Empowering Caregivers & the Minnesotans They Serve (Human Services)

DHS Establishing New Agencies

The 2023 Legislature separated two distinct areas of policy and programming from the umbrella of management from the Department of Human Services and created two new agencies. The Department of Children, Youth, and Families and the Direct Care and Treatment agency will soon be independently managed and operated. The 2024 Legislature continued establishing the two new agencies by codifying agency responsibilities, budget management, operations, and programs.

The Department of Children, Youth, and Families

By July 1, 2024, a new Commissioner for the Department of Children, Youth, and Families (DCYF) will be formally established within the new department. The 2024 Children & Families bill (HF 5237) included priority investments related to engagement, partnership, and navigation of the new agency. 2024 funding was dedicated to the following:

  • An intergovernmental committee will advise DCYF on providing services to children, youth, and families. The DCYF commissioner will co-develop a process with AMC and MACSSA to meet at least quarterly with the new advisory committee.
  • A department leader who will be responsible for coordinating services and outcomes for children’s mental health and children with or at risk of disabilities between DCYF, DHS, and related agencies.
  • Creating an office of family navigation within the new department. The bill transfers several programs from DHS and MDE that were either created after the 2023 Legislature established the new agency or were missed in the original transfer of programs. Note that this legislation does not explicitly include transferring programs related to homelessness and housing support to the new agency.

Direct Care and Treatment

Direct Care and Treatment is a highly specialized health system that cares for people with mental illness, substance use disorders, and developmental and intellectual disabilities. The patients within this system have complex conditions and most health care providers cannot or will not serve them. Because of this framework, the new agency is established differently than other agencies.

The Direct Care and Treatment agency will be established on July 1, 2025. The executive board vested the agency’s overall management and control. The executive board must appoint a chief executive officer, who is responsible for the agency’s administrative and operational duties. Key oversight and accountability measures that were added in the 2024 Human Services supplemental budget bill (SF 5335) are:

  • The governor may request that the executive board review the performance of the chief executive officer at any time. Within 14 days of receipt of the request, the board must meet and conduct a performance review as specifically requested by the governor.
  • The Direct Care and Treatment chief executive officer is appointed by the executive board, in consultation with the governor, and serves at the pleasure of the executive board, with the advice and consent of the senate.
  • The executive board will establish an advisory committee to provide state legislators, counties, union representatives, the National Alliance on Mental Illness Minnesota, people being served by direct care and treatment programs, and other stakeholders the opportunity to advise the executive board regarding the operation of Direct Care and Treatment.

AUTONOMY AND INDEPENDENCE FOR PEOPLE WITH DISABILITIES Supportive Parenting Services for parents with disabilities (SF 5097 Hoffman)

  • A court or agency shall not deny a prospective parent the ability to proceed with an adoption due to the prospective parent’s disability.
  • A child is not considered to be without proper parental care based solely on the disability of the child’s parent, guardian, or custodian.
  • A person or agency shall not file a petition alleging that a child is in need of protection or services on the basis of a parent’s disability.
  • The local agency or court must offer a parent with a disability the opportunity to use supportive parenting services to assist the parent if the petitioner makes a prima facie showing that a parent with a disability cannot provide for the child’s safety, health, or welfare.

Streamlining & Simplifying MA-EPD (SF 4197 Maye Quade)

Continuing the work from 2023, the 2024 law changes premium reviews for Medical Assistance for Employed Persons with Disabilities (MA-EPD) from every six months to every twelve months. It also allows enrollees to report changes in circumstances within 30 days instead of 10 days. In 2023, the Human Services budget bill eliminated the asset limit for MA-EPD. However, premiums were not eliminated. MA-EPD is a program for people who are above the income limit for medical assistance but require additional care and services, such as PCAs and specialized equipment, that traditional health insurance does not cover.

Consumer Directed Community Supports (SF 4420 Mann)

Consumer Directed Community Supports (CDCS) allows participants to stay in their own homes and live the lives they choose, instead of living in institutions or group homes where they receive a prescribed set of services. To promote this independence, the following changes were enacted to CDCS:

  • Lead agencies must provide information on how the CDCS budgets are calculated, a comparison of traditional waiver services, and notice of a right to appeal.
  • Counties with CDCS policies cannot be inconsistent with DHS policy
  • Goods and services that directly benefit a CDCS recipient can be used by others (ex: accessible toilet)

Improving User Experience for People Seeking and Using Disability Services (SF 3894 Boldon)

$614,000 in one-time spending will be used to contract with an independent party to study people’s experiences in accessing and navigating medical assistance state plan and home and community-based waiver services to improve people’s experiences and understanding of the options and services.

Legislative Task Force on Guardianship (SF 5244 Dibble)

$400,000 is appropriated to create the Task Force that will make recommendations to address concerns and gaps related to guardianship and less restrictive alternatives to guardianship in Minnesota. Policy options the Task Force will explore include securing ongoing funding for less restrictive alternatives, guardian certification or licensure, and reducing the removal of civil rights when appointing a guardian.

