Thank you, Pat. I think we did go a little bit over I think that was good conversation because that recommendation is being voted on so I think having some, you know, clarity and people asking questions about it is important. All right. We will move on to the fiscal analysis. So, I'm going to turn it over to Colin and you've probably heard me - Audrey's advancing the slides.
Slide 19
Colin Stemper: Sounds good. All right. Thanks, everybody. So, I'm going to present some slides with the physical analysis that we've requested at the last Council. OK. So, I think the way we'll do it is maybe I'll present one topic and then we can pause and folks ask any questions about what was presented and then we'll move on and I guess I'll look to you, Michelle, for spending too much time on one and we can move along, but first, a little bit of background. So, the following slides provide estimated ranges prepared by the fiscal analysis or fiscal analysts. So, these aren't fiscal notes, but they're produced and reviewed by the same people who do the fiscal notes. So, I, you know, I said ranges at the beginning of what you're going to see here. And that's done intentionally so you know when you see a fiscal note during the legislative session, it's precise dollar value. And we're presenting ranges today because we want you to get an idea of kind of generally what we would expect to save with these ideas. And they're presented in ranges of $5,000,000 increments and that's because, you know, when we get to next session, those fiscal notes will be based on either the November 2026 or February 2027 budget. So, the base that the numbers for the. analysis based on will be a little different, so that could move the numbers precisely a little bit. Typically, we also don't produce fiscal notes unless there is actual bill language that we're providing because we can see the full impact of what the bill would do or the idea would do. We're not asking anyone to produce bill language here forcefully for you and all of us. So that means sometimes we have to fill in some gaps with what we would assume would be the case here, so precise bill language could move things a little bit in one direction or another, but we're hopeful that by providing information in $5,000,000 bands we're getting a general idea of what we would say. So that's the reason that these estimates are within a range. We'll go to the first slide.
Slide 20:
Colin Stemper: On the next slide, which we were just talking about, which would be a reintroduction of TEFRA rebates when the Council that they were interested in repricing the Governor’s budget item from this past session that didn't pass, which was reinstating fees for income above 675% of the federal poverty guideline. Well, the analysts who worked on this want to provide you a few options? That's not necessarily to say that you have to take any of these other options, but to provide you a few scaling options too. So, there is one above 675% FPG that's anticipated to say between 20 and 25 million in the next biennium. Over 545 FPG t was 35 to 40 million and then over 275- I'm missing a percentage- there is between 70 and 75 billion. So, these estimates reflect a 1/1/28 effective date, assuming the 2027 legislature would pass that. So, I'll pause here and reminder, we'll be talking through these ideas, the ideas themselves a little bit more later on in the meeting. But in terms of the fiscal estimate. Does anyone have any questions about this one?
Michele Craig: Yes, we have an a hand online, Alex.
Alex Kotze: Great. Thanks. Hey, Colin, can you remind me what the fees used to be before they were taken away, what FPG?
Colin Stemper: I don't know that off the top of my head but-
Alex Kotze: That's OK. Maybe you can follow up for later I because we used to have them, and I thought it was 545, but I might be wrong.
Colin Stemper: Yep, we will follow up and let you all know.
Alex Kotze: Thank you. And these are the two years, right? It's the 28 you have the 28-29 biennium, that's what the dollars are.
Colin Stemper: This is the biennial savings for both years.
Alex Kotze: Thank you.
Michele Craig: Jennifer in the room?
Jennifer Giesen: I have two questions. One is, does the savings reflect both sort of the income of the payment of the fee and the reduction in the number of people that would be on, do you know what the number of people that you would estimate would be on? It's probably guestimate more than an estimate. But would not be receiving services as a result?
Colin Stemper: Yeah, it’s a good question. So first it does include the collection of the fees and the reduction of people accessing the service. So, you're right about that. You know this really is kind of a guesstimate because we don't collect TEFRA fees anymore. So, we also don't have data on how many people would be impacted by this so how they approach this analysis was looking back to the last time we did collect these, how many people above this threshold we're paying fees at that time and that just kind of carried that number? I don't know exactly. What that number is.
Michele Craig:. Oh. I'm sorry my brain stopped for a second. Addison. We'll invite you to provide the final question or comment and then I think we'll move on to the next one.
Addyson Carpenter: I was able to pull up the fee schedule from 2014. It was effective June, so less than 25 of the federal poverty guidelines. The monthly fee was none. 275 to 544 was a sliding scale of 2.76 to 7.5. And then anything above it I can all put the link in the chat, but the only people that didn't have it was anybody below 275%.
Michele Craig: Thank you for that, Addyson. The next one.
Colin Stemper: Sounds good. The next slide?
Slide 21
Colin Stemper: OK. So, the next one is also what we were just talking about, which is the elimination of CFSS consultation services. So, this is the outright elimination. It's not the allowance for some people to not use it otherwise and received case management services. So, this fiscal estimate is anticipated to be budget neutral and the reason that that's the case is that the analysts expect the cost of this service to migrate to other services like case management. And so, as a result, the elimination would not yield any savings estimate. Any questions?
Jennifer Giesen: Do you know- so I can see how that would happen for people that receive waivered services and the few people that are still on case management like for these services. But how would that- what would the transfer cost be for people who are just on like MA fee-for-service?
Colin Stemper: I don't have that specific call out, I think the idea was-sorry Tarryl, this is Colin. The idea was that the-
Tarryl Clark: Sorry Colin, I meant before. I didn't know who asked the question.
Colin Stemper: It was Jennifer. Thank you. So, I can follow up exactly where folks thought the costs were migrate to you know, when we talked about it as a Council and we expressed concern about those folks who didn't have a case manager. The conversation at that point was that with the support and direction would move somewhere else in the MA system, but I can follow up and confirm what those other supports are assumed to be?
Michele Craig: Anna.
Anna Hegland: This is Anna Hegland. I think this one was probably the most disappointing for me because we've been talking about this in three work groups for probably 6 months. So, know that we spent that much time on something that the department is considering budget neutral was disappointing for sure. This is not my area of expertise, but I think my question is also related to how we got to neutral. I think what I have been hearing in a lot of the subgroups from people with experience with this service that it feels very duplicative. So, if it's a duplication, how are we assuming that that's going to go somewhere else, so I think that's really my question and I guess my ask would be that we revisit the fiscal note to see if we can find some savings there.
Michele Craig: Thank you. And then Jay.
Jay Johnson: Yeah, I'm going to say that you clearly didn't – in your group or whoever discussed this clearly, didn't include anybody that receives the services or anybody from the county that has to administer this, because all that it's doing is a duplication of service and there is absolutely for the most of us that receive PCA services and who are on these programs, it's a duplication of services. So, you guys totally struck out on that. Because for people like myself and Addyson and Jillian and whoever else is on here with a disability, we have to go through this. If we're on waivers, we have to go through three consultations. We have to go through one with our county manager with our, with our case manager, and then with the CFSS case manager, so. Yeah, you, you, you guys, you guys struck out on that one, that's for sure. So, I think I agree with like what Anna said is that this came up in three this came up in all three discussions and I mean and it was what was the purpose for adding it because of the program worked just fine for 35 years. Before this was added so it was, it was in the step that someone, someone sitting in an office had an idea at somewhere, somewhere, didn't run it through the proper channels. It got adopted and here it is. So, you just made the comp you, you just made, whoever did it just made the process more complicated for everybody in the state of Minnesota. So, congratulations on striking out on that.
Michele Craig: We have two comments on online 1st and then we can do one more in the room and then I think we're going to need to move on to the next items. So online, let's start with Addyson then Richard. Then we'll do Jennifer in. The room. So, Addyson, Rick.
Addyson Carpenter: I just want to echo. I just want to echo what Jay said like it is very even when I because we had to redo my entire MNchoice and are restarting my plan that it is very much duplicative as well as we, I had both our county supervisor for all of our waivers for our county as well as my county case worker here earlier this week. And like Jay said like even they were saying how duplicative that is, for those of us that are on waivers, especially because pretty much all of the information that goes from the CFSS document is also in our like service plan or our MNchoice assessment, whatever document we get from the from the county that they have to type up anyways. So, I feel like it would be much less expensive versus them paying like for Lydia and I alone, it's $1200 that we're paying every year for absolutely nothing.
Michele Craig: Rick.
Rick Varco: I won't belabor my comments and I'll have more of them when we actually vote on this, but I was not surprised too much that this came back as budget neutral. While these services may be duplicative for some people, they are not for others. And I think one of the things to note is that they are likely for the people who are they, they are the most duplicative for the savings, are likely to be the least because they have the least need for them. And so, you know, I'll comment later when we vote, but I just would say I'm not entirely surprised by the fact that this comes up as budget neutral. The forecasting has to get done at some point because it is important for people to know their options.
