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County staff brief commissioners on LTSS waiver growth and contingency planning for a potential state cost shift
Summary
Crow Wing County staff outlined long-term services and supports (LTSS) caseload growth, a state advisory council's cost-savings ideas to avoid a projected shift to counties, and local processes for rate exceptions; staff projected a contingent county share of $283,000 in 2027 and about $578,000 in 2028 if a state cost shift occurs.
Tammy Loyuk, Crow Wing County adult services manager, presented a lead-agency waiver review and local LTSS work aimed at managing growing home- and community-based services caseloads. She told commissioners the county's waiver programs served roughly 1,291 individuals as of January 2022 and that participation has increased faster than population growth; the county’s lead-agency review showed full compliance in face-to-face visits and no corrective actions, but staff flagged continuing barriers including staffing, housing and transportation.
Morgan Althouse, who has been participating on a state LTSS advisory council subcommittee, described the statewide effort to identify savings that could prevent a contingent cost shift to counties. She said the advisory work identified an $89.5 million contingent cost-share in FY28–29 statewide targeted at residential/residential-like services and offered examples of ideas under review such as reinstating TEFRA parental fees (the Tax Equity Fiscal Responsibility Act of 1982) and requiring transitions from certain waivers at age thresholds. "These ideas could produce substantial savings," she said; advisory materials provided to the board included estimated savings figures (advisory materials included a rough estimate, cited in discussion as roughly $40 million for certain TEFRA scenarios).
County staff told commissioners they are budgeting for a contingent cost share in 2027 and projected a county share of about $283,000 for 2027 and roughly $578,006.70 for 2028 if the state cost shift occurs and is implemented as described. Trish Eckstead, disability services supervisor, described a local Rate Exception Review Team: Crow Wing County had 57 active rate exceptions in a caseload of roughly 475 cases, and the county has instituted a service approval committee and written guidance to manage exception documentation and appeals; Eckstead noted those exception reviews are time-consuming but necessary to balance provider requests and program integrity.
Commissioners pressed staff on the state-to-county budget consequences and asked for follow-up detail; staff offered to share exception files and provide further briefings. The advisory council is scheduled to deliver a final report to the legislature in December 2026 that staff said the legislature must adopt to prevent any cost shift.
