Good, Better, Best — Continuous Improvement in Minnesota’s Choices System
One of the standout themes at the ADvancing States HCBS Conference in Baltimore (August 2025) was the importance of continuous improvement. In a field where policy, workforce, and technology all intersect, no system can remain static. Minnesota’s Choices program offered a masterclass in what it takes to build, refine, and sustain a truly person-centered assessment and care planning tool.
The session, titled “Good, Better, Best — A Commitment to Continuous Improvement is the Secret to Success,” was led by:
Sandy Holms-Stella, Minnesota Department of Human Services (DHS)
Mary Lenertz, Minnesota DHS Disability Division
Darcy Buttki, Minnesota DHS
In partnership with FEI Systems
Together, they walked attendees through the evolution of Minnesota Choices — a system that has moved from paper and silos to a fully certified, agile, and user-informed platform that touches thousands of lives each month.
What Is Minnesota Choices?
Minnesota Choices is a person-centered assessment and care planning tool used to determine eligibility for long-term services and supports (LTSS). It is:
A computer-based application used by counties, tribes, and managed care organizations.
Designed to help older adults and people with disabilities make informed decisions about their care.
Central to the state’s vision of a uniform assessment process across programs and populations.
Before Choices, assessments were fragmented. Each LTSS program had its own system, creating duplicative assessments and especially confusing processes for people who were dually eligible for Medicaid and Medicare.
The History of Choices
Pre-2013: Assessments were program-specific and siloed.
2013: Minnesota launched its first unified assessment system.
2016: Added a support planning application. But instead of streamlining, it merged multiple systems in a way that was resource-heavy and inefficient.
2023: Major revision with FEI Systems as a SaaS partner. Focused on certification, customization, and continuous user feedback.
This iterative history underscores a key lesson: system integration isn’t a one-time event — it’s a long-term investment in design, certification, and improvement.
Why Certification Matters
Minnesota went through the heavy lift of securing CMS certification for Choices. Why? Because certification isn’t just a stamp of approval — it unlocks federal matching funds:
During development: 90% federal match
During maintenance: 50% federal match
After certification: 75% federal match
Pro tips for certification (from the MN team):
Partner closely with internal IT and vendors — lean on their experience and resources.
Be clear and transparent about data origins and security. CMS will scrutinize both.
Practice, practice, practice for review sessions; use plain language and get broad input.
Plan for agile releases (every 4 weeks) and continuous feedback.
Certification was not just a technical achievement — it was a strategic financing move that ensures sustainability.
Wins So Far
Minnesota DHS highlighted several successes since relaunching Choices:
Sunsetting paper processes to eliminate duplication.
Automated recertification workflows.
Snowflake access for MCOs to securely build reports.
Standardized datasets for consistent reporting.
BlueZone scripts for smoother data entry into MMIS.
User feedback loops leading to ongoing agile releases.
Perhaps most importantly: a single assessment now produces consistent results across agencies, reducing confusion and improving communication.
Challenges and Observations
Despite successes, the system still faces real-world challenges:
Time intensity: Assessments can take 10+ hours; support plans add another 2 hours.
Multiple systems: Users juggle 4–5 systems in parallel.
Irrelevant questions: Some age- or program-specific questions frustrate users.
Manual data collection: From families and physicians, later entered into Choices.
Frequent support plan revisions causing confusion.
Feedback has been overwhelmingly positive on usability (“easy to train new users,” “scroll spy,” “auto-population”), but the workload issue is front and center. Minnesota is already exploring AI-driven tools to reduce “clicks,” automate data entry, and streamline workflows.
Continuous Improvement in Action
The team emphasized that Choices is not a static product. It is governed by a strategic roadmap with built-in processes for feedback, improvement, and user engagement. Examples include:
User workgroups to identify unknown challenges and potential enhancements.
AI pilots to scan documents and input data.
Workflow dashboards to track assessment and support plan statuses.
Defect and enhancement tracking to improve quality assurance.
Every month, over 12,000 assessments are completed in Choices. With volume this high, continuous improvement isn’t optional — it’s essential.
Looking Ahead: Waiver Reimagine and Person Portals
Minnesota is also aligning Choices with broader policy reforms:
Waiver Reimagine: Simplifying from four waivers to two, shifting from diagnosis-based to lifestyle-based eligibility (home vs. facility).
Self-direction expansion: Embedding consumer direction beyond just one program.
HCBS Person Portal: A future consumer-facing portal where individuals can log in to view their assessment, budget, and care plan.
These initiatives demonstrate how IT modernization is inseparable from policy reform. A flexible, certified system like Choices makes it possible to adapt as policies evolve.
Governance: Formalizing Oversight and Accountability
Another key theme was governance. Minnesota DHS has formalized structures to clarify:
Oversight roles and authority
Accountability mechanisms
Decision rights for IT strategy and resources
This ensures that Choices isn’t just a tech tool but a governed system aligned with compliance, funding, and program priorities.
Why This Session Mattered
While many HCBS conference sessions focus on workforce or service delivery, this one highlighted the infrastructure backbone that makes those efforts possible. Without certified, user-friendly systems, policy ambitions remain stuck in silos and paper processes.
Minnesota Choices illustrates how:
Certification translates into sustainability via federal match.
Continuous improvement keeps systems relevant for users and beneficiaries.
Integration reduces burden on workers, MCOs, and families alike.
Policy reform is only possible with system reform.
My Reflection
This session reinforced something I see often in my consulting work: policy, workforce, and technology are interdependent.
If we want to simplify waiver structures, expand self-direction, or empower consumers with portals, we can’t do it on paper-based, fragmented systems. Minnesota’s story shows the power of iteration — trying, failing, refining, and moving forward with a relentless commitment to improvement.
And perhaps most importantly, it showed that “good enough” is not good enough. The mantra of good, better, best is what allows systems to keep pace with both user needs and federal expectations.
As federal initiatives like the OBBB Act and the Medicaid Access Rule reshape HCBS, states that invest in continuous improvement today will be best positioned to implement those changes tomorrow.