Michele Craig: Thank you. And we'll do one final comment in the room with Jennifer and then Jay, we'll come back to you once we get through the other ones if we have time, but we need to get through the other ones too. So, Jennifer, can you provide the final comment?
Jennifer Giesen: I just wanted to emphasize that that the move from PCA to CFSS did become much more complicated for some clients of ours who's not receiving waivered services that you can now choose from the budget versus an agency model which is much more like CDCS it expanded the services that people can get. And I think it if they had nobody providing any consultation or assistance to them, it would be very difficult for many of our clients to manage that switch and have a CFSS sort of plan of services that effectively met their needs and for them to really, truly be able to understand their choices. So, my concern would just be for people who are on, like, fee for service. What would the what would the replacement, how would they get that consultation if CFSS, if the consultation services went away for them? I think people on waivers who have you know, case management people on managed care do have the health plan services available to them. So, it's the fee for service population that I would really worry about having a very difficult time managing that, especially if they are new to the program.
Michele Craig: Thank you. We're getting to about 15-16 minutes, so Colin. If you give a few more to present and then we can come back.
Colin Stemper: Sounds good. So, moving to the next slide, this is the first of two analysis related to transitioning people from the brain injury and CADI waiver to the elderly waiver, so this option requires a transition unless a person is using customized living services for community residential services. The request from the Council was also to add night supervision or the services of night supervision and employment services to the elderly waiver. This is not included in this estimate. We need a few more conversations about how the rate setting for those services would work on the elderly waiver before we can exactly price that, but we wanted to share with you what we have ready today, so this proposal or this idea would say about 20 to $25 million over the fiscal year 28-29 biennium. You know, once we sort out those ideas with night supervision and employment services, adding those services to the elderly waiver would reduce the savings that we see here, so I just want to note that and this is kind of what it would be without adding those services, so happy to take any questions on this one.
Michele Craig: We have two hands up online here. Alex, then Rick.
Alex Kotze: Thank you. I'm a little surprised at the low number because we've asked for this in the past in a different group I've been on and it was much larger and I know it wasn't a full fiscal note. But is there something different than what you all have looked at in the past? Is it the CRS? I'm just surprised because previously I saw something. Well, upwards of like 80 to $100 million over a biennial, I'm just surprised.
Colin Stemper: Yeah. Not to spoil a surprise or anything, but the next the next analysis will show numbers much closer to what you were previously familiar.
Alex Kotze: OK. OK. Thank you.
Michele Craig: Rick.
Rick Varco: I haven't followed this proposal closely, and so can you just give me a sort of rough guide to how it saves money? Is that fewer people use the program, they get fewer services or they're paid a lower rates? And then I think my biggest question is. If somebody is getting PCA services under the BI or CADI waiver, would they still be eligible for the same level of services under the elderly waiver?
Colin Stemper: So generally, 2 things are driving savings in this. First, you know for comparable services, payment rates are generally lower on the elderly waiver than they are on disability waiver programs. So that's a piece of it. The elderly waiver also has case mix budget caps that control spending as well, so that also provides some cost containment compared to this other waivers and in terms of PCA, you know if a person is eligible. For PCA on and BI and CADI, they would continue to be on EW, but those the cost of those services would have to fit within the budget cap and that program.
Rick Varco: OK, I think I understand.
Michele Craig: Great. Alex, do you have another comment or is your hand still up?
Alex Kotze: Oh, no, sorry. I'll take it down.
Michele Craig: Addyson?
Addyson Carpenter: I am just curious because this has come up with waiver reimagine and stuff as well. Would we, would we be running into issues with Olmsted and the Jensen settlement and those if only people on the BI or CADI are able to stay on their those waivers? Being that it's decided based off of where somebody lives and not like not the most integrated setting. I don't know who might have an answer for that. I just wanted to make sure it was brought up.
Colin Stemper: This is Colin. And I was going to make a disclaimer that I'm not a lawyer and so I'm not going to answer that question, but if anyone else has thoughts, lawyer or not they're very welcome.
Sherry Gustafson: Are you talking about Waiver Reimagine Addyson?
Addyson Carpenter: No, for if we, because the proposal is to transition only individuals that are on living in CRS or customized living which are not like the most integrated setting. So, for like this proposal would we run into issues with like the Jensen settlement and Olmsted and all of the legal precedents of the most integrated setting, because it's only the people that are living in group homes that that those people would be allowed to stay on BI and CADI. But if you don't live in those it would cut the funding and access to services.
Sherry Gustafson: But they would still be able to get services in their home on the other hand, right?
Addyson Carpenter: Yeah, but you would have access to less money, so I don't like, I don't know what the answer to this is. I just know with Waiver Reimagine it's been brought up because the funding if you live in the community is less than the funding for if you live in a group. And I know that that there has been, it has been said that by attorneys and people who are very involved in the have been very involved in in judge and settlement and all of those that that is going to be if Waiver Reimagine is implemented then that is going to go to court.
Sherry Gustafson: We think that community services are less expensive than if you are in, you know, place somewhere in a residential setting or assisted living. Usually, it is less expensive in the community.
Michele Craig: This is Michele. If I could jump in really quickly to the hand in the room, Genevieve.
Genevieve Gaborialut: Yeah. Hi, this is Genevieve. I was on the workgroup- at least one of them that was talking about this and I think our goal was compared to the next slide which forces everyone to go on to the elderly waiver at certain age. This was to preserve as many people being able to have more choice and be able to either stay in their personal home or staying in CRS or customized living with assisted living and not have a different rate cap affect them by being put on the elderly waiver. So I think this was intending this. This sliding was intending to prevent future cost increases but given the current folks that are could be on with choices. So, I hear what you're saying. And I, you know, I think that's worth. With the concern, but I think we were kind of tailoring this to be to try to find a cost savings where we don't want to have any cuts.
Michele Craig: Thank you. This is Michele. I'm going to move us forward; we’re about 10 minutes behind. So, we'll come back to this if people have more comments or if you want to send them to me, we can go by. I think one quick take away is obviously we there's some requests for more impact analysis which we'll take note of. But Colin, turning it back over to you for the remaining 10 minutes to talk about the final items.
Slide 23
Michele Craig: Yeah, we’ll go to the next slide. So, this is the second version of the analysis, so pretty similar. This one requires everyone to transition for people who are currently over 65, and all people who become 65, who are currently on BI and CADI. Those folks would transition to the elderly waiver. This option would also not add new services and this assumes an effective date of January 1st of 2028 and the biennial savings for this proposal is between 100 and 105 million. So that's it. Any questions? Anna, I know you had your hand up before I moved us on. Do you? Would you like to raise your comment or question now?
Anna Hegland: I guess my question was just whether or not the analysis took into consideration people who maybe started needing 24 hour care facility level care after already transitioning. Does it allow for people to move back to CADI?
Colin Stemper: It would not.
Anna Hegland: But isn't there a current mechanism right now to move back to CADI once you're on EW based on needs? So, what you're saying this is supersede that?
Rachel Shands, DHS: This is Rachel from DHS. So yes, right now the policy is you can stay on after age 65 if you've been on BI or CADI or if you switch to EW, you can switch back to CADI or BI. If you were on it before age 60. So, I think we're interpreting this proposal to get rid of that flexibility and say once you're 65 or older, you're on EW and removing that flexibility.
Michele Craig: All right. We have one comment online. So, let's give one more comment on this. Before we go into, the final one that Colin has. So Pat Wright online.
Pat Wright: Yeah. Yeah, thanks at rate. Yeah, this is probably a unique point, but I feel like I need to at least put it out there. So, I'm currently on CADI and was given the choice when I turned 65 to go on elderly, but in talking to my case manager it didn't really make sense. I'm for one thing; I would lose her because I would have to belong to an HMO for my case management and then also the other thing I just decided to call the assessor that did my assessment last fall and see what the budget would be and it was going to be triple what it is now on CADI. So, I don't know how many people that might be affecting, but I don't think we can say it's clear across the board and going to be all these savings for everybody. So that's my comment. Thank you.
Michele Craig: Thank you, Pat. Let's see, we have about 7 minutes, so I'm calling. We're going to go back to Colin for the finish this presentation and then we'll come back for any remaining comments going forward.
Slide 24:
Colin Stemper: Sure. So, I have two slides left, this one and we can go through and in almost no time at all. So, during our last Council meeting, we had requested the estimate for repeal of the long term services and supports loan program. The 2026 legislature repealed that program and did not update the target, so there there's no money left in in that account, so that that's $0.00. So just wanted to follow up because we had said we would spend time on that one. So, we can move to the next slide.
