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Minnesotans take care of each other. That’s our promise. But many of the proposed Department of Human Services (DHS) “program integrity” legislative ideas put that promise in danger for people with disabilities who rely on steady, human support to live, work and stay connected. When they get this wrong, it won’t be a policy glitch — it will be missed medications, lost housing, and a knock at the door from a staff person who has to say, “I can’t come anymore.”
Yes, we must stop fraud. But proposals now starting to leak out would continue to break care first and sort it out later. The clearest example is a plan to convert Integrated Community Supports (ICS) from an average daily rate to tiny 15‑minute billable chunks with caps and extra prior authorization. On a spreadsheet that looks tidy. In a living room at 7 a.m., it looks like staff watching the clock instead of watching for a seizure, or cutting a visit short when someone is overwhelmed and needs extra time to calm down. You can’t slice a relationship into 15‑minute pieces and call it “integrity.”
Other changes pile on: new billing limits across disability and older adult services, expanded electronic check‑ins, tighter documentation rules, and an end to some remote support options that helped people stay stable during workforce shortages. Big providers with compliance teams might manage. Small, rural and culturally specific providers — the ones families turn to because they understand language, culture and history — will struggle or close. When they disappear, people lose more than a provider; they lose the trusted person who knows their routines, their triggers, their hopes. That’s what continuity of care really means.
The most alarming piece gives the state more power to stop provider payments and makes it harder — or impossible — to appeal at all. A payment “withhold” isn’t a timeout. It’s a knee to the neck. Payroll stops. Staff leave for steadier jobs. Appointments vanish. Apartments are lost. Even if an allegation is later disproved, the damage is already done. We cannot claim to protect the program while pulling the rug from the people the program exists to serve.
Here’s a better path that protects both dollars and dignity:
- Put continuity of care into law. Before any disruptive action, require a person‑centered plan that keeps services in place — backup staffing, a warm handoff when needed and extra protections in rural areas where there is no “next provider.”
- Use the lightest effective intervention. Start with targeted audits and corrective action. Reserve immediate withholds for verified, urgent safety risks — not an algorithm flag or a paperwork error.
- Restore due process and transparency. Keep fast appeal rights and share evidence so providers can correct mistakes — or be held to account — without people losing care in the meantime.
- Do not unitize relationship‑based care. Keep ICS as a daily rate and fix documentation with simple tools, coaching and a real‑time help desk so it’s easier to do the right thing.
- Fund the change you expect. If new rules add work, pay for training and startup costs — especially for small providers — so compliance doesn’t mean closures.
If you want to know what’s really at stake, don’t look at the budget book. Look at a Tuesday afternoon when a direct support professional shows up to help someone get to work, manage anxiety or make dinner with their roommate. If that worker stops coming because their agency couldn’t make payroll, everything unravels fast: no ride to work, no paycheck, late rent, eviction risk, hospitalization. That is how people end up in institutions or homeless or dead — not because they did anything wrong, but because policy treated them like an entry in a claims system instead of a human being.
