StoryWaiver Case Management System and ReformsSeptember 10, 2026

Minnesota Counties Decry Unsustainable Waiver Case Management System, Seek Reforms

Local officials and state agencies are calling for a comprehensive overhaul of the current flat-rate reimbursement model for waiver case management, citing overwhelming caseloads and uncompensated work that strain county resources.

Published Oct 16, 2026

State officials and county representatives are increasingly vocal about the urgent need for significant reforms to Minnesota's waiver case management system. The current structure, which relies on flat rates and often fails to reimburse for critical unbillable tasks, is reportedly straining county resources and impacting the quality of care for individuals with disabilities.

The concerns were raised during a recent Minnesota Senate discussion, where several stakeholders highlighted the inadequacy of the existing funding model. County leaders described how the 15-minute unit flat rates for waiver case management have remained stagnant for an extended period, despite a growing number of programs and an increasing client base.

Our rates for waiver case management have not been changed in quite some time. They are flat rates, 15-minute units. And they are not sustainable. We've had growing numbers of programs. We have now counties are just trying to manage overwhelming case loads. So it really shouldn't be a surprise that we're struggling as a system to sustain these services at the level and the quality that we want to.
— Christie Graham, Director of State Government Relations, DHS

The challenges for county-based case managers extend beyond the flat-rate system. Many perform essential duties that are not eligible for reimbursement, further exacerbating the financial strain on local governments and potentially diverting resources from direct client support.

For our waiver case managers, one of mine this year had eight individuals in and out of the hospital this summer. I don't we don't stop providing care at that time but that's not waiver billable time. So to just to expand on Luella's point like we could run that data we can look at the the department could pull the waiver billing time but there's so many other things that we do that are not reimburseable to the counties.
— Pat Meechum, Aging and Disability Services Manager, Pine County

Other Topics from This Document

Provider Revalidation and Continuity of Care for Individuals with Disabilities
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Votes (3)

Impacts of Provider Revalidation and Authorization Delays on Disability Services

Hearing/Discussion - No Vote Taken

Several individuals testified about significant disruptions caused by DHS's revalidation process and the authorization contractor, Eccentra. Key issues included delays in authorization for EIDBI treatment impacting 1,000 children, financial instability for autism providers, critical nursing service authorization delays leading to severe health crises for clients, and inaccuracies in DHS's provider data systems leading to unpaid services and staff turnover. Witnesses advocated for immediate continuity of care, improved efficiency, and accountability from DHS and its contractors.

DHS Update on Revalidation and Continuity of Care Reforms

Hearing/Discussion - No Vote Taken

Commissioner Connelly presented DHS's perspective on the revalidation process, emphasizing federal mandates and the unprecedented scale of the effort. DHS detailed measures taken to support providers, reported on revalidation progress (3,600 providers revalidated, 1,500 appeals completed), and acknowledged documentation challenges and CMS scrutiny. The department outlined rebalancing efforts by allocating more staff to regular provider enrollment and hiring new personnel. The Commissioner also discussed continuity of care reforms from the 2026 legislative session, including new requirements for providers, lead agencies, and DHS to ensure seamless transitions, and provided an update on the housing support grant program.

County Perspective on Revalidation and Contracted Case Management

Hearing/Discussion - No Vote Taken

County representatives discussed their dual role in revalidation (supporting providers and being providers themselves), acknowledging frustrations but also improvements in DHS communication. They emphasized the foundational importance of case management and detailed reasons for utilizing contracted case management, including budget flexibility, culturally specific expertise, and managing clients outside their county of financial responsibility. The discussion highlighted the complexity of measuring case manager hours and the current unsustainability of waiver case management rates, calling for the newly established advisory working group and rate evaluation to find long-term solutions.

Notable Quotes (13)

After eight months of work, we now still only have twothirds of the autism provider locations being revalidated for authorized coverage of medically necessary EIDBI treatment. But once that hard work was completed, the families and providers have now been surprised and frustrated to discover that the state's authorization contractor, Eentra, was now failing to authorize the treatment of 1,000 children, which is onethird of the entire group of children who receive TERA fee for service coverage of EIDBI in the state of Minnesota.
— Eric Larson/Chair, Autism Treatment Association [00:07:34]

Impacts of Provider Revalidation and Authorization Delays on Disability Services

The assessor and appeal judge stated that since he did not have status seizures in the past year that he cannot be given the code 03 on call medical. This is what is very troubling and wrong. Caregivers have to be ready if in case a seizure o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o occurs and follow the protocol at any time. DHS is rewarding a medical crisis rather than prevention in this case.
— Arland Christensen/Caregiver [00:13:30]

Impacts of Provider Revalidation and Authorization Delays on Disability Services

An authorization delay honestly almost cost me my life this year. I was assessed as needing and approved for private duty nursing services back in November of 2024. These services were not optional. They were determined necessary because I have significant medical needs requiring ongoing management within my home um and the community. But being approved for nursing and actually receiving those nursing services have been two very different stories.
— Addison Carpenter/Disability Advocate [00:16:55]

Ordinances & Resolutions (11)

EIDBI treatment manualOther

State manual calling for authorization requests to be processed within 7 days.

Corrective Action PlanPlan

Required by US CMS for combating fraud, leading to revalidation efforts.

CDCS (Consumer Directed Community Supports)Plan

Program under which Arland Christensen's son receives services via the DD waiver.

DD waiver (Developmental Disabilities waiver)Other

Waiver program discussed for assessment variables related to medical needs.

CAC (Community Access for Community Integration) or hospital level of care waiverOther

Waiver program Addison Carpenter depends on for services.

Minnesota waiver rate lawOther

THE SAUK RAPIDS RECORDER

Minnesota Counties Decry Unsustainable Waiver Case Management System, Seek Reforms

Other Topics from This Document

Provider Revalidation and Continuity of Care for Individuals with Disabilities

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Path Towards Reform and Continuity of Care

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Votes (3)

Notable Quotes (13)

Ordinances & Resolutions (11)

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