1. Reflections on 10 Years of Disability Employment Systems Change: Minnesota’s Medicaid Infrastructure Grant MaryAlice Mowry, MIG Director September 12, 2011 National Home and Community-Based Services Conference

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

3. 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

4. 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

5. 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

6. Systems Change Model: Change Maturity Model Control Work The new idea has been integrated into the system and is part of the expectations. Unknown Work Ideas and opportunities exist that we don’t know anything about. Adaptive Work We begin to adapt the new ideas to fit our systems. Learning Work We begin to learn about new ideas. Identify what needs to leave the system…

7. Vision/Core Values MN 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. An “Opt Out” System Make Work Part of the Plan DB101 Tools, resources, training and communications for Professionals Waivered Services Assessment (MN Choices) Advocacy Consistent Communications Inter- and Intra- agency collaboration Provider capacity State policy DB101 On-line and “live chat” tools and resources for PWD and families

14. Systems Change Model: Adaptive Action