PROMOTING DIVERSITY OF CARE SETTINGS

Protecting group homes and small assisted living providers from discriminatory zoning laws (SF 3829 Boldon)

The new law will exempt licensed residential programs (also referred to as group homes) governed under home and community-based standards (245A) and assisted living facilities (144G) with a licensed capacity of six or fewer residents from rental licensing regulations imposed by any town, municipality, or county.

Assisted Living Relocation

Small assisted living (AL) providers are typically BIPOC-owned and rent single-family homes to provide culturally responsive care. These types of providers were left out of the 2019 assisted living reform process. Because of this, their unique licensing structure was not considered and it became illegal for an AL provider to transfer their licenses from one property to another. Beginning March 15, 2025, an assisted living facility with a licensed resident capacity of five residents or fewer is no longer required to apply for a new license solely because the licensee receives approval to relocate a facility.

Helping People Move to Independent Living Settings (SF 2968 Hoffman)

$430,000 in FY 24/25 and $2.2 million in FY 26/27 will help DHS to increase the allowance for transitional supports from $3,000 to $5,0000. This service helps people with items and expenses necessary to move from a congregate care setting to their own home or an integrated community support setting.

UNPRECEDENTED RATE INCREASES IN ELDERLY WAIVER SERVICES AND FUNDING COMMUNITY- CENTERED PROGRAMMING FOR SENIORS

Hospital Bed Access Crisis and Senior Supports

$2.7 million will establish Elderly Waiver (EW) enhanced rates for high-need participants. The Elderly Waiver (EW) program funds home and community-based services for people 65 and older who require the level of care provided in a nursing facility but choose to reside in the community, whether at home or in an assisted living facility. Currently, providers are not fully compensated for providing care to these types of participants with complex behavioral needs and this often leads to this population of seniors boarding in acute care hospitals.

Protecting Vulnerable Residents in Assisted Living Facilities (SF 4296 Hoffman)

Many residents in assisted living facilities are not getting their mental health care needs supported and have reported that assisted living staff often call 911 when experiencing a mental health crisis, which leads to seniors boarding in hospitals. The new training requirements include appropriate de-escalation techniques, basic information about mental illness diagnoses and symptoms, medication interactions, suicide prevention, and trauma-informed care.

$400 MILLION IN DIRECT FUNDING TO STABILIZE LONG-TERM CARE BUSINESSES ACROSS THE STATE AND BOLSTER THE LONG-TERM CARE WORKFORCE

Modifying the 2023 Nursing Facility Loan Program

In 2023, nearly $100 million was appropriated in the Human Services budget bill for a financially distressed nursing facility loan program. This $100 million was in addition to the $300 in direct payments to nursing facilities. The loan program guidelines will be expanded to provide financial assistance to long-term services and supports (LTSS) instead of being limited to nursing facilities. Additionally, LTSS providers can qualify for financial assistance. LTSS providers include those who provide care in home and community-based settings, offer PCA/CFSS services, and early intensive and behavioral intervention services (EIDBI). This change creates a revolving loan program for the LTSS industry.

Ongoing Additional Funding for Rural Nursing Facilities

In 2023, Senate DFLers established funding for the Critical Access Nursing Facility (CANF) program for the first time. CANF is a dedicated program specific to nursing facilities in rural Minnesota. In 2024, the Legislature appropriated $576,000 in FY 24/25 and $1.3 million in FY 26/27 to further enhance the program by providing ongoing funding.

Increasing Nursing Facility Financial Transparency (SF 4580 (Hoffman)

This provision clarifies the state’s understanding of how nursing homes use Medicaid reimbursement dollars by requiring nursing facility owners and operators to report related-party transactions on annual cost reports submitted to DHS. With this information, DHS can ascertain whether the facility owner, licensee, director, or leader is acting prudently and not inflating related-party costs.

Emergency Relief Grants for Rural Providers Offering Services for Children and Youth Living with Autism Spectrum Disorder and Related Conditions

$650,000 will go toward grants to financially distressed organizations that provide early intensive developmental and behavioral intervention services (EIDBI) to rural communities.

Simplifying Regulations and Training Requirements for Long-Term Care Providers & Facilities

Consumer advocates, the Department of Health, and care providers worked together to develop policies that will provide regulatory relief for assisted living facilities. Changes include ensuring small providers don’t have the same regulatory requirements as large providers, simplifying food preparation guidelines, and decreasing training requirements by removing duplicative training requirements.

COMPETITIVE WAGES AND SUPPORT FOR PROFESSIONAL CAREGIVERS

Protecting Wages of Professional Caregivers

A personal care assistance (PCA)/Community First Services and Supports (CFSS) provider must use all additional revenue attributable to the rate enhancements from 2022 and only for wages. The provider agency must not use the additional revenue attributable to any enhanced rate to pay for mileage reimbursement, health and dental insurance, life insurance, disability insurance, long-term care insurance, uniform allowance, contributions to employee retirement accounts, or any other employee benefits

Exploring Reimbursement Options (SF 4042 Hoffman)

DHS must study options to permit reimbursement of Community First Services and Supports services (formerly PCA services). By February 1, 2025, recommendations must include how to pay for up to eight hours of overtime per week, asleep overnight and awake overnight staffing, and services in shifts of up to 80 consecutive hours ($170K one-time).

