Home and Community-based Services and Medicaid Reform
HCBS Partners Panel Idea Generator
Summary of Results
Background
The Idea Generator was distributed to the members of the HCBS Partners Panel who were asked
to fill it out and distribute it through their networks so others could participate. The Generator
was in the form of a Snap Survey. Participants were asked to list up to 5 ideas, in priority order,
for reforming home and community-based services. The responses were in a narrative format.
Results were sorted by compiled and sorted by topic by DHS staff. Since topic areas overlap and
people could combine several ideas in one response, the counts provided below are estimated.
Counts are also duplicative, in that one response may have been counted under more than one
theme.
There were 125 surveys submitted.
Major Themes
Reform Benefit Sets (70)
This is a broad category under which falls all sorts of suggestions about services. There are a
couple of noticeable sub-themes.

Common Service Menu ( 14)

Housing/Transition (10)
Housing access services, safe housing for children 16+, protocols for providers to sell their
homes to residents, relocation services

Technology/Service (9)
Make use of and pay for technologies that can reduce staffing costs/monitor, telemedicine,

Mental Health (7)
More availability of services (including evenings and weekends), better criteria for mental health
clients to be able access waiver services, supportive employment, more support for mental health
and behavior issues (current limits are too restrictive), peer support, autism-specific services

Companion Services/Supervision (5)
Pay for people to take someone to dr. appts. or do other companion tasks or just supervise people
with low levels of need who can’t be left alone.
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
Preventative services (2)

Room and board (2)

Transportation (2)

Other (7)
Variety of ideas including, flexible “wrap-arounds” to support natural supports, combining
services such a “therapeutic respite”, nursing home services for short-term acute situations,
family foster care, Resource Homes, shared care options.
Point of Entry (39)
This broad category includes comments about:




assessment (give people access, reflect functional needs, get at needs of people with
mental illness, universal standards, process, addressing changing needs, reflect available
natural supports, assess in teams),
trying to get to right service/right time,
information (talk about acceptable levels of risk, easier to understand)
eligibility (age restrictions, lower level of need still need support, ideas for who should
and shouldn’t get services)
Payment/regulation (39)
There are many comments about increasing rates, bundling funding, needs-based budgets and
budget methodology, allowing providers to share in cost savings, simplified rates, tying rates to
Difficulty of Care, SLS service funding structure, spending limits, LTC vouchers and county of
responsibility.
Regulation (37)
18 of these comments were about the 4 bed limit of residential settings (17 against it, 2 for it).
More shared care, less regulation, eliminate redundant adult foster license requirement, limit
foster care homes access to PCA, eliminate/revise group home moratorium, revise regs to better
support transition, have providers contract with state not counties, reduce reg burden on PCA—
do more oversight with audits, req more degreed positions.
Simplify (36)
Hand-in-hand with Regulation, the big message here is decrease paperwork, simplify getting and
providing supports, reduce rules and regs.
Value/Principle (35)
Many submitted values or principles, such as serve people in their home, include consumers in
planning, work from a client’s point of view, focus on normalcy, be cost-effective, consider
behavioral disabilities, remove barriers, consider people’s dignity, raise taxes, etc.
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Consumer Directed Services (34)
Many responses were general endorsement of self-directed services. One person endorsed lower
caps on consumer-directed services; another criticized it. A couple of people commented on how
moratorium removed choice. Other themes emerged:

CDCS and improve budget methodology (7)

1915(j) (3)

