Clay County officials warn CFSS rollout and assessor workloads are delaying in-home services; new licensing fee to bring county revenue

Clay County social services leaders told the Board of Commissioners on April 14 that changes to Minnesota's long-term services programs have strained local capacity and slowed access to in-home care.

"In 2025, our intake line documented 1,121 intakes," Mary Koskinen, supervisor of the Licensing and Disability Services Division, told the board during the annual departmental update. Koskinen, who took the supervisory role in December, described a licensing program that in 2025 included 57 family adult foster homes (101 beds), 121 corporate residential settings (333 beds) and 51 licensed child foster homes.

Koskinen said the Community First Services and Supports program, or CFSS, which began rolling out in October 2024, added a required consultation step before counties can approve services in the home. That extra step has created a bottleneck: Koskinen said there are about 57,000 Minnesotans using CFSS or PCA statewide but only 16 consultation-provider agencies exist statewide and, as of October 2025, only seven were taking new referrals.

"The lack of service providers leads to delays, confusion, and service gaps," Koskinen said, noting Clay County has no local consultation agencies and must rely on state-registered providers who take referrals across Minnesota.

Holly Warner, supervisor of Clay County's home and community-based disability services, said the county manages roughly $100 million a year in waiver-funded services and is serving people across several waiver programs: about four under the brain-injury waiver, 578 on the CADI waiver, 10 under the CAC program and 210 on the developmental disabilities waiver in 2025.

Warner and Koskinen told commissioners the CFSS onboarding process has also shifted administrative responsibilities onto MnChoices assessors, adding coordination and documentation duties that previously would fall to case managers. Koskinen said Clay County had 6.5 full-time certified MnChoices assessors in 2025 and that initial assessors completed 536 assessments that year; she said 41% of initial assessments were approved to be open to CFSS, which could add about 155 CFSS clients locally if all follow through with onboarding.

Both supervisors stressed caseload concerns: Warner said Clay County added a 2026 budgeted case-management position to bring the team to 15 case managers, and that average caseloads have trended around 65 cases per case manager in recent years. She told the board that contracted case managers from other counties help reduce travel burden but noted a pending state legislative effort could eliminate contracted case management, which the presenters warned could force the county to add staff to cover travel and face-to-face visit requirements.

Koskinen also flagged a licensing-policy and revenue change: an annual renewal fee of $2,100 for adult corporate foster care licenses in 2026, with 50% of the fee directed to the county. "This will contribute nearly $200,000 in revenue for Clay County this year," she said, while noting some providers might close because of legislative changes.

Commissioners asked for clarification on whether local providers could reduce CFSS delays; presenters said the consultation step is provided by state-registered agencies and is available remotely, so local proximity would not necessarily solve the statewide provider shortage. County staff said the Minnesota Department of Human Services is working to add more consultation providers but offered no timeline.

The board did not take action on policy changes at the meeting; presenters concluded the update by outlining recruitment efforts, training funded by a DHS capacity-building grant to increase employment services, and ongoing monitoring of caseloads and licensing compliance.

The board's next agenda includes further consideration of a separate ordinance and routine business items.