Slide 25:
Colin Stemper: So, we know that we're going to be talking through some nursing facility items a little bit later today and we will work on producing estimates for those if the Council would like and just you know, we had some range of savings options. Which no one's voted on, so we're not locking anyone into these numbers, of course, so depending on the Council selection of the TEFRA and WD options, we've identified between $40 and $180 million in savings. So that's kind of where we're at. And of course, we'll price those nursing facility items and any others that the work groups identify in the coming month or so. That's what I have for you. Thank you so much.
Slide 26:
Michele Craig: Thank you, Colin. All right, we have 5 minutes before break. So real quick. I want to come back to a couple of things. I believe, Jay, you had your hand up before I had to move us on. So, I want to come back to see if you had any final thoughts before we go to break. And then also Sherry made a comment in the chat that said, Oh my gosh. Pardon my pronunciation, here it's Itasca County. How do you pronounce it?
Colin Stemper: Itasca.
Michele Craig: Thank you, Itasca County, excuse me, has a social worker assigned to assist a CFSS only clients with their plan. So, I just wanted to read that comment for folks here in the room and then Jay if you wanted. To say anything before we go to break.
Jay Johnson: No, I want get together with Addison and Jillian and see if we can come up with something that would make sense to discuss in the future. I don't have anything to say.
Michele Craig: Thank you very much. Well, anyone else before we move to break? All right, I am not. Oh, Pat your hand is up. But I'm thinking maybe it's still up from your comment, right. I think that's the case. I'm going to go ahead and move us to breaks. No problem. Everybody enjoy a little over 10 minute break here. We'll see you at 2:40 to reconvene. For members of the public, we are going to enable the chat function now for anyone who would like to sign up to provide public comment at the end of this meeting at 4:30. So thank you all. And we'll see you back in a little bit.
Slide 27:
Michele Craig: So, the remainder of this meeting is really going to be focused on the first round recommendation rating voting. We will talk through the process a little bit before we get into the actual voting. However, before we launch into that, Colin did some research or called a friend. During the break and has some follow up information for you on the total LTSS cost savings. So, Colin, I'll turn it over to you.
Colin Stemper: Yeah. This was following up on the request from the start of the meeting about how much LTSS funding was reduced. During the 2026 session, and so I'm looking at the 2028-2029 by any because that's the target that we have hit and it's just a hair over $306 million. There's your number for the folks who asked.
Michele Craig: Thank you. I got thumbs up seeing a thumbs up online. Anything else before we kind of dive into what this voting is going to look like? All right, next slide please, Audrey.
Slide 28
Michele Craig: So, this will be the first voting on recommendation that you all have done as a Council of things you want to go over here. We will pause to see what questions you have. So first I'd like to say we'll conduct the voting procedure in adherence with your Council charter that states Council members will vote on each recommendation to determine which recommendations are included in the legislative report. Recommendations that receive a majority yes vote will be included in that. And as the votes taken by each Council member will be included as well. Today's voting is first round voting, so this is really just to provide an indication of Council is initial preference for recommendations to include in the report. This isn't final - the final vote on what to include will be in the August meeting. Again, knowing that there is still a lot of impact analysis and fiscal analysis that has to be done on the recommendations and potentially some new recommendations that may surface. Today is just to kind of gauge where everybody is at with their preferences on these recommendations. So, I'm going to talk about the procedure and then I'm going to pause for questions. So, for each of the seven recommendations that are being brought for vote today for each of them, the following will happen in order. I will provide a one-minute description of the recommendation. Then we'll have one three-minute period for a council member to provide a voluntary statement of support. And one three-minute period up to three-minute period. It doesn't have- you don't have to fill the whole 3 minute, but up to three minute for a council member to provide a statement of dissent. Again, voluntary. We'll call on the basically first person to indicate by raising their hand that they'd like to provide that statement.
If no one volunteers to or wants to provide a statement of support or dissent we’ll just move directly to the vote, then I'll call on each member, similar to how we vote for the adoption of the minutes. I’ll call on each of you to say yes or no, say yes or no and alphabetical order by first name. And then we'll be recording those votes in the meeting minutes. Alright questions. I can see this.
Rick Varco: Uh, you say you have to vote yes or no? Is abstain or something less than like a maybe rather than yes are those allowable votes.
Michele Craig: Thank you. That's a great question. The chair is shaking his head. So maybe or abstain is acceptable status. Anna in the room?
Anna Hegland: I think my question is similar, there are a lot of things in here that we’re, you know, loosely recommending that I'm not in favor of, but there are definitely things that I think we can continue to vet. So, in those cases, I would say yes, right, but that doesn't necessarily indicate that I like the idea and want it to be in the final report. If we vote no on something or majority says no to something, does that mean we will no longer vet it? It will be off the table. It won't be at town halls. I just want to make sure. We know what happens.
Colin Stemper: Yeah. So, to be upfront, we'll still go through the alphabetical order. I'm going to be voting yes on everything today because that it feels like that keeps a lot of options alive. It gets input from people in the town halls. We're going to fully vet them. I may not vote yes on everything once we get to the actual voting in August, but I'm going to keep everything moving today. My understanding and PCG can correct me if I'm wrong. If majority no vote on an idea today, then we will not be including it in the town halls and we'll kind of be ending discussion about that idea at this point.
Michele Craig: Yes, I think there was some consideration that maybe especially for those things that maybe were even that they would move those forward. But I think if it comes out as a very clear majority, no, but I think that will be something to be taken off.
Jillian Nelson: This is Jillian. I'm sorry. I don't have the ability to raise my hand. I'm on my phone and this is my office at the moment. Can I make a suggestion that rather than a Yes/No. Or maybe vote? Maybe we do a scale vote. Like from a scale of 1 to 10. Like 10 being yes, I absolutely support this. One being no, I think this is the worst idea ever. And then adding those all together, averaging them out, and then each idea has a score. And that gives us some idea of overall where we are fitting, not just in terms of yes or no, because yes or no is really black and white and maybe is really black and white. So like, if I'm just a little bit like I have a little bit of concern, I want to look at the numbers more I might be an 8. But. If it's something where I really don't necessarily think this is morally right, but also I recognize that something we might have to do, maybe it's a six. So, it kind of gives us some idea of where we're all sitting, feeling wise and comfort wise with them, rather than just that black and white, yes or no.
Michele Craig: Thank you, Jillian. Colin?
Colin Stemper: Yeah, thanks for the suggestion, Jillian. And I think you know one thing, we hope. Is that we can all leave the meeting today to know which ideas are moving forward and I would just worry about having to go back and tabulate a range. So maybe you know. Yes, no. Maybe could kind of function like a 123 scale for approval and you know like I was noting I'm not necessarily in support of everything that we're going to be voting on but this this is mostly just to continue the analysis and conversation and get public input too on this.
Jillian Nelson: I mean, I guess. I guess that like the comment that you not necessarily in support of everything, but you're just going to vote yes to move things forward doesn't actually move things forward, it just rubber stamps something which to be completely honest, just rubber stamping crap at DHS is how we've gotten to the point that we've gotten now. Like, I mean, I don't necessarily think it's going to be that big of a trial. I mean, I think even someone on this committee could volunteer to add things up and tabulate them as we go, because finding the average number or something isn't and like, I mean, cause if this is what we're going to do, then I'm just going to vote maybe on everything which that also doesn't necessarily give us any real data about what we should forward with. It gives us a very watered down, very unresponsive or like unrealistic data, and I mean we've gotten here because we've used stupid data and stupid systems to make choices for the disability community. We need to do something smarter than what we've previously been doing if we're going to make changes that are going to significantly impact this community. And I say that as someone whose life literally depends on us getting this right.
Michele Craig: Thank you, Jillian. I really appreciate that perspective. I think for today where we're at and on and Colin let me know if you're not on board with this. I think a rating idea, a rating system is a good idea. We've not previously like laid that out as to like what should be for consistency about what one through 10 will do for everybody. So, I think for today. The best course to proceed again, knowing that there is still a lot of information to be gathered, there's still a lot of refining discussions to be doing on these recommendations for today. It will be a yes, no, maybe, or abstain vote. And I think that will be the best.
Jillian Nelson: I mean, if we're, we are making such watered down votes where we have the option of yes, no, maybe or abstain, why are we bothering voting at all? Why are we not just moving forward with everything? Because this isn't actually providing us with any information. And all this is doing is wasting valuable work time.
