How Minnesota pays for disability services

Waiver inventory

Excluded as aging-only: Elderly Waiver, MN.0025.R09.00, ages 65+, nursing facility level of care, with additional 1915(a)(1)(a) and 1915(b)(1) authority.

All five Minnesota waivers include Consumer Directed Community Supports and operate with concurrent Section 1915(b)(4) authority. General program page: mn.gov

No 1915(i) or 1915(k)/CFC authority appeared for Minnesota in the CMS factsheet retrieved.

State-only funded programs

Minnesota operates three named grant programs outside Medicaid waiver authority, all administered by the Department of Human Services through county and tribal lead agencies. I could not retrieve appropriation amounts or program parameters for any of the three before the session's web search budget was exhausted; the mn.gov program pages returned navigation only on fetch.

• Family Support Grant (FSG). Cash grants to families raising a child with a disability at home, to purchase goods and services that support keeping the child in the family home. Administering agency: Minnesota DHS, delivered through county and tribal lead agencies. Annual appropriation: not found. mn.gov
• Consumer Support Grant (CSG). A cash alternative to Medical Assistance home care services, specifically in lieu of home health aide, personal care assistance, and private duty nursing. Because it substitutes for Medicaid state plan services, its funding mix is not purely state; treat the "state-only" label with caution. Annual appropriation: not found. mn.gov
• Semi-Independent Living Services (SILS). Support for adults with developmental disabilities living semi-independently who are not on a waiver. Administered by county lead agencies with state grant funding. Annual appropriation: not found. mn.gov

What I checked: the DHS people-with-disabilities program index, the DHS home and community-based services pages, the 2026 to 2027 Governor's revised biennial budget for Human Services, and the Minnesota House DHS budget overview. None of these surfaced FSG, CSG, or SILS appropriation lines in the excerpts returned.

County / regional / local funding

Minnesota runs an unusually strong county lead agency model, but the funding is state and federal rather than county-levied.

County and tribal lead agencies. Counties and tribal nations serve as lead agencies for all four disability waivers. They perform the MnCHOICES assessment that establishes eligibility and level of care, assign case management or care coordination, authorize services, and manage waiver capacity. This is the mechanism by which allocations reach individuals.

Allocation mechanism and its ongoing replacement. Historically DHS distributed waiver resources to counties as county-level allocations, and the county decided who received an opening. Waiver Reimagine is the initiative replacing that with an individual budget methodology, consolidating the four disability waivers into two based on living arrangement rather than diagnosis. An expert panel developed the individual budget methodology, and the Human Services Research Institute has been the technical partner. - Individual budget methodology expert panel materials: house.mn.gov - HSRI project page: hsri.org - DHS March 2026 delay notice: mn.gov - DHS July 2026 update on 2026 legislative changes: mn.gov - Waiver Reimagine Advisory Committee: mn.gov - Advocacy summary: arcminnesota.org

County levy for IDD services: None identified. No county mill levy, county board levy, or regional center local funding stream dedicated to IDD was found in the DHS or legislative sources retrieved. Counties fund their share of administrative and social services costs from general county levy, but there is no dedicated IDD levy comparable to Michigan's mental health millages. What I checked: the DHS HCBS waiver pages, the Governor's biennial budget for Human Services, the Minnesota House DHS budget overview, and the Senate HHS committee forecast presentation.

Funding scale

• People served: 62,827 people received home and community-based services through the disability waivers each month in FY2023 (Department of Human Services, 2026 to 2027 Governor's revised biennial budget, mn.gov). A secondary source puts the current figure at approximately 63,000 Minnesotans monthly (https://www.brightpath-mn.com/brightpath-blog/minnesota-disability-waiver-changes-taking-effect-in-2026, secondary).
• Overall Medicaid context: Minnesota Medical Assistance totals roughly $24 billion with 1.2 million average monthly enrollees in FY2026. Medical Assistance is 89 percent of DHS spending and 95 percent of the DHS budget goes to forecasted programs. "LTC Waivers and Home Care" is a reported spending category but the dollar amount was not broken out in the presentation retrieved. Sources: house.mn.gov and assets.senate.mn
• Biennial budget context: The state biennial budget totals $66 billion (secondary, brightpath-mn.com).
• FMAP: Minnesota's base FMAP is described as "just over 50 percent." Starting October 2026 Minnesota's matching rate changes from 50.68 percent to 51.36 percent, modestly reducing the required state contribution. Source: assets.senate.mn
• Medicaid HCBS DD waiver spending, state vs federal share, spending per participant: Not found. The Governor's budget book does not break disability waiver spending out by fiscal year in the sections retrieved.
• Waiting list: No current figure found. The most recent numbers located are dated: the CADI waiting list was eliminated as of October 1, 2016; the DD waiver had 89 people waiting as of January 1, 2018, with an average wait of 79 days. Fund utilization ran 97 percent for CADI, CAC, and BI in FY2017 and 94 percent for the DD waiver in CY2016. Source: house.mn.gov These are eight to ten years old and should not be presented as current.
• Budget pressure, 2026 to 2027 biennium: The Governor's recommendations include four named change items explicitly reducing disability waiver growth: "Reduce Disability Waiver Growth: DWRS Rate Exceptions and Input Monitoring," "Reduce Disability Waiver Growth: Residential Services," "Reduce Disability Waiver Growth: Day and Unit Based Services," and "Reduce Disability Waiver Growth: Cap inflationary adjustments." Dollar amounts for each were not in the excerpt retrieved. mn.gov

