Hennepin County: Waiver Finance


Our team monitors and allocates funding for Hennepin County’s disabled population that are on Federal Medicaid waivers. We adhere to federal, state and county policies to minimize risk to county tax payer dollars.  The team is comprised of a supervisor and three staff members that have input on allocation of funding and enrollment. Our goal is to maximize spending of the budget received from the state to enroll or assist as many eligible people as possible for waivered services. At present, there are approximately 8,800 waiver recipients in the county.

Before consulting with SCC, our environment was filled with controversial and toxic communication that resulted in delayed services, lack of services and denial of services for eligible waiver recipients. Since there was a lack of trust between our team and the service area that has responsibility for seeking services and waivers for eligible recipients along with numerous unwritten policies and procedures applied to the same population, email was the only form of communication.

Several attempts to institute face-to-face or phone conversations between our staff and members from the service area were thwarted and communication became worse. Our team had experienced multiple leadership changes over the last three years. Members were anxious to be heard and felt that when they brought issues and resolutions forward they had fallen on deaf ears and they were not given proper credit for the work they had performed.

What were the issues you faced? Why did you seek out a consultant?

Our team was facing breakdowns in communication and/or miscommunication between our team, service area and customers of the service area. Policy interpretations were a big part of the issues. However, missing information or lack of clarity regarding funding was another key issue that caused divides among the staff.

When communication took place it was over email that often contained as many as five or more separate strings of emails pieced together. One instance had 23 email strings that made communication confusing because no one could tell what the question was or what had already been answered, or who asked and answered which parts.

Getting staff and service areas to agree on what part of the decision making process each owned continues to be an issue. We control the administrative part, and the service area controls the clinical side. However, they often intersect causing friction and indecision for both parties that affect the client in the form of missed opportunities or delays in receiving service.

Working with your consultant(s), what action(s) did you take/changes did you make to overcome this problem and move forward?

After taking individual assessments and reviewing the team’s combined assessment, we determined our areas of strength and need for improvement. We decided to build on our strengths while we improved opportunities to build trust, commitment to one another and define objectives to get results. We met as a team to define our roles and responsibilities, stopped doing work we weren’t responsible for and allowed and encouraged other areas to do their part and we would be available as a resource.

Additionally, we created processes that brought clarity on what we need in order to provide funding and why it is necessary for us to have certain information as well as the policy that supports the need for the requested information. We collaborated with the service area and their customers to get a basic understanding of each other’s job functions and how we could help each other gain efficiencies.

Positive outcomes: Which parts of this process of change went well and why?

We’ve experienced better communications that have led to transparent collaboration with our partners to make processes more efficient. The team trusts the processes because they were involved in guiding key decisions that get results. Meetings provide more clarity and include a decision making and responsibility assignment. This allows everyone to review minutes at will to remind them of discussions, key objectives and outcomes. People were added to all waiver programs, an accomplishment that hadn’t occurred for several years.  Fewer people lack services due to conflicts and misunderstandings between our team and partners. We now receive compliments as opposed to complaints.

Negative outcomes: Which parts of this process of change didn't go so well and why?

In the beginning some team members were resistant to take the assessment to get results that formulated a team report. Some felt the results would be used to move them from their current position to a different one they may object to. Additionally, members thought the survey was not approved by the department and would be useless. However, participants confirmed individual results were accurate and useful. The results helped them to see where they could improve by tweaking one or two areas.

Once there was buy-in the team was able to move forward and concentrate on the results of the assessment to make our working relationships more palatable. In times of high stress team members revert back to directing the process as opposed to collaborating. However, gentle reminders and influence gets them back on track to getting better outcomes by giving others a voice in the process just as they had sought previously.

Lessons learned: What were the key learnings of this experience?

Although we all want excellence, everyone has a different definition of what that looks like. Compromise is not easy when there is resistance. Once everyone’s perspective is known attitudes of resistance diminish. Inclusiveness renders better results than being directive. Transparency and collaboration help everyone accept what needs to happen.