Michele Craig Yeah. Thank you, Jillian I respect your perspective. I think we do have it laid out today to do the vote and I think once we give all the members a chance to vote, we'll actually be able to see where people are at and get that information. And we'll note the perspective that you've provided as well. We appreciate that. But I think in interest of time and this is what we laid out for the agenda, we'll proceed with the voting.
Jillian Nelson: Can I ask if anyone from the committee- who was involved from the committee in making the choice of what our voting procedure was, was it anyone from the committee or was it just the organization who facilitates this?
Michele Craig: Colin?
Colin Stemper: Yeah, I think our voting procedure is laid out in the Charter.
Jillian Nelson: I mean, our voting procedure for how we take a vote is laid out in the Charter, the procedure for deciding what our voting system is to rank things is not laid out in the Charter. I've read the charter. So, what I'm asking here is, did a company who has no vested interest in the outcome of the disability community make the decision on how we're going to rank these and decide what to move forward? Or did the committee that was legislatively appointed to make decisions on this make that decision? Because if the committee did not make the decision, I would like the committee to decide whether or not we're going to use a watered down vote of yes, no or maybe, or if our committee is more interested in actually ranking these in a way that gives us some data of where we are sitting on, what to move forward.
Michele Craig: Lisa.
Lisa Vala: Yes, I just want to say that a weighted vote for each item would provide more information than the system that has been set forth, so I know it's a change in what is on the agenda, but I believe it probably would be a better metric for deciding what we're doing.
Genevieve Gaboriault: This is this is Genevieve, and I just propose we go for yes/no. And I didn't even know maybe was on the table. Just I just. I've done a lot of ranked scoring and we need to have that set ahead of time. I think since today it's just a winging of sorts. Let's just move forward.
Jillian Nelson: I mean, like I, I'm still going to continue to say I think this is a waste of time then if we are using a watered down system that was selected for this Council by an outside entity. And like, can we bring it to a vote for the Council on what we want to do if we want to have a weighted score that gives us real input or if we want to do this stupid yes, no or maybe because I mean, we've already had people say that they're just going to vote yes on everything and someone else me saying that they're just going to vote, maybe because this isn't something that is giving us real data. The reality is, is lack of data is a form of discrimination. And that lack of data is why people with disabilities are dying, and why our services are being cut left and right. Because we have not kept data because we have not made decisions based on data because we have done stupid things and that is why we are in this situation. So maybe we stop doing things in the easiest way. The way that was decided by some outside entity, the way that we might be possibly less problematic. Let's just do things that actually have merit and can actually give us value because doing things the simple way is why people with disabilities are dying. Literally as we speak, people are going without services because this is how decisions have been made in this community. And I for one am tired of it.
Michele Craig: Thank you, Jillian. Alex, you have your hand up.
Alex Kotze: I just want to clarify that we are voting to move things forward for a final vote in August, so we could consider a different way of voting for August based on what Jillian has brought forward. Is that accurate? Like we're just trying to keep things on the table or not, is that correct?
Michele Craig: Yes, that is correct.
Alex Kotze: Can I ask why we have a vote of maybe then?
Michele Craig: Yes, thank you. We'll come back. We'll come right back to that, Alex. I think Anna a hand too. I don't know if you were responding to what Alex said or not.
Anna Hegland: My interpretation is that a yes vote means we want to seek public opinion or and or that we need more information from DHS before we eliminated from consideration. A no vote means let's not waste time on this anymore. We're all done with it. We're not going to seek opinion. We're not going to ask DHS anymore questions. That's kind of how I'm considering the vote today. I definitely understand all of the different complexities that need to go into the final vote, and I definitely think it's worth having more consideration about how we do that piece. Just want to make sure that I'm on the right path in terms of what we're voting on today. It's- we're all done or it's staying on the table and we're sitting in a page or fiscal analysis.
Michele Craig: Yes, that is correct and anyone else feel free to jump in. I think that the maybe was at the suggestion of some members of the Council today as a little bit of a way to say medium understanding that maybe the way this is this is set up still needs some work and to Anna’s point, something that we could continue to look at, perhaps getting some work feedback on and doing differently for the August meeting, but I do want to pause I don't see, before I go to the question, I want to see Colin as chair there. Should we move the vote on the way we're voting? Or would we like to proceed with a larger group with the group like to proceed with voting yes or no, essentially.
Colin Stemper: I'm seeing some head nods of no in the room, in terms of voting on voting. So. Let's proceed.
Michele Craig: All right. I think we do have one more comment or one hand raised and then I think we'll proceed with the agenda, Taryl.
Tarryl Clark: Mine is a question. I put it in the chat that I know we started talking about other things. Are we only voting on items for which it's been determined there would be fiscal state savings or that we don't yet have that information? There was one. I know there's strong feelings on probably moving it forward and. Not moving it forward to the fiscal note came back Colin, given our Charter is to find savings, are we voting on that one?
Colin Stemper: Yep, this is Colin. We will be voting, we will be voting on that one as well as the nursing facility ones. We don't have savings on yet again to keep them moving, keep the conversation going, get town hall input on and we'll produce savings. Or produced estimates for those ones at a later date as well. So. The neutral ones and the ones we don't have savings for yet will be included in voting.
Tarryl Clark: So is your thought then that you'd keep looking to see if there were savings because we had other things we talked about that just didn't have savings. So, we haven't brought them to you all.
Colin Stemper: Yeah, you know it's kind of up to the Council if you all want to continue exploring and recommend or recommend that one, regardless of saving status, we just kind of need an official decision because it's been brought here on whether you want to continue moving it forward or not?
Tarryl Clark: So, does that mean, I'm sorry to belabor it, does that mean we're going to be able to get physical information from DHS prior to any other ones coming here, because we just didn't have that information or we it would have impacted what came to you most likely?
Colin Stemper: Yeah, before, before we take final votes in August, we will absolutely have fiscal information for everything we're talking about.
Tarryl Clark: Thank you. I appreciate this is hard.
Jillian Nelson: So, wait, I think I'm understanding Tarryl’s question differently than I think you are. What I'm hearing Tarryl say is that there are options that their work group came up with that we did not have fiscal information with prior to this meeting. So those things did not come to this meeting. And so, if we they're not in this meeting, we're not voting on whether or not to move forward with them. So, are those things just completely just excluded now because?
Tarryl Clark: So, Jillian, just to confirm, there were things that we were told there was neutral, so we didn't bring them forward. That's what I was trying to say. Colin was saying that one of these, and I feel pretty neutral about it at the moment, there's pros and cons, so but one of the things that we found out today and of course somebody's out weed whacking right outside my window sorry, was that it was neutral right our group because of the definition is we have to find savings. We likely wouldn't have moved it forward whether there had been, you know, frustration with that. Now it sounds like this is the way it is for today and that's fine. But I just wanted to clarify that there were other things that were neutral that we didn't bring forward because we were told they were neutral savings.
Michele Craig: This is Michele and I'll just add that all of those items are not lost. We have them all in record, we have them in notes, we have them on a list. So, if there are things the work groups, those ideas, work groups want to resurrect and talk about again, that's there. Nothing has gone away. This is just what discussions have moved forward for the vote today, based on your July work group discussions. OK, Jay, your hand is up. So, if you'd like to make a comment and then if there's nothing else, then we can proceed with moving through the recommendations. So, Jay?
Jay Johnson: I'm going to. Yeah, I'm going to take this back to the CFSS consultation thing because it's one of the things that they said was neutral, I guess. I would like to see what the budget is for that. We didn't see any numbers on it. We just we just got a statement. So, something to me it doesn't pass the sniff test. I'd like to see what the numbers are, what we're actually spending on the CFSS, and the CFSS Consultation services portion of the program.
Michele Craig: Thank you, Jay, we’ve got that noted. Alright. Anything else? Are we good to move on? OK, next slide please.
Slide 30
Michele Craig: OK, so for each recommendation you will see two slides. There is the first slide is where we'll talk about just a brief description of the impact that has been talked about thus far, knowing that there is more impact analysis needed for most of these recommendations, including the impact on people receiving service. Providers, families. But those are that's information that we're really looking to continue to gather through the town hall meetings and the feedback there. So, note that's the case for each of these recommendations. So, the first recommendation for today is the elimination of the CFSS Consultation services. We've had quite a bit of discussion about this. I will recap with this this is it is to eliminate the consultation services as it is, as it may be duplicative in nature with case management. The idea will require legislative and federal approval, and it may change how people access or receive CFSS as some people, as has been talked about today don't have a case manager and often relies on that consultation service for some system or service navigation. Wanted to note that this recommendation was also a theme in the feedback that we received through the community partner survey a couple months ago. Next slide please.
