Purpose

This bill would overhaul Minnesota’s long-term care waiver system for people who need hospital- or nursing-home–level care. It creates a new two-home and community-based services waiver under the federal 1915(c) authority and establishes an individualized budget approach that focuses on a person’s assessed needs rather than where they live. It also adds a specific pathway (a budget exception) to support self-directed home care nursing services and requires new online planning and tracking tools.

Main Provisions

• Two-home and community-based services waiver (under 1915(c)) for people needing nursing home, hospital, neurobehavioral hospital, or intermediate care facility for persons with developmental disabilities levels of care.
• Individualized budget methodology (under 1915(c)) that bases the budget solely on a person’s assessed needs, not on the person’s residence. The plan cannot be determined by where the person lives.
• Establishment of an individualized budget methodology exception to enable access to self-directed home care nursing services.
  • Lead agencies must submit budget exception requests.
  • Eligibility criteria include: recent assessment showing need for hospital-level care, eligibility for a support range budget of E or H, and not currently receiving certain other waiver services.
  • If home care nursing is chosen, services must be ordered by a physician, physician assistant, or advanced practice registered nurse and delivered by a registered nurse or licensed practical nurse within their scope of practice.
  • If a person’s annual reassessment shows they no longer meet the criteria, the budget exception must be terminated.
• The commissioner of human services may seek federal authority as needed to implement these changes.
• The new waiver menu and individual 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 required by July 1, 2026 to provide accessible information about total budget, eligible services, and services used.
  • The tool should support informed choice and explore real-time tracking of a person’s remaining budget.
  • Input from people with disabilities must be sought before implementing the tool.

Changes to Existing Law

• Amends Laws 2021, First Special Session, chapter 7, article 13, section 73 (as amended), to implement Waiver Reimagine Phase II.
• Updates take effect January 1, 2027 (or later if federal approval is required) and reflect strategies to reimagine the waiver program structure and budgeting approach.

Implementation Timeline and Oversight

• Effective date: January 1, 2027, or upon federal approval, whichever is later.
• By July 1, 2026: development and implementation of an online support planning and tracking tool.
• Ongoing requirement to ensure access to services in home and community settings and to seek federal authority as needed.

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Relevant Terms waiver reimagine; two-home and community-based services waiver; 1915(c) waiver; individualized budget; budget exception; self-directed home care nursing services; hospital-level care; nursing home; neurobehavioral hospital; intermediate care facility for persons with developmental disabilities; lead agencies; home care nursing (RN/LPN); physician/physician assistant/advanced practice registered nurse order; annual reassessment; DHS form 7096; E budget; H budget; online support planning and tracking tool; informed choice; real-time budget tracking; service disruptions; federal authority; SSA/ Social Security Act.