1. Integration of Consumer-Directed Services into MN’s Home & Community-Based Service System Jane Vujovich MN DHS February 22, 2010

2. Minnesota’s HCBS System Vision Consumer-Directed Services Permanent Statewide Multi-points of access Multiple funding streams Area Agencies on Aging Long-Term Care Consultation MCOs Provider Network Senior LinkAge Line Tribes Counties

3. Changing Focus From being system-focused –Rules prevail –Experts “know best” –Consumer lacks direct control over needed supports To person-centered –Consumer along with their family and friends are “experts” –Consumer gains control over resources –Plan based on personal preferences and priorities

4. Trading in Old Assumptions Professional do planning Use agency-based services Business as usual Providers control service funds and delivery Creating New Realities Consumer are purchasers Consumer-directed planning, employment of workers Flexible spending Revised roles for providers

5. Minnesota: Building on Experience Oct 1 2004 CDCS All Waivers 37 MOU Counties 1995 Self Determination Project 1996 Alternative Care Cash Grants 19971999 June 2004 Consumer Directed Services Under Title III PCA Choice CDCS w/i MR/RC Waiver Consumer Support Grants April 1 2005 CDCS Across All Waivers Statewide

6. Minnesota: Building on Experience 1915 J Passed 200720082011 Live Well At Home Program (aging) Self-directed Services under Veterans, Title 3, grants, private pay 2010 Tentative 1915 J Implementation 2015 Broad Use of Consumer- Direct Services 2009

7. Key Strategies for Building System Capacity Broadly integrate -- across funding streams, programs, and services Assure quality and safeguards through sound policies and practice Collect data and evaluate outcomes Invest in training Facilitate networking and relationship building among key players

8. 2800 waiver users 58/87 counties Aging network providers as support planners Many champions statewide Consumer-Directed Services TODAY 6/15 FSEs working with AAAs & ppay market Awareness High-risk Self-pay users emerging & using FSEs 7/7 AAAs Area Plans Support CD $200,000 Title III For CD VD-HCBS Coming Soon!

9. 9 CLP Project Goals u Bolster Aging Network’s capacity to target pre- MA eligible high-risk older adults and family caregivers u Help the private pay market use consumer- directed services u Establish method to measure and report target group diversion from MA diversion

10. 10 The Live Well At Home Program strategically helps high-risk persons avoid and/or delay spending down to Medical Assistance. Through “risk” management and self-directed purchasing community living continues. Target Market: (Title III and CLP grant funds) èHigh-risk older adults with incomes at 200-250% of FPG and their family caregivers

11. 11 The Model

12. 12 uRapid Screen risk factors: èAssistance with > 2 ADLS èInjurious fall èNo family caregiver èStressed family caregiver èLives alone èPlanned housing move èMemory concern èAdditional Question About Income

13. 13 LWAH Implementation Strategies  Broadly disseminate LWAH Rapid Screen © uBuild statewide capacity for diversion support uEngage participants with risk management and self-direction uCollect data, evaluate impact

14. 14 Implementation Con ’ t  Use MN ’ s ADRC – MinnesotaHelp Network èInformation and Assistance  LinkLive ™ for secure network communication and data transfer èScreening èClient data tracking and outcomes

15. 15 Implementation Continued u Implement VD-HCBS èSouthwest MN – 11 counties èUsing Medicaid waiver option & Live Well At Home models

16. 16 On-going Challenges u Uneasiness and fear of “change” and what it brings u Re-direction of Title III money by the AAAs u Survival of small non-profits as consumer-directed services continue to emerge u Engaging consumers with managing risk factors, and using private funds for buying consumer- directed u Diminished informal network from which to hire workers

18. 18 Jane.vujovich@state.mn.us Jane.vujovich@state.mn.us 651-431-2573 www.mnlivewellathome.org