Audrey Davis Sorry about that, Michele. There's some technical issues I'm sharing my screen one more time
Michele Craig: OK. Thank you. All right. Thank you. So, moving on to slide two of two consultation or elimination of CF business consultation services. So, the first thing we have here is there one Council member who would like to provide a statement in support of this recommendation. If so, please raise your hands.
Jillian Nelson: Can you tell us what recommendation it is?
Michele Craig: Yes, it's the idea to eliminate the CFSS consultation service.
Sherry Gustafson: Clarification. So, the previous conversation we said a vote for yes is moving something forward, a vote for no would be we're not going to waste any more time on it. So, I wanted to make sure we clarify what a yes and a no vote means on this one here based on this.
Michele Craig: Can you repeat the question I'm sorry.
Sherry Gustafson: This is Sherry. I just previous, yes, previous conversations we talked about voting yes would be moving things forward. No means we're not wasting any more time on it. And then this the way that this is worded, I want to make sure that we are answering. In the intended way, yes or no. Would you know? I don't want it to be confusing.
Michele Craig: Do you mean that where it says statement of support and statement of dissent or?
Sherry Gustafson: Could you just clarify what a yes or a no, what would mean in this situation.
Michele Craig: OK, I think for all of the recommendations, a yes, or vote means to continue to move it forward for further impact analysis and then a no vote is don't move it forward for any additional impact analysis and then if there is somebody who wanted to vote abstain. Or maybe those? This would. Abstain obviously wouldn't apply and maybe would continue to move forward for analysis. Did that answer your question?
Sherry Gustafson: Sure. Thank you.
Michele Craig: All right. So, I believe for this recommendation to eliminate CFSS consultation service to provide a statement of support. Jay, you raised your hand, but would you like to provide that statement?
Jay Johnson: Yeah, I support eliminating the consultation services, I also support getting the getting the numbers on it since we don't have numbers from other things, I support getting the numbers for this.
Michele Craig: All right. Is there a Council member who would like to provide a statement of dissent? Raise your hand. And I see Rick. 3 minutes.
Rick Varco: Yeah, I won't take up the three minutes. I'll just say that consultation services are a key part of self-determination which is sort of at the core of the States disability policy or should be. And it is a keyway for clients in to figure out whether the agency model or the self-directed option is best for them. I understand that that these consultation services may be redundant for some, there are many people at various levels of navigating this system, but I can tell you in my Union we have a large amount of experience of clients, even those who've gone through case management and consultation services, especially during the transition from PCA to CFSS who did not understand their options, got sort of steered into the agency model and wound up not being able to work with the worker they wanted to or not being able to pay the worker what they wanted to or not being able to control their services the way they wanted to and. Therefore, we would oppose eliminating it.
Michele Craig: Thank you, Rick. And now we're. Going to move on to the vote. OK, we're again. We're going to go in alphabetical order by first name. So, I will start with Addison.
Addyson Carpenter: Yes.
Michele Craig: Thank you, Addyson. Alex?
Alex Kotze: Yes.
Anna Hegland: Yes.
Michele Craig: Barb?
Barb Weckman Brekke: Yes
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Genevieve?
Michele Craig: Jay?
Jay Johnson: Yes.
Michele Craig: Jennifer Ballinger. Don't believe I don't believe she is on. Jennifer Giesen?
Jennifer Giesen: Yes.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: Thank you. Lance? I don't believe Lance is joining us today. Let me check- no. Lisa Antony Thomas. No, she has not joined today. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Thank you. Lori.
Lori Schluttenhofer: Yes.
Michele Craig: And Louella Kaufer is absent. Musab? I don’t believe he’s on. Nicole.
Nicole Hansen: Yes.
Michele Craig: Pat Wright?
Pat Wright: Yes.
Michele Craig: Pat Mecham?
Pat Mecham: Yes.
Michele Craig: Rick.
Rick Varco: No.
Michele Craig: Roxanne?
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes.
Michele Craig: Sherry Gustafson?
Sherry Gustafson: Yes to move forward I would prefer a modified plan.
Michele Craig: Thank you. Tarryl?
Tarryl Clark: Yes, to move forward.
Michele Craig: And Zahnia. And I don't believe Zahnia is on.
Michele Craig: All right. Thank you all. So that did you all hear Jeremy as he read the votes?
Jeremy Thomas (PCG): 19 yeses, one no, and six absent.
Council Member: Can we get? I know on a regular here this, but I mean can we get a more clear fiscal note like carve out people who don't have access to managed case managers or county case managers maybe where it's not?
Colin Stemper: Yeah, absolutely. And that's part of the purpose of moving these forward is to get more information, absolutely.
Barb Weckman Brekke: I thank you for that. I think that's a good point because if we weren't going to move one forward, it would be this because they we said there's no cost impact, but I think we're saying we don't believe that. Can you, can you persuade us that that's true is that?
Michele Craig: Thank you. And that was Barb, you're in the room. Sorry.
Slide 32:
Michele Craig: All right, let's move forward to the next recommendation. So this recommendation is a reinstatement of the TEFRA fees so we've discussed this, we've discussed this one as well earlier in the meeting, but this proposal reinstates the TEFRA fees for families with incomes over 675% of the federal poverty guidelines for medical assistance (MA) under the tax equity and Fiscal Responsibility Act of 1982. Legislative and federal approval is required for its implementation, estimated that the proposal would affect approximately 4.3% of people receiving MA under the TEFRA Option. You discussed in the in the work groups too that there may be a decrease in MA and with the community based services utilization as fewer families might access services or get services elsewhere. And we discussed earlier in the presentation there are levels of fiscal impact here and the work group discussing or, the two work groups actually discussing this idea have not had a chance to really discuss those levels and which of that they would want to include? So, for today's vote, this is to move this general idea moving forward for further analysis, knowing that in the July Work Group meetings that the work group work groups discussing this idea will then take a closer look at those fiscal impact or the fiscal impact presented today to determine which of those that they would want to include in the final recommendation for final vote. Next slide please.
Slide 33:
Michele Craig: So similar to the other, the previous recommendation, is there a Council member who would like to volunteer to provide, provide a statement of support for this recommendation? Jillian, I see your hand up. Do you want to provide that?
Jillian Nelson: Yes. I do. Let me turn my camera on. This is a wildly complicated one for me to support, but I do very, very strongly support this. I was actually part of the team that worked on ending TEFRA fees, but we have reached a very, very fine line where we are having to make choices that are going to either cut supports from all people or we can bring back some fiscal responsibility for those who have access to significant resources. If you do the math for 675% of the federal poverty guideline, it is $184,000 for a family of three. That is a significant amount of money to be making. That is amount of money where you should be able to contribute to that. Additionally, since we have removed the TEFRA fees in parenting groups, I have seen an increase of parents who are at those higher income Levels making choices like, well, we don't necessarily need services and supports. I was a stay at home mom already, so we've just chosen to do all paid parent and we're putting that into investments or we're able to take this vacation because of that. And I think if we're going to be doing this work from a disability justice lens. We need to make sure that we are not taking away services from people that do not have the resources to fill in the gaps when those services are removed from their Medicaid options while allowing individuals who do have access to resources to provide for themselves to continue to access those resources at no fee and no buy in, while it's harming people who do not have that same level of privilege.
Michele Craig: Thank you, Jillian, for that statement. Is there a Council member who would like to provide a statement of dissent? I am not hearing or seeing anyone in person in the room, so I think we will then move forward for the vote, yes or no to continue with this recommendation. So, we'll start with, oh, I'm sorry. Jay, you raised your hand.
Jay Johnson: Yes. And I didn't quite understand. So, a statement of dissent. Does that mean? And that was and I don't know if I fully understand what Jillian was, what Jillian's point was, but was Jillian saying that perhaps 675% is too high? And perhaps we should consider? You know lowering that or is this?
Jillian Nelson: No to clarify that I'm saying that if you were at 675% of the federal poverty guidelines in your family income, you have the means to help pay for your services and supports through TEFRA fees.
Jay Johnson: So, if we move this forward, then we still get 675% or would we could, could we lower that to and I can't, I'm not looking at what the other two options were in the past but. So that's my question here.
Jillian Nelson: Can I ask why you would want to lower it? Because then it would be people with lower incomes paying TEFRA fees. The higher the percent, the more the person the families making.
Jay Johnson: Sure. So, so, so what's so I guess my, my question is what's the threshold if it's at 500, if it was 500% you know what's that number, I mean what you know what's that, federal poverty guideline number? That we're multiplying.
Jillian Nelson: I have them right here. So, for a one person family. The federal poverty guideline is 15,960 for two it's 21,640. For three it's 27,320. So, the number I typically will use in discussing this is that 675% for a family of three, that's 184,410. If we were to lower that to say 500, that would be 136,600.