Remote Worker Training and Development Services for CFSS (SF 3991 Boldon)

Remote worker training and development services are allowed for Community First Services and Supports (CFSS) recipients with chronic health conditions or severely compromised immune systems via two-way interactive audio and visual telecommunications. The recipient’s health care provider must approve that the remote services are appropriate.

WAIVER SERVICES RATE METHODOLOGY AND SYSTEM CHANGES


Waiver Reimagine – Promise Collaboration Between DHS and Disability Advocates (SF 4399 Hoffman)

The Department of Human Services is required to consult with the Waiver Reimagine Advisory Committee and provide quarterly public updates on policy developments related to the reform of the disability waiver services framework. The Waiver Reimagine Advisory Committee will also have input on the implementation and development of the MnCHOICES 2.0 tool.

Disability Services in Acute Care Hospitals (SF 5335 Hoffman)

$940,000 in FY 24/25 and $6.2 million in FY 26/27 is appropriated to DHS to develop a state plan and seek federal approval for covered services by January 1, 2025, that will provide waiver services in hospital settings. Acute hospital stays do not meet all the needs of people with disabilities, especially patients with complex behavioral needs. People who engage in disruptive behavior and experience psychotic episodes, impulse control, or neurological disorders are more likely to revisit hospital emergency departments. This new law will allow a person’s waiver direct care worker to help them when they are in the hospital.

SUPPORT FOR INFORMAL CAREGIVERS

Rest for Primary Caregivers

Short-term relief for primary caregivers is prioritized through additional funding for respite services.

  • $2.2 million for grants for respite care for people caring for others living with dementia
  • $2.5 million for grants for ALS-specific respite services
  • $3 million for respite care services for children who are at risk of residential treatment or hospitalization (SF 4699 Wiklund)

Eliminating Parental Fees (SF 5317 Maye Quade)

In 2023, Senate DFLers eliminated parental fees for families caring for children with disabilities. However, parental fees were not eliminated for children in out-of-home placement settings. In 2024, parental fees will be eliminated for parents with incomes over 275% FPL whose children receive medical assistance (MA) services in children’s residential facilities (CRFs), psychiatric residential treatment facilities (PRTFs), and Intermediate Care Facilities for persons with Developmental Disabilities (ICFs/DD). ($239K FY 24/25 and $478K FY 26/27)

Pediatric Hospital-to-Home Pilot Program (SF 4094 Maye Quade)

A competitive grant to a home care nursing provider will develop and implement a pilot program to help families caring for children with complex medical needs get their children out of the hospital and back home with friends and family.

Parental and Spouse Compensation for PCA/CFSS Services

The new PCA program, Community First Services and Supports, has been delayed by several years. CFSS includes compensation for parents and spouses, but the current PCA program does not. In 2023, the Legislature temporarily continued funding parental and spousal support. CFSS was delayed again and the 2024 Human Services temporarily funds this service again beginning October 1, 2024. ($4.8 million FY 24/25)

Did Not Pass

Elimination of Special Minimum Wage
Family Residential Services Advisory Task Force

In 2023, rates were adjusted for Family Residential Services. Providers requested a Task Force to oversee the rate adjustment process and delay of the tiered rate structure. The Task Force did not make it in the final Human Services bill.

Licensed Practice Nurse (LPN) Focused Assessments in Assisted Living Facilities

Providers requested a regulatory change to assessments conducted in assisted living facilities. Currently, comprehensive assessments are conducted quarterly by RNs. Providers asked for every other assessment to be a less comprehensive assessment completed by LPNS. The request was not related to scope of practice, but a change in the assessment guidelines. Consumer advocates such as AARP were concerned about the assessment change and the final Human Services budget bill kept the comprehensive assessment requirement.

Keeping the Disproportionate Share Program in Elderly Waiver Services

The final Human Services budget adjusts the rate floor to $141 per resident per day, and the Disproportionate Share Program in the Elderly Waiver program will eventually sunset on January 1, 2026. In 2023, Senate DFLers invested a historic $400 million in the Elderly Waiver services program. This resulted in a 45% rate increase for EW services, irrespective of the DSP. DHS will evaluate the new rates that began on 1/1/24 for a year into 2025 and the delay of the sunset will help providers realize the impact of the 45% EW rate increase.

The Disproportionate Share Program was originally intended to help providers care for people on the EW program because the rates were historically very low compared to other waiver services. The DSP is not based on a person’s care needs and has a perverse incentive for care providers to not take people with high needs.

The additional investment in 2024 for enhanced rate to the Elderly Waiver program for seniors with complex behavioral health needs and the EW reform study will both help providers and the people who access EW services.

Senate DFL Media