Residential funding detail

Minnesota is the only one of these three states that sets residential rates by a statutory cost-build formula rather than a negotiated contract or a published fee schedule. This is the Disability Waiver Rate System (DWRS), and it applies across the CAC, CADI, BI, and DD waivers.

What residential settings are funded. - Community Residential Services (CRS). 24-hour staffed residential in a corporate or licensed provider-owned setting (formerly corporate adult foster care). Licensed under Minnesota's 245D standard. - Family Residential Services (FRS). Adult foster care or child foster care provided in the license holder's own home, the closest Minnesota analogue to host home or shared living. Includes life sharing as a distinct daily service. - Integrated Community Supports (ICS). Support in the person's own residence in a setting where the provider does not own the housing, Minnesota's supported living model. - Customized Living and 24-Hour Customized Living. Housing-with-services settings; these are exempt from the 2026 rate remediation. - Individualized Home Supports (IHS), with and without training and family training, and Night Supervision for in-home and family settings.

Payment structure. DWRS builds a rate from published component values rather than publishing a flat rate per service. The build is: a base direct care hourly wage specific to the service, multiplied by a competitive workforce factor, plus program plan support, utilization and absence factor, general and administrative support, client program and supports, transportation, and for residential services a facility use allowance. Because staffing ratios and hours vary per person, the resulting rate is person-specific. Residential services are paid on a daily basis; unit-based services on a 15-minute basis.

Component values effective January 1, 2025 (https://mn.gov/dhs/assets/2025-DWRS-component-values_tcm1053-650690.pdf):

Base direct care hourly wages: - Community residential services: $16.47 - Family residential services: $16.47 - Integrated community supports: $16.47 - Adult day services: $16.60 - Day support services and prevocational services: $18.53 - Individualized home supports: $15.89 - Night supervision: $16.52 - Positive supports, analyst: $23.55; professional: $47.14; specialist: $17.61 - Employment development and employment exploration: $25.42 - Employment support: $22.73 - Individualized home supports with family training: $19.81 - Individualized home supports with training: $20.47

Framework components: - Competitive workforce factor: 6.7 percent applied to direct care hourly wages - Program plan support: 5.60 percent (day services) to 15.50 percent (unit-based with programming) - Utilization and absence factor: 1.70 percent to 9.40 percent by service - General and administrative support: 13.25 percent - Client program and supports: 2.79 percent to 12.58 percent - Transportation: $24.28 per person per week for day services; varies for residential - Facility use, residential services: $2,113.36 to $3,773.84 per person

Acuity tiering. Historically DWRS residential rates were driven by staffing hours rather than an acuity tier. That is changing. Effective for service start dates on or after January 1, 2026, Family Residential Services moves to a tiered rate structure based on the MnCHOICES case mix assessment, applying to FRS adult daily, FRS child daily, and life sharing daily. Community Residential Services is also subject to remediation. Source: dhs.state.mn.us

Room and board. Waiver funds do not pay room and board in Minnesota. Residents in community residential and family residential settings pay room and board from SSI and from Minnesota Supplemental Aid. I was not able to retrieve the current MSA amount or MSA housing assistance figure, so no number is asserted. Note that DWRS does include a facility use component ($2,113.36 to $3,773.84 per person) inside the provider rate, which covers provider facility costs distinct from the resident's room and board obligation.

Rate exceptions. DWRS permits DHS-approved rate exceptions for people whose needs exceed what the framework produces. Services with DHS-approved exceptions are exempt from the 2026 remediation. Effective July 1, 2026, rate exceptions for residential providers serving people with high needs require stricter qualifying criteria (secondary: brightpath-mn.com). One of the Governor's named budget reductions is specifically "DWRS Rate Exceptions and Input Monitoring."

Rate structure link. mn.gov

Comparable service rates

Minnesota does not publish a flat dollar rate per service. Every DWRS rate is computed per person from the framework. The table below gives the published base direct care wage and the framework components that build each rate, which is the closest published equivalent, plus the framework link.

Positive supports rates, useful for behavioral services comparison: analyst $23.55/hour, professional $47.14/hour, specialist $17.61/hour base direct care wage.

