Damon Leivestad Direct Care Sustainability Act
SF1127, the “Damon Leivestad Direct Care Sustainability Act,” makes several changes to Minnesota’s Medical Assistance and community-based long-term care programs. It would eliminate Medical Assistance asset limits for employed persons with disabilities who are age 65 or older, and it would eliminate premiums for employed persons with disabilities. The bill also creates a designated employment incentives asset account for certain older enrollees, allowing specified assets to be disregarded when determining eligibility, and it preserves related eligibility protections for some people who lose disability-based coverage after meeting a 24-month enrollment requirement.
The bill also revises the Community First Services and Supports (CFSS) payment structure. It replaces the current single enhanced rate with tiered enhanced rate increases based on the number of CFSS hours a person qualifies for per day, and it adds separate enhancements for services provided by certain licensed or certified workers, on weekends, and overnight. The bill requires providers to use the additional revenue for wages and wage-related costs, and it updates the CFSS rate-setting methodology in Minnesota Statutes section 256B.851 to reflect the new enhanced-rate design and related wage-index calculations.
In addition, SF1127 directs the Department of Human Services to seek federal approval to reimburse CFSS delivered during an acute care hospital stay, so long as the services are not duplicative of hospital obligations and are tied to the person’s support plan. The bill also specifies that these hospital-stay CFSS services should help preserve functional abilities and support transitions back to home and community settings. Most provisions are effective January 1, 2026, or upon federal approval, whichever is later.
The overall sentiment reflected in the bill text is supportive of direct-care workforce stability and continued community-based services. The bill’s title and structure suggest an intent to strengthen wages, improve retention, and reduce administrative barriers for people with disabilities who work and rely on Medical Assistance. No committee transcripts or recorded votes were provided, so there is no documented public debate in the supplied materials to indicate broader legislative support or opposition.
Potential points of contention are likely to center on the fiscal and administrative effects of eliminating premiums and asset limits, the cost of the new CFSS enhanced rates, and the need for federal approval before several provisions can take effect. Providers and direct-care workers may favor the wage enhancements and reimbursement changes, while budget-conscious policymakers or administrators may scrutinize the cost, implementation complexity, and interaction with federal Medicaid rules.
The bill would amend Minnesota Statutes sections 256B.056, 256B.057, 256B.85, and 256B.851 to change Medicaid eligibility rules and CFSS payment methodology. It removes asset limits for certain employed persons with disabilities age 65 and older, eliminates premiums for employed persons with disabilities, and creates a new disregarded asset account for qualifying older enrollees. It also restructures CFSS enhanced rates, updates rate-calculation formulas, and authorizes reimbursement for CFSS provided during acute care hospital stays if federal approval is obtained. Several provisions are contingent on federal approval and are effective January 1, 2026, or later.
Based on the bill’s language and title, the measure appears generally favorable to people with disabilities, direct-care workers, and CFSS providers by increasing payment rates and reducing eligibility barriers. The bill is framed as a sustainability measure for direct care, suggesting a positive policy orientation toward workforce retention and community-based care. Because no committee testimony or votes were provided, there is no recorded opposition or support in the supplied materials beyond the bill’s apparent pro-provider and pro-consumer design.
The main likely areas of contention are cost, Medicaid compliance, and implementation. Eliminating premiums and asset limits could raise concerns about program expenditures and eligibility expansion, while the new tiered CFSS enhancements and wage-related requirements may draw scrutiny from budget officials and rate-setters. The hospital-stay reimbursement provision may also be debated because it requires federal approval and must be structured so it does not duplicate hospital services or conflict with Medicaid home- and community-based services rules. Direct-care advocates and disability stakeholders would likely support these changes, while fiscal conservatives or administrators may question affordability and operational complexity.