Purpose

This bill aims to (1) implement Waiver Reimagine Phase II for Minnesota’s home and community-based services, (2) create protections around budgets for people receiving these services, and (3) add tools and rules to help manage and plan services in a way that supports living at home. It also updates how the program is funded and tracked, and sets timelines for implementation.

Main Provisions

• Two-home and community-based services waiver structure

  • The bill requires a two-home and community-based services waiver program under section 1915c of the federal Social Security Act for people who need nursing home–level, hospital-level, or similar care at home, including those with developmental disabilities.

• Individualized budget methodology

  • It directs the creation of an individualized budget method for these waiver services, so each eligible person has a personal budget based on their assessed needs.

• Budget exception to support self-directed home care nursing

  • It creates an opportunity for a budget exception to fund self-directed home care nursing services, with specific eligibility criteria and oversight.

• Eligibility and service rules for budget exceptions

  • To qualify for the budget exception, a person must meet criteria tied to: hospital-level care level, an E or H budget, and not receive certain other residential or community supports.
  • Home care nursing services funded by the budget exception must be ordered by a physician (or physician assistant or advanced practice registered nurse) and provided by a registered nurse (RN) or licensed practical nurse (LPN) within their licensed scope.
  • If a person’s annual reassessment shows changes, the budget exception can be terminated.

• Federal authority and settings

  • The Department of Human Services may seek federal authority as needed to implement these changes.
  • The new waiver menu and budgets must allow people to live in their own home, a family home, or any home-and-community setting of their choice, while avoiding unintended service disruptions.

• Online support planning and tracking tool

  • By July 1, 2026, the department must develop and implement an online tool that helps people understand their budget, eligible services, and chosen services.
  • The tool should be accessible and show total budget, services chosen, and allow real-time tracking of remaining funds where feasible; input from people with disabilities should be sought before rollout.

• Implementation safeguards for budget reductions

  • When Waiver Reimagine Phase II is implemented, no one should see their individual authorized budget reduced by more than 10% unless there is a documented decrease in need.
  • Reductions are to be determined using the most recently approved budget amount and the MnCHOICES assessment prior to Phase II.
  • If a person’s MnCHOICES assessment after Phase II shows the same or greater needs, the 10% reduction limit continues to apply to future budget determinations.
  • If MnCHOICES shows a decreased need after Phase II, the 10% reduction limit no longer applies, and the budget amount for future determinations will be set using the Phase II methodology.

• Cost-of-living adjustment (COLA)

  • The methodology for Waiver Reimagine Phase II must include a cost-of-living adjustment for all waiver recipient budgets.

• Codification and reporting

  • The bill requires the reduction limits and the COLA to be included in any proposed language that codifies Waiver Reimagine Phase II.

• Implementation timeline

  • Phase II takes effect January 1, 2027 or later if federal approval comes later.
  • The online planning and tracking tool must be in place by July 1, 2026, with ongoing work to make it accessible and useful for people choosing and using waiver services.

Significant Changes to Existing Law

• Establishes Waiver Reimagine Phase II as a formal two-home and community-based services waiver under the 1915c authority.
• Introduces an individualized budget approach for waiver services, replacing or augmenting prior budgeting methods.
• Adds a formal budget exception pathway specifically to support self-directed home care nursing.
• Creates a formal online planning/tracking tool for budget management and service planning.
• Imposes a hard 10% cap on budget reductions during Phase II implementation (with exceptions based on reassessments) and requires a COLA to be built into the new budget methodology.

Implementation and Oversight Considerations

• Lead agencies are responsible for submitting budget exception requests to the commissioner and for helping ensure services remain available in the home and community settings without unintended disruptions.
• The department may seek federal authority as needed to implement these changes.
• The state must ensure access to self-directed home care nursing and that service offerings align with the needs identified in assessments.
• A formal public-facing online tool will help people understand budgets and services and support informed choice.

Relevant Terms - Waiver Reimagine Phase II - two-home and community-based services waiver - 1915c (federal waiver authority) - individualized budget - budget exception - self-directed home care nursing services - home care nursing - registered nurse (RN) - licensed practical nurse (LPN) - physician order - MnCHOICES assessment - E budget - H budget - online support planning and tracking tool - total budget - real-time budget tracking - lead agencies - cost-of-living adjustment (COLA) - reduction limit (10%) - unintended service disruptions - hospital-level care - neurobehavioral hospital - intermediate care facility for persons with developmental disabilities - federal approval - budgeting methodology