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Long‑term care: waiver structure, CFSS transition and waiver consolidation timetable
Summary
House research staff outlined Minnesota’s long‑term care programs, described five Medicaid waivers serving different populations, said the Personal Care Assistance program is being phased out for Community First Services and Supports, and noted a planned consolidation of disability waivers.
Danielle Pinelli of House Research briefed the committee on long‑term care services and supports available to older adults and people with disabilities, noting programs operate under a mix of Medical Assistance (federal‑state partnership), state‑only funds and Older Americans Act federal funding administered by the Board on Aging.
Pinelli summarized the main long‑term care delivery channels: nursing facilities and intermediate care facilities for people with developmental disabilities, and a range of home‑ and community‑based services (HCBS). She said the Personal Care Assistance program is being phased out and replaced by Community First Services and Supports (CFSS); that phase‑out began on Oct. 1 and continues through Sept. 30 of this year, according to the presentation.
The briefing reviewed five HCBS waivers and their target populations: - Community Alternative Care (CAC) waiver for people with chronic illnesses who meet hospital‑level care needs. - Community Access for Disability Inclusion (CADI) waiver for people with disabilities who need nursing‑home‑level care. - Developmental Disabilities (DD) waiver for people who need intermediate‑care‑facility level services. - Brain Injury waiver for people with traumatic or acquired brain injuries who need nursing‑home or neurobehavioral hospital level care. - Elderly waiver for older adults at risk of nursing‑home placement.
The presenters noted that waiver services cover supports necessary to avoid institutionalization and extensions of services in the Medicaid state plan. They explained waivers must be approved by the federal Centers for Medicare and Medicaid Services and require periodic renewals.
A major policy change in progress is a DHS program called "waiver reimagine," which aims to consolidate four disability waivers into two; the staff presentation said that transition is scheduled to begin Jan. 1 of next year.
The committee was also told that while people categorized as elderly or disabled make up about 15% of Medical Assistance enrollees, they account for roughly 60% of MA spending—an allocation that has budget implications for long‑term care oversight and appropriations.
Committee members asked for enrollment and funding trend data for specific programs such as the Supported Independent Living Services (SILS) program and caregiver grants; presenters said staff would follow up with those figures.