Jay Johnson: What's your multiple on that, Jillian, it's 27,000 * 6.75.
JillianNelson:6.75
Jay Johnson: And that comes to what?
Jillian Nelson:184,410.
Jay Johnson: So, what if it what if it was? If it was 500%.
Jillian Nelson: If it's 500%, it comes to about 136,000, which I think there that $50,000 difference between 136 and 184 is a significant difference between having a comfortable life and having excess resources to be able to contribute. I mean I do want to also realistically take into place that I don't want to thrust families with children with disabilities into poverty. I think the forced poverty nuance of living with disability is crap. But like, so looking at like the average cost of living in Minnesota and like, where is a comfortable level to be considered middle class and where is a comfortable level to be considered to have those resources, I think I think 675, that's what the governor's office proposed. And I think it's very reasonable.
Jay Johnson: You say you don't think it should be lower.
Jillian Nelson: I don't think it should be lower.
Jay Johnson: I think we should discuss it.
Alex Kotze: I agree with you, Jay. I can I clarify because the question on the table from Jay, if I'm understanding Michele, could you clarify when you introduced this item, you said we're voting on the 675, but the other items would stay on the table and we could continue to discuss all options between the 275, the 545 and the 675 that Colin presented earlier.
Michele Craig: Yes, that is correct since those. Those estimates are going to. Yeah. So, they need to be further discussed.
Jay Johnson: I don't have a statement of dissent then.
Michele Craig: Thank you and thank you for that clarification that I think we will move to the vote then. Addyson?
Addyson Carpenter: Yes.
Michele Craig: Alex?
Alex Kotze: Yes.
Michele Craig: Anna?
Anna Hegland: Yes.
Michele Craig: Barb?
Barb Weckman Brekke: Yes.
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Genevive?
Genevieve Gaboriault: Yes.
Michele Craig: Jay?
Jay Johnson: Yes.
Michele Craig: Jennifer Ballinger, I'm still seeing as absent. Jennifer Giesen?
Jennifer Giesen: Yes.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: I believe that Lance is still absent. Lisa Antony-Thomas is not here. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Lori?
Lori Schluttenhofer: Yes.
Michele Craig: Louella is absent. Nicole?
Nicole Hansen: Yes.
Michele Craig: Pat Wright?
Pat Wright: Yes.
Michele Craig: Pat Meecham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Abstain.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes.
Michele Craig: Sherry Gustafson?
Sherry Gustafson: Yes.
Michele Craig: Tarryl?
Tarryl Clark: Yes.
Michele Craig: And I believe that Zahnia is not here.
Michele Craig: So yeah, that was fully as far as our votes, except the abstains and the absence of 18, yes. Jeremy?
Jeremy Thomas: 18 yesses, one abstain.
Michele Craig: Thank you. And I see a hand up here before you move on. Jillian, is your still your hand up still from volunteering for the statement of support?
Jillian Nelson: Yes.
Michele Craig: Next slide please.
Slide 34:
Michele Craig: The next recommendation is the requirement for participants age 65 on the BI or CADI waivers to transition to the elderly waiver. Please note with this one similar talked about for TEFRA, there are two versions. So, Well, similar is there. There are different versions of this idea.
Jeremy Thomas: I was looking at the numbers, sorry. I apologize, Roxanne.
Michele Craig:. Oh, Roxanne, I apologize. I missed you for the TEFRA vote.
Roxanne Portner: No, that's OK. I just dropped in the chat. Yes vote for me
Michele Craig: Well, thank you. I apologize for that.
Jeremy Thomas: I just saw it like 18 and 19 are different numbers.
Michele Craig: OK, so moving back to this one, so similarly this recommendation as you've discussed during the fiscal analysis has two versions of this with differing amounts of fiscal impact. So, voting on this recommendation is moving this recommendation forward for further analysis, knowing that in the July workgroup meeting, the work group really needs to discuss further what that fiscal analysis is for those two versions and decide what is the final version. If any, that the work group wants to put forward for the recommendation. So again, this is a vote for this general idea, knowing that there's more specific data. So briefly here, this does require this would require legislative and federal approval that may cause service disruptions for people receiving services when they transition to the elderly waiver. It's anticipated there would be a decrease in CADI and BI participation and an increase in the elderly waiver participation so moving on to the next slide. Is there a member who would like to provide a statement of support? I see your hand. Alex.
Alex Kotze: I'm happy to provide a statement of support. This is one I've been bringing up since. the very beginning, mostly well for a couple of reasons. First, the elderly waiver is designed to serve people over 65, and I think that with such a large target this is an option on the table, particularly more relevant now that the state passed a budget with over $300 million worth of reductions, so we no longer have those on the table. This is the largest item we saw today. And because EW is meant for that population and we have seen, if you look at the data we have seen more and more people stay on CADI waivers. And not move to EW. And we heard today some reasons are because they don't want to change case managers and there are other reasons I think this would have to be- We'd have to really talk about how we would word this to make sure- I don't want anyone to end up in homelessness. I don't want those things to happen, but I do want to leverage the elderly waiver for the group of people it was meant to serve and I no longer think it's doing that. So, I'm definitely a yes vote on this.
Michele Craig: Thank you. Alex, is there a Council member who would like to volunteer to provide a statement of dissent? Jennifer Giesen here in the room.
Jennifer Giesen: I'm not supportive on a supportive of this position with vision. Just because the elderly waiver and the CADI waivers are really designed to serve two different populations and people with disabilities who are over 65 have different needs than just people who are aging without a disability, although many tend to accrue them as they get older, but they are, they are meant to serve different populations, and I believe that this, although they've done much to align the services under the elderly waiver with services under the county waiver, there are still significant differences and I believe that if we that there are people who are under the CADI. They have significant disabilities, many of the have spinal cord injuries and use power wheelchairs, but they don't qualify for a CADI level of service and their needs would definitely not be met by an elderly waiver budget. There are- I'm a big advocate for assistive technology for people with disabilities. The elderly waiver doesn't cover assistive technology the way the CADI waiver does now and I just think that again it's a different population and we would advocate for keeping people who have a disability qualify for the CADI waiver on the CADI waiver even after the age of 65.
Michele Craig: Thank you, Jennifer. And we do have a comment in the chat. I would like to note here for folks in the room and for DHS, I think we'll have this as a takeaway, I think for further analysis from Lisa Vala said as we know, the population is aching and the baby boom bubble is still to come. Has this been considered in the fiscal impact? So, I think that's one we can take back? And Anna do you have a question?
Anna Hegland: I just wanted to clarify, you know, I plan to vote yeah today despite having really significant concerns about this, I strongly oppose moving everyone, but I think it's worth having a conversation. I think AT is a great example of something that wouldn't be accessible. I'm looking forward to getting public input on this. I think, also going to see probably some dissent there. So, I think it's worth moving forward from that perspective and seeing whether or not there are enough carve outs that still get us some savings and don't create harm. I'm not sure if that's considered support or dissent, but I have a very reserved yes, coming today so I just wanted to note that.
Michele Craig: Thank you for that, Anna. All right, before you move to vote, we'll just note, while you were saying that there was a thumbs up and then Alex noted in the chat, the forecast always considers population and aging and good to take that back as well. So thank you for that. Let's move on to the vote for this one, we'll start with Addyson.
Addyson Carpenter: Yes.
Michele Craig: Alex?
Alex Kotze: Yes.
Michele Craig: Anna?
Anna Hegland: Yes.
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Genevieve?
Genevieve Gaboriault: No.
Michele Craig: Jennifer Ballinger? I'm sorry. I just. I just want to make sure each time that someone hasn’t popped? Up miss their vote but I don't. I don't think the other Jennifer is on, so Jennifer Giesen?
Jennifer Giesen: No.
Michele Craig: Jillian?
Jillian Nelson: No.
Michele Craig: Lisa Antony Thomas she hasn’t joined yet. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Lori?
Lori Schulttenhofer: Yes.
Michele Craig: Louella is absent. Looks like Lance is absent still. Nicole?
Tarryl Clark: She may have lost her signal. She was driving.
Michele Craig: Pat Wright?
Pat Wright: No.
Michele Craig: Pat Meacham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Maybe.
Michele Craig: Roxanne?
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes.
Michele Craig: Sherry Gustafson?
Sherry Gustafson: I voted maybe as well because right now people with disabilities have the option to move to EW, and I like that option. But I'm interested in moving it forward if we have more discussion. So neutral.
Michele Craig: Thank you. Zahnia I believe is still absent. Jeremy, can you repeat?
