Reflections on 10 Years of Disability Employment Systems Change:Minnesota’s Medicaid Infrastructure Grant

MaryAlice Mowry, MIG DirectorSeptember 12, 2011National Home and Community-Based Services Conference

The Challenge: Move from an “Opt in” to an “Opt out” system

Systems Change Model: Self-Organizing Systems

A collection of individual agents, who have the freedom to act in unpredictable ways, and whose actions are interconnected such that they produce system-wide patterns.

• Ensures that all parts of a complex system act together in coherent ways.

• Over time participants will generate coherent patterns across the system.

Short List of Simple Rules

• Make connections; act across “silos”.

• It’s got to be about infrastructure.

• It has to be sustainable.• This is about ALL people with

disabilities.• It’s about people, not programs

Pathways to Employment: Short List of Simple Rules

Pathways to Employment: Changing the Conditions for Self-Organizing

• Multi-agency collaborative design• Blending and braiding funding• 5-year Strategic Plan• Grant-making that created new

opportunities• Encouraged innovation by imposing only

essential constraints• Built upon “exchanges” that already

existed

Systems Change Model: Change Maturity Model

ControlWork

The new idea has been integrated

into the system and is part of the expectations.

UnknownWork

Ideas and opportunities exist that we don’t know

anything about.

Adaptive WorkWe begin to adapt the new ideas to fit

our systems.

Learning WorkWe begin to learn about new ideas.

Identify what needs to leave the system…

• Vision/Core ValuesMN Department of Human Services

Continuing Care Division Vision

C ─ Community membership / integration H ─ Health, wellness and safety O ─ Own place to live I ─ Important long-term relationships C ─ Control over supports E ─ Employment earnings and stable income

• Changing mindsets

Pathways to Employment: Control Work within DHS - Disability Services Division

Pathways to Employment: Control Work / Sustainability Planning

• Creating a communications framework– Integrated messaging– Tools

• Supporting development of external capacity– MN Employment Policy Initiative– MN Training and Technical Assistance Center– MDE grants– Seven-County Metro Group

DB101:A Platform for Transformation• Support at all stages

• An expanded benefits planning systems

• What DB101 has to offer• Content• Estimators• Experts

Exploration & Planning Tool

DLL & db101.org

Phone & Online Assistance

Formal Benefits Planning

Work Incentives Connection

In-depth Phone & 1:1 Assistance

Data & Information

DHS

Back-end Support

Pathways to Employment: Control Work / Sustainability Planning

• Developing and embedding expertise– Training– Policy– Assessment

• Creating policy agenda and developing policy capacity– Medicaid Buy-In policy that incents work– Tracking employment-related policy across

agency

Sources: State taxes paid from MN Dept. of Revenue; Total annual premiums billed from MN Dept. of Human Services Special Recovery Unit. *reports amount of state taxes paid after tax credits**Represents total return to State, ½ of premiums collected go to federal government per federal medical assistance percentage

• Developing collaborative relationships within DHS and externally– “Connecting the dots” – keeping apprised of and

supporting various disability employment –related efforts

• Health Care Eligibility• Health Care Financing• Minnesota Family Investment Program• “Employment is a key protective factor…”

• Seizing opportunities– Money Follows the Person– Medicaid Reform Waiver

Pathways to Employment: Control Work / Sustainability Planning, cont.

An “Opt Out” System

Make Work

Part of the Plan

DB101Tools, resources, training and communications for Professionals

Waivered Services

Assessment (MN Choices)

Advocacy

Consistent Communicatio

nsInter- and

Intra-agency collaboration

Provider capacity

State policy

DB101On-line and “live chat” tools and resources for PWD and families

Systems Change Model: Adaptive Action