Community First Choice Option (3)
Coordination (32)
Comments addressed the need for coordination at both agency/division levels and also at the
service delivery level. There were also a couple of comments about integration of services
(community-based, such as park and rec, and across waivers).
Process (24)
There were many suggestions about improving the processes by which services are delivered—
six specifically about case management and most of those about allowing people to choose case
managers. Another wanted SPMI cm to return to counties. Several suggested having AC
financial eligibility determined by financial workers. Better communication, working in teams,
safeguards for consumer-directed services, better transitions out of hospitals.
Quality Assurance (18)
Many people were interested in having a quality assurance system that focuses on people not
paper. Consumers pick their own team to do ombudsman work. QA system designed for
community-based services, not institutions—transition from licensing-based system to one based
on individuals achieving their goals—from compliance to outcomes. QA/Voice review.
Housing (18)
Several of these comments were also counted under Reform Benefit Sets. Several commented
on the need for safe, affordable housing. Housing Access Program, supported housing for
people with mental illness, need for transitional housing and types of foster care were all called
out. There were some comments that spoke to the positive aspects of congregate living and
others that addressed the value of people controlling their own homes.
Combine/Align Waivers (15)
People commented on both having a common service menu (which is noted under Benefit Set
Reform), but also on aligning definitions, policies and procedures.
Employment Supports and Benefits Planning (14)
Supportive employment for people with mental illness, more employment services, customized
work or retirement programs, make work part of the plan all the way along, more than 20
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hours/week, employment is the outcome for under 65, community vocational providers, open up
DT&H to CADI waiver, community-not segregated work, incent providers towards paid work
outcome, supported employment provided in small groups
Training (13)
There were many ideas about how staff could be better trained (housing issues, mental and
chemical health, HCBS choices/enrollment/billing, person-centered concepts, geriatrics), have
training on-line, train community members on geriatric issues, train families to plan, guardians.
Preserve/Restore/Waiting Lists/More $ (12)
People wanted eliminate waiting lists, preserve our current system, restore things that have been
cut/reduced/capped, or add more money and services to the system.
Finish Current Reform Projects (9)
People commented most frequently about starting to use MnCHOICES, but rate-setting and
provider enrollment were also mentioned. The degree of concern about how assessment is done
is also captured in the Point of Entry/Assessment theme.
Flexibility (7)
These comments ranged in the area addressed but the general idea expressed was that people
should have more flexibility to use lower cost services to avoid higher cost ones and to respond
to the mobility of our society.
Consumer Obligation (7)
Most of these comments were about the EW obligation which people found confusing or thought
should be eliminated. A couple of people commented that consumers should contribute
something to their services. A couple of others cautioned against that.
Cost Analysis (7)
Suggestions about assessing costs in innovative ways, particularly looking across traditional lines
such as across departments, sectors, programs.
DHS Structure (6)
There were concerns about organizational structure of DHS Chemical and Mental Health
Administration, among other comments.
Measurement (6)
These comments were varied. See also “Cost analysis” and “Goal/Outcomes”
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Goals/Outcomes (5)
The idea expressed here was that by understanding the actual goals, services could better be
targeted and ended. Also, that goals vary with age and population—duration service should be
attached to goals/outcomes, not to what kind of service it is. On the other hand, one responder
sees this as an opportunity to break down aging/disability divisions by recognizing shared
goals/outcomes.
End a Service (4)
SOS, adult foster care, DT&H, ICF-MRs were all mentioned as services to drop.
Information Technology (4)
Systems need to work together better and be easier to use.
Self-responsibility (4)
Increase insurance coverage, savings, exercise, nutrition.
Process for doing Medicaid Reform (3)
Listen to county workers, providers, stakeholders.
Rural/Urban Costs and Regs (3)
Costs of providing care is different in rural vs urban settings. Congregate care might be cheaper
when mileage and time is factored in.
Mental Health (2)
Note that there were many comments about services to better serve people with mental illness
under Reform Benefits Set. These comments were about improving availability of services that
already exist.
Natural supports (2)
Identify what caregivers actually want. Support caregivers. There are also several comments
about reimbursement for family caregivers.
Other (42)
These were responses that were all across the board and only mentioned by one or two people.
Examples: continuity of patient information, review why costs vary so greatly, insurance instead
of MSC+, make GRH portable to other settings, recognize the mess of the PCA system, regional
approach to waivered service allotments, allow a foster care option without 24-hour plan of care,
eliminate concurrent host county contracts, conflict of interest (primary providers as rep payees),
link providers to actual (not on-line) ADRCs, implement IDTT, preventative strategies, be wary
of managed care, innovation/pilot projects (alternate settings).
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