Official rate schedule links

• DWRS framework component values effective Jan 1, 2025 (the single most useful published rate document): mn.gov
• 2026 disability waiver rate-setting frameworks index (spreadsheets with all formulas visible): mn.gov
• Same page, alternate path: mn.gov
• 2026 DWRS rate remediation bulletin (which services are remediated, which are exempt, FRS tiering): dhs.state.mn.us
• DSD eList, Jan 1, 2026 DWRS component value updates: dhs.state.mn.us
• DSD eList, update on DWRS rate remediation efforts: dhs.state.mn.us
• DWRS program hub: mn.gov and dhs.state.mn.us
• DWRS cost reporting: mn.gov
• DWRS cost reporting manual: mn.gov
• DWRS frequently asked questions (banding, exceptions): mn.gov
• How direct care service rates are determined: mn.gov
• Waiver plan amendment documents: dhs.state.mn.us (CAC, CADI, DD, Fall 2025), dhs.state.mn.us (BI, CAC, CADI, DD), dhs.state.mn.us

Notable features and flags

• Jan 1, 2025: Current published DWRS component values took effect, including a 6.7 percent competitive workforce factor applied to direct care wages and a 13.25 percent general and administrative allowance. Base direct care wages for the three residential service types all sit at $16.47 per hour.
• 2025 legislative session, effective Jan 1, 2026 or upon CMS approval: The legislature required DHS to update base wage index values from the Bureau of Labor Statistics for fifteen DWRS framework services. This "rate remediation" takes effect only after CMS approves the CAC, CADI, and DD waiver amendments plus the BI waiver renewal. Customized living, adult day bath, and any service with a DHS-approved rate exception are exempt. Sources: dhs.state.mn.us and dhs.state.mn.us
• Jan 1, 2026: Family Residential Services converts to a tiered rate structure driven by the MnCHOICES case mix assessment for FRS adult daily, FRS child daily, and life sharing daily. This is a genuine acuity-based restructuring of Minnesota's host-home analogue.
• April 1, 2026: DHS submits the Brain Injury Waiver five-year renewal to CMS with an April 1, 2026 effective date.
• March 2026 and July 2026: DHS announced that Waiver Reimagine will not launch by the legislature's original January 1, 2027 date. A secondary source reports the target has shifted to January 1, 2028. Waiver Reimagine consolidates the four disability waivers into two organized by living arrangement rather than diagnosis, and replaces county allocations with individual budgets. This is the largest pending structural change in any of these three states. Sources: mn.gov mn.gov brightpath-mn.com (secondary, for the 2028 date)
• July 1, 2026: Stricter qualifying criteria take effect for residential provider rate exceptions for people with high support needs, paired with a named budget reduction item on DWRS rate exceptions and input monitoring. This is a direct provider capacity risk for the highest-acuity residential placements.
• 2026 to 2027 biennium: Four explicit "Reduce Disability Waiver Growth" change items in the Governor's recommendations, covering rate exceptions, residential services, day and unit-based services, and a cap on inflationary adjustments. Minnesota is in a cost-containment posture on disability waivers even while remediating rates upward for some services.
• Jan 1, 2026: Assessment process liberalization. MnCHOICES accepts verbal confirmation instead of written signature, and people aged 21 to 65 may attest to unchanged needs for up to two consecutive reassessments, though counties must still offer a full assessment annually. Separately, assisted living facilities may not terminate a resident's contract because the resident switched from private to public funding.
• October 2026: Minnesota's FMAP rises from 50.68 percent to 51.36 percent.

Confidence

Solid: the waiver inventory with CMS waiver numbers, the DWRS architecture and its January 1, 2025 published component values including all thirteen base direct care wage lines and the seven framework components, the 2026 rate remediation scope and its exemptions, the January 1, 2026 Family Residential Services tiering, the Waiver Reimagine delay past January 1, 2027, the Brain Injury Waiver renewal date, the 62,827 monthly figure for FY2023, and the FMAP change to 51.36 percent in October 2026. Estimated: the approximately 63,000 current monthly figure and the January 1, 2028 Waiver Reimagine target both come from a secondary provider blog and should be confirmed against DHS. Could not find: per-waiver enrollment for DD, CADI, BI, and CAC separately; total disability waiver spending in dollars for any recent fiscal year; the state versus federal split; spending per participant; any current waiting list count (the only figures located, 89 people on the DD waiver list with a 79-day average wait as of January 1, 2018 and CADI's list eliminated October 1, 2016, are eight to ten years stale); appropriation amounts for the Family Support Grant, Consumer Support Grant, or Semi-Independent Living Services; the Minnesota Supplemental Aid amount that covers residential room and board; and the dollar value of the four disability waiver growth reduction change items. The mn.gov DHS site renders as navigation-only when fetched, which blocked several of these; the dhs.state.mn.us eDocs URLs fetch correctly and are the better route. The web search budget for this session was exhausted, which prevented locating those eDocs URLs for the grant programs and the per-waiver enrollment counts.