Reflections on 10 Years of Disability
Employment Systems Change:
Minnesota’s Medicaid Infrastructure Grant
MaryAlice Mowry, MIG Director
September 12, 2011
National Home and Community-Based Services Conference
The Challenge:
Move from an “Opt in” to an “Opt
out” system
Systems Change Model:
Self-Organizing Systems
A collection of individual
agents, who have the freedom
to act in unpredictable ways,
and whose actions are
interconnected such that they
produce system-wide patterns.
Short List of Simple Rules
•
•
Ensures that all parts of a complex system act together in
coherent ways.
Over time participants will generate coherent patterns
across the system.
Pathways to Employment:
Short List of Simple Rules
• Make connections; act across
“silos”.
• It’s got to be about infrastructure.
• It has to be sustainable.
• This is about ALL people with
disabilities.
• It’s about people, not programs
Pathways to Employment:
Changing the Conditions for
Self-Organizing
•
•
•
•
Multi-agency collaborative design
Blending and braiding funding
5-year Strategic Plan
Grant-making that created new
opportunities
• Encouraged innovation by imposing only
essential constraints
• Built upon “exchanges” that already existed
Systems Change Model:
Change Maturity Model
Unknown
Work
Learning Work
Ideas and opportunities
exist that we don’t know
anything about.
We begin to learn
about new ideas.
Adaptive Work
Control
Work
We begin to adapt
the new ideas to fit
our systems.
The new idea has
been integrated
into the system and
is part of the
expectations.
Identify what needs to leave the system…
Pathways to Employment:
Control Work within DHS Disability Services Division
• Vision/Core Values
MN Department of Human Services
Continuing Care Division Vision
C ─ Community membership / integration
H ─ Health, wellness and safety
O ─ Own place to live
I ─ Important long-term relationships
C ─ Control over supports
E ─ Employment earnings and stable income
• Changing mindsets
Pathways to Employment:
Control Work / Sustainability
Planning
• Creating a communications framework
– Integrated messaging
– Tools
• Supporting development of external capacity
–
–
–
–
MN Employment Policy Initiative
MN Training and Technical Assistance Center
MDE grants
Seven-County Metro Group
DB101:
A Platform for Transformation
• Support at all stages
• An expanded benefits planning systems
DLL & db101.org
DHS
Work Incentives Connection
Phone & Online Assistance
Back-end Support
In-depth Phone & 1:1 Assistance
Exploration & Planning Tool
Data & Information
Formal Benefits Planning
• What DB101 has to offer
• Content
• Estimators
• Experts
Pathways to Employment:
Control Work / Sustainability
Planning
• Developing and embedding expertise
– Training
– Policy
– Assessment
• Creating policy agenda and developing policy
capacity
– Medicaid Buy-In policy that incents work
– Tracking employment-related policy across agency
Amount of taxes & premiums paid by MA-EPD,
SSI 1619(a) & 1619(b) enrollees (2003-2009)
$7,000,000
$6,000,000
$5,000,000
Total Annual Premiums Billed MAEPD Only
$4,000,000
Taxes Paid & ½ Premiums
Billed** MA-EPD Only
Amount of State Taxes Paid* MAEPD
$3,000,000
Amount of State Taxes Paid*
1619a,b
$2,000,000
$1,000,000
$0
2003
2004
2005
2006
2007
2008
2009
Sources: State taxes paid from MN Dept. of Revenue; Total annual premiums billed from MN Dept. of Human Services Special
Recovery Unit. *reports amount of state taxes paid after tax credits
**Represents total return to State, ½ of premiums collected go to federal government per federal medical assistance percentage
Pathways to Employment:
Control Work / Sustainability
Planning, cont.
• Developing collaborative relationships within
DHS and externally
– “Connecting the dots” – keeping apprised of and
supporting various disability employment –related efforts
•
•
•
•
Health Care Eligibility
Health Care Financing
Minnesota Family Investment Program
“Employment is a key protective factor…”
• Seizing opportunities
– Money Follows the Person
– Medicaid Reform Waiver
An “Opt Out” System
Advocacy
Waivered
Services
Assessment
(MN Choices)
DB101
Tools, resources,
training and
communications
for Professionals
Consistent
Communications
Make
Work Part
of the Plan
DB101
On-line and “live
chat” tools and
resources for
PWD and families
Inter- and Intraagency
collaboration
Provider
capacity
State policy
Systems Change Model:
Adaptive Action