Purpose

• Establish Waiver Reimagine Phase II to reorganize certain disability and aging services into a two-home and community-based services waiver structure under Minnesota’s federal waiver authority (section 1915(c)).
• Create an individualized budget methodology so people who need hospital- or nursing-home–level care can receive services tailored to their needs.
• Protect access to self-directed home care nursing services through a budget exception process.
• Allow people to live in their own home or another home of their choice, while aiming to avoid gaps in services.

Main Provisions and What the Bill Seeks to Accomplish

• Waiver Structure and Eligibility
  • Implement a two-home and community-based services waiver program structure for people who require levels of care provided in a nursing home, hospital, neurobehavioral hospital, or intermediate care facility for persons with developmental disabilities.
  • Implement an individualized budget methodology for these same individuals.
• Budget Exceptions for Self-Directed Nursing
  • Create an exception process to access self-directed home care nursing services (home care nursing) funded through the budget.
  • Lead agencies must submit budget exception requests to the commissioner.
  • Eligibility for budget exceptions requires:
  • A hospital-level care need evidenced by a formal assessment and supporting medical documentation.
  • A support range budget of E or H.
  • Not currently receiving certain other community-based services.
  • Home care nursing services under the budget exception must be ordered by a physician, physician assistant, or advanced practice registered nurse, and provided by a registered nurse or licensed practical nurse within their scope of practice.
  • If a person’s annual reassessment shows these requirements are no longer met, the commissioner must terminate the budget exception.
• Federal Authority and Service Access
  • The commissioner may seek all necessary federal authority to implement the new structure.
  • Ensure the new waiver service menu and individual budgets allow people to live in their own home, a family home, or any home and community-based setting of their choosing.
  • Ensure Waiver Reimagine does not cause unintended gaps in services.
• Online Planning and Tracking Tool
  • By July 1, 2026, develop and implement an online tool to support planning and tracking.
  • The tool must present information in an accessible format, show the total budget, eligible and used services, and allow exploration of real-time budget options.
  • Seek input from people with disabilities before implementing the tool.
• Protection Against Deep Budget Reductions
  • When implementing Phase II, do not reduce a recipient’s individual authorized budget amount by more than 10% unless there is a documented decrease in need from the MnCHOICES assessment.
  • Use the most recent authorized budget amount and the pre-Phase II MnCHOICES assessment to determine whether a reduction violates this 10% rule.
  • If a MnCHOICES assessment after Phase II shows needs are the same or higher, the 10% reduction limit remains in effect for future determinations.
  • If needs decrease after Phase II, the 10% reduction limit no longer applies, and the budget amount will be determined using the Phase II methodology for future determinations.
• Cost-of-Living Adjustment (COLA)
  • Include a cost-of-living adjustment in the Phase II budget methodology for all individual budgets.
• Integration into Law
  • The COLA and the reduction limits must be included in any proposed statutory language codifying Waiver Reimagine Phase II.

Significant Changes to Existing Law

• Amends prior Waiver Reimagine language to add Phase II structure, an individualized budget approach, and a formal budget exception pathway for self-directed home care nursing.
• Elevates the role of MnCHOICES assessments in determining budget reductions and ongoing eligibility.
• Creates a concrete online planning/tracking tool and requires an accessible format for informed choice.
• Establishes explicit protection against large, automatic budget reductions unless need changes are documented.
• Adds a COLA mechanism to ensure budgets keep pace with living costs.

Implementation Timeline and Oversight

• Effective Date: January 1, 2027 or upon federal approval, whichever is later.
• By July 1, 2026: Develop and implement the online support planning and tracking tool; begin exploring real-time budget tracking and gather input from people with disabilities.
• Ongoing: Lead agencies submit budget exception requests; the commissioner may seek federal authorities as needed; monitor to prevent unintended disruptions in services.

Practical Impact and Public Considerations

• More individualized budgeting and choice for people who need higher levels of care, with a focus on allowing home- or community-based living options.
• Introduces a formal process to access nurse-directed home care services outside traditional fixed-budget models.
• Adds protections to avoid sudden, large cuts to services unless a documented need change occurs.
• Requires new digital tools to help people understand and manage their services and budgets.

Relevant Terms - Waiver Reimagine Phase II - two-home and community-based services waiver program - 1915(c) waiver program - individualized budget methodology - authorized budget amount - budget exception - self-directed home care nursing services - MnCHOICES assessment - hospital-level care - E or H budget - home and community-based setting - physician order; physician, physician assistant, APRN - cost-of-living adjustment (COLA) - online support planning and tracking tool - unintended service disruptions - federal authority (SSA section 1915(c))