Jeremy Thomas:12 yes, 4 No, 8 absence and two abstains/ maybes.
Tarryl Clark: I didn't get to vote. you can put me down as yes.
Michele Craig: 13 yes, 4 no. 7 absent and two abstain.
Slide 36:
Michele Craig: Thank you. Thank you. Sorry about that, Tarryl. All right, let's on to the next set of recommendations.
Michele Craig: So, this recommendation proposes to eliminate the planned closure rate adjustment, or PCR, a program for nursing. Facilities under PCR, nursing facilities may be paid a rate add-on to incentivize the permanent closure of nursing facility beds and compensate them for bed closures, PCR was implemented before the current cost based reimbursement system value based reimbursement, or PCR, under VR nursing facility providers are reimbursed based on actual costs, including adjustments to reflect increases in fixed costs per day due to increases or decreases in occupancy. Under current law, PCR add-ons are paid in perpetuity until the facility ceases operation, resulting in duplicate payment or for reduced capacity under both ER and PCR. Legislative and federal approval would be required, and because the proposal would decrease overall payment to nursing facilities, there may be an impact to people using these services. And just to note, the next three recommendations are all related. Four are related to nursing facilities and they were these were things that were in the DHS budget that didn't get implemented that the benefits work group picked up and put forward for recommendation. Next slide.
Slide 37:
Michele Craig: Sorry, coming back here. Jay, do you have a question?
Jay Johnson: Yes, a statement of support.
Michele Craig: Thank you. Go ahead with the statement of support.
Jay Johnson: I support eliminating these add-ons. The nursing facilities had an opportunity to join our Council and they decided not to . So, you know, I'm in support of eliminating this.
Michele Craig: Thank you Jay. is there a Council member who would like to provide a statement of dissent? I am not hearing or seeing anyone who wants to provide that statement, so let's move forward to the vote. Addyson?
Addyson Carpenter: Yes.
Michele Craig: Alex?
Alex Kotze: Yes.
Michele Craig: Anna?
Anna Hegland: Yes.
Michele Craig: Barb?
Barb Weckman Brekke: Yes.
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla: Yes.
Michele Craig: Genevieve?
Genevieve Gaboriault :Yes.
Michele Craig: Jay?
Jay Johnson: Yes.
Michele Craig: Jennifer Ballinger is absent. Jennifer Giesen?
Jennifer Giesen: yes.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: Lance is absent. Lisa Antony Thomas is absent. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Lori?
Lori Schluttenhofer: Yes.
Michele Craig: Louella is absent. Musab is absent. Nicole, and she's still may be out of reach here. Pat Wright?
Pat Wright: Yes.
Michele Craig: Pat Mecham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Yes.
Michele Craig: Roxanne?
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes.
Michele Craig: Sherry Gustafson? Sherry, I saw you come up mute, but I don't think I heard anything.
Sherry Gustafson: Yes.
Michele Craig: Thank you. Tarryl?
Tarryl Clark: Yes.
Michele Craig: And Zahnia is absent.
Jeremy Thomas: 19 yeses, 7 absent.
Michele Craig: Thank you. Moving on to the next slide for the next recommendation. This recommendation is to eliminate the performance based incentive payment program or PIPP. PIPP is a competitive program that selects and funds provider initiated projects aimed at improving. Of the quality and efficiency of nursing home care like PCR, a PIPP was implemented at a time when reimbursement rates were not cost based. The program allowed for nursing facilities to pay for additional costs related to these projects. However, under VBR rates are already adjusted to reflect these costs. Therefore, the recommendation proposes the elimination of PIPP as a duplicative payment. Just again, same impacts here, legislative and federal approval would be required because the proposal would decrease overall payment to nursing facilities. There may be an impact of people using this service and their new price. Next slide.
Slide 39:
Michele Craig: So, is there a Council member who would like to provide a statement of support? Jay.
Jay Johnson: I support the elimination of the PIPP. Again, my reasoning is they you know that that group had a chance to get this table on part of this committee and they weren't.
Michele Craig: Thank you, Jay. Is there a member who would like to provide a statement of dissent? Genevieve.
Genevieve Gaboriault: I wasn't at the benefits meeting where we discussed these, but speaking as the ombudsman for long term care, these programs it's a few million dollars and they're really looking at quality indicators of residents use to identify novel ways to support them through incontinence. Behavioral health, It’s a small amount of money that has a good impact for resident quality of life.
Michele Craig: Thank you, Genevieve. All right, let's move to the vote then. Addyson?
Addyson Carpenter: Yes. Oh my gosh, yes, sorry.
Michele Craig: Thank you. Alex?
Alex Kotze: Yes.
Michele Craig: Anna?
Anna Hegland: Yes. So that I can have an opportunity to talk to somebody from the long term care space.
Michele Craig: Thank you. Barb?
Barb Weckman Brekke: Yes.
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Genevieve?
Genevieve Gaboriault: No.
Michele Craig: Jay? Jay, if you said something we didn't hear you.
Jay Johnson: Yes, yes.
Michele Craig: Thank you. Jennifer Ballinger is absent. Jennifer Giesen? I'm sorry.
Jennifer Giesen: I say no.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: Lisa Antony Thomas is absent. Lisa, or Lance Hegland is absent. Lisa Antony Thomas is absent. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Lori?
Lori Schluttenhofer: Yes.
Michele Craig: Louella is absent. Musab is absent. Nicole is absent. Pat Wright?
Pat Wright: Yes.
Michele Craig: Pat Mecham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Yes.
Michele Craig: Roxanne?
Roxanne Portner: No.
Michele Craig: Sherri Pickthorn?
Sheri Pickthorn: Yes.
Michele Craig: Sherry Gustafson?
Sherry Gustafson: Yes.
Michele Craig: Tarryl?
Tarryl Clark: Yes.
Michele Craig: And Zahnia is absent.
Jeremy Thomas: 16 yeses, 3 Nos. 7 absences.
Michele Craig: Thank you. Ee're down to two more recommendations. If we can move to the next slide. So, this recommendation is just to establish a cap on the allowable health insurance cost for nursing facilities at $15,000 per enrollee prior to cost based reimbursement. Prior to cost based reimbursement payment rates established… I really messed up that sentence. I don't know what I'm saying here. In the before times payments and nursing facilities for employee health insurance were included in the operating rates and thus subject to limits. Since VBR removed this reimbursement limit nine years ago, health insurance costs have increased by 69%. Some facilities were self-funded. Insurance plans were reimbursed more than $30,000 per enrollee in the 2024 calendar year. That's more than triple the state contribution in the current plan year for the state employees, so this recommendation as proposes to establish a limit for the cost of nursing facilities may be reimbursed under BPR for employee health insurance. Again, legislative and federal approvals required, and because the proposal would could decrease or decrease on nursing facility payment or at least impact payment to nursing facilities that could impact on people using services, those services and their payments. So next slide please.
Slide 41:
Michele Craig :Is there a council member who would like to provide a statement of support? Jay?
Jay Johnson: I would like to provide a statement of support. The simple fact that There is no members from that group on our Council.
Michele Craig: Thank you, Jay. Is there a member of the Council who would like to provide a statement of dissent?
Genevieve Gaboriault: I have a question about where like which subgroups are saying all of these, is that going to the provider rates or I just have a lot of questions about a lot of these, their payment structure is a lot different and understanding what 15,000 actually means in comparison to other things. I think all those questions are things I will have if we move this forward. So just want to know where those things will be discussed.
Michele Craig: Yes, thank you. That is a great question. And I think a good, a good point of discussion for the Council. So, this was brought forward by the benefits Work group and I believe even in that conversation, they acknowledge should work, group discussion or not. So, I think that's up to you all as Council members and we can put it on the agenda for even all three work groups for July and that's what members would prefer, or if we just like it, benefits and provider rates, it's really up to you. So, I don't know if that's something you want to decide today or if you want to agree to put it on the agenda for all three work groups. And then as we get closer to time and have those. Discussions. That that way nobody gets excluded since these are. Recommendations that are a little outside of what everyone has been discussed. Is there any feedback or preference there?
Genevieve Gaboriault: I don't necessarily care where it goes, I just want to make sure. That. If we're going to move, really all of these things forward that we have the data early. Enough so in July before we get to August, so.
Michele Craig: Thank you for that. Any other questions or comments before we move to vote? Let's proceed with the vote then. Addyson?
Addyson Carpenter: Yes.
Michele Craig: Alex?
Alex Kotze: Yes.
Michele Craig: Anna?
Anna Hegland: Yes.
Michele Craig: Barb?
Barb Weckman Brekke: Yes.
Michele Craig: Colin?
Colin Stemper: Yes.
Michele Craig : Darla?
Darla Thompson: Yes.
Michele Craig: Genevieve?
Genevieve Gaboriault: Yes.
Michele Craig: Jay?
Jay Johnson: Can you hear me?
Michele Craig: Now we can.
Jay Johnson: Yep.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: Jennifer Ballinger is absent. Jennifer Giesen?
Jennifer Giesen: Yes.
Michele Craig :I'm sorry I switched to that.
Michele Craig: Lance, absent. Lisa Thomas is absent. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Louella is absent. Mussab is absent. Nicole is absent. Pat Wright ?
Pat Wright: Yes.
Michele Craig: Pat Mecham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Yes.
Michele Craig: Roxanne?
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes.
Michele Craig: Sherry Gustafson?
Sherry Gustafson: Yes.
Michele Craig: Tarryl?
Tarryl Clark: Yes.
Michele Craig: Zahnia is absent.
Jeremy Thomas: 19 yes and 7 absent.
Michele Craig: Thank you. Let's move to the final recommendation for vote for today. So, this recommendation is around increasing financial incentive essentially to increase quality and nursing facility care, the VBR methodology reimburses based on a providers costs and also ties payment limits to nursing home quality scores and independent evaluation of PBR 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. They concluded that a revised threshold formula is needed for VBR to meet the intended goals of increasing quality for Minnesotans accessing nursing facility care. This recommendation proposes changing the computation 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 rewarding cost efficiencies. And again, this would require legislative and federal approval and decreases the overall payment or could decrease the overall payment to some nursing facilities, which may affect people using the service and their families. Here is there a Council member who would like to provide a statement of support. Alex?
Alex Kotze: I'm happy to do it. I mean, I'm in support of the nursing facility, ones in our work group were packaged together. I think that as we move forward, we should consider reductions in the nursing facility area and this is an. We had that. Has grown exponentially in the forecast and an area that has a lot of money in it. I think it's an opportunity to really have a in depth conversation about where we are spending our money. We've been at this table a lot together and we. Talked a lot. About the long term services side and the and the disability side. And I think this is also an area we should have on the table. So, I'm voting yes for it.
Michele Craig: Thank you, Alex. Is there a Council member who would like to provide a statement of dissent and? Audrey, can we move to the next slide, please?
Slide 42
Michele Craig :And I just realized too there was a comment in the chat here because I've read all that I missed this one. I apologize, Rick; Rick said in the chat care providers and leading age, we're unable to participate because of technical problems. In the statute creating the AC, which I assume you mean Advisory Council. Let's move forward to vote then. If there are no other questions or comments. Addyson?
Addyson Carpenter: Yes.
Michele Craig : Alex?
Alex Kotze: Yes.
Michele Craig: Barb?
Barb Weckman Brekke: Yes.
Michele Craig : Colin?
Colin Stemper: Yes.
Michele Craig: Darla?
Darla Thompson: Yes.
Michele Craig: Genevieve?
Genevieve Gaboriault: I just want more information and I feel really. I guess I'll be maybe if that's all.
Michele Craig: Yes.
Michele Craig: Jennifer Ballinger absent. Jennifer Giesen?
Jennifer Giesen: Maybe as well.
Michele Craig: Jillian?
Jillian Nelson: Yes.
Michele Craig: Lisa Antony Thomas is absent. Lisa Vala?
Lisa Vala: Yes.
Michele Craig: Louella is absent. Musab is absent. Nicole is absent. Pat Wright?
Pat Wright: Yes.
Michele Craig: Pat Mecham?
Pat Mecham: Yes.
Michele Craig: Rick?
Rick Varco: Yes.
Michele Craig: Roxanne.
Roxanne Portner: Yes.
Michele Craig: Sherri Pickthorn?
Sherri Pickthorn: Yes
Michele Craig: Yes, that was right, Sherry, Sherry Gustafson?
Michele Craig: Yes, but I also agree it would be nice for our group. To get more information on number 456 and seven for future use.
Michele Craig: Thank you very much. We will do that. Tarryl?
Tarryl Clark: Yes.
Michele Craig: Zahnia Is absent.
Jeremy Thomas: 17 yeses, 7 absence, and two maybes.
Michele Craig: Thank you. That's the last of the recommendations for today. So based on the vote for today, all of these recommendations will continue to move forward for further discussion in the July work Group, further fiscal analysis on the few where there was a request for that and then impact analysis as well as inclusion, in the town hall meeting, so that we can get more that you can receive more direct feedback from people themselves on the potential impact of these recommendations. So, we're at 3:55, so let's take 5 minutes to wrap up and then we have one person signed up, I believe for public comment. So, if we could please advance to the next slides.
Slide 44
Michele Craig: So again, in the first round, both established the initial level of support among Council members. The second bullet, I think we revised a little bit today, but also all of these did receive either majority, yes, with some maybes and abstains and some absence, but enough to continue just to have the discussion and impact analysis. So, the July work group meetings will have those discussions as well as discuss if there are ideas for new recommendations, because there is still that gap, as was talked about in the fiscal analysis presentation between what's existing now based on recommendations and what the Council target is. And then if there are new recommendations from the July work group meetings will include those for the town hall meeting next slide. As I mentioned, PCG will continue on work on the fiscal analysis. We'll be working on the other analysis as well with DHS input, we'll have the July work group meetings second round, final vote in the August of 2026 Council meeting. And I think we can also if we need to have some discussion of work groups to make sure we come to the to the you all feel comfortable coming to the August meeting, clearly understanding what that voting is going to look like and know and agree with that what that process will be. And those recommendations at that time receiving a majority yes vote unless discussed otherwise, will be included in the final report. All right, next slide please. Questions, comments? Anna? In the room.
Anna Hegland: I just would ask that in the minutes we not call it an initial vote. I think a lot of us have questions still. So, I think if we could just make sure the minutes reflect that we voted on things that we don't want to continue to explore.
Michele Craig: Okay, move forward, is that okay Language. Okay, thank you for that. In the final minutes here, next slide, please. Oh, I'm sorry, Alex. I didn't look at my screen.
Alex Kotze: No, sorry. Michele, can you clarify how or in the future note to us how we're going to vote on different levels or options for these like for TEFRA at the 675 and the 545 and the 275 like I'm unclear how we're voting on those.
Michele Craig: Yes, thank you for that. That will need to be discussed in the work groups that are that raised that recommendation idea to decide in the work groups which level or levels they would like to put forward for the final vote. And so, once that's done, we'll come back for the August meeting, we'll have those very specific levels. Does that answer your question?
Alex Kotze: It does. It feels a little off to me because the work groups are small and so like, I don't know, it's fine. I understand. I'm just if you end up picking a certain level and it can't get votes here. I I'm just concerned about that.
Michele Craig: Thank you for that. And I guess the one thing I would say is I think the work groups, you guys are free to put things on the agenda that you want to. So, if you want to continue to have these discussions and the work groups, we're there to help support you and then we can help have discussions about how to coordinate with the larger. The larger because there are actually 2 worker meetings between now and the August meeting as well. So, I think there's some time for those smaller conversations and to bring them all together. Other questions or comments from Council members?
Pat Mecham: Pat Mitcham. Has there been any advancement on, I know in our provider rates workgroup, we talked about addressing specifically the data. On like the workforce or the competitive workforce factor impact to providers that we are again. Eight months into this and we I don't know that we've seen data that actually shows what that impact is to the providers. I know we've had a little bit of information about the counties, but I think we feel we're in the same boat too that it's unclear. So, we're taking votes and passing on potential cuts and changes without knowing what's the actual cuts and changes are in legislation.
Colin Stemper: Yeah, that's still on our list. We just needed to get these fiscal estimates, so we'll share that with the group. Hopefully for the next workgroups. For the next.
Michele Craig: All right. Anything else before we adjourn and move to public comment? Well, thank you all for your time and spare time and consideration and the conversation today we'll look forward to seeing you in the July work group meetings. I'm going to look here at the comments. I need to turn on. Let me find we have one person signed up for public comment. Looks like there's a Jerry Nyland/Brianna Clowen, pardon me, I may be pronouncing your name incorrectly, from Beltrami County, so I need to find you in the participants and enable you to speak so. One moment please. I'm not seeing anybody in the attendee list under that name either name. Can someone, Jeremy, can you take a look, please? They may have gone. Yeah, I’m not seeing anyone by either name, and we don’t have any, like, just phone numbers called in either that I see.
Michele Craig: Council chair, are you good? If we adjourn then? All right. Well, thanks. Thank you again everyone. We'll consider the meeting adjourned and then look forward to talking with you all in July. You have a good rest of the day.