Advocacy – Home & Community Options, Inc.

2019 HHS Omnibus Bill Overview and Competitive Workforce Factor

June 19, 2019 By HCO

Below you will find information on the 2019 Health and Human Service Omnibus Bill.

HCO is excited that the 2019 Legislative Session listened to concerns and are working to find solutions that help address provider financial stability.

Below is information from ARRM on both the HHS Omnibus Bill and additional details regarding the Competitive Workforce Factor. As you can read, the competitive workforce factor has many stipulations including CMS approval, banding, and each individual rate calculations. During the next two months we will be learning more from ARRM, DHS and CMS how each of these changes will impact HCO and our services.

HCO is committed to quality services and competitive wages. We will continue to work with our legislators, stakeholders and staff to fulfill these commitments and our HCO Mission.

Stay tuned!

If you have any questions, please contact Suzanne R. Horstman (SuzanneH@hco.org).

From ARRM:

2019 Health and Human Service Omnibus Bill Overview: What’s In, What’s Out

It’s hundreds and hundreds of pages long, spends billions of dollars, and regulates thousands of state programs and private organizations. If you’re thinking of the Health and Human Services Omnibus Budget Bill, you’re right on!

ARRM has completed its review of this massive piece of legislation. This article walks through what’s in, and what’s out, and how it matches up with the association’s priorities. Our team will be breaking down key provisions in an ongoing series of fact sheets and articles, but this provides your general overview. Items that are italicized will be featured in future blog posts in the coming two weeks with a more thorough background and analysis, items with an asterisk were included on ARRM’s 2019 Legislative Agenda.

If you have any questions about any of the items listed below, please feel free to reach out to Sara Grafstrom at sgrafstrom@arrm.org.

Included in the Health and Human Service Bill that we SUPPORT

* Competitive Workforce Factor for DWRS at 4.7%: A Competitive Workforce Factor has been added to the DWRS framework at 4.7%. This adjustment will cost the state $34 million in 2020 and 2021 and $30 million in 2022 and 2023 and represents about a 4% increase in DWRS rates.
* Change to the inflationary adjustment from every 5 years to every 2 years: Beginning in 2022, component factors will automatically be adjusted ever 2 years, using 30 month and 1 day old data.
* Requirement of an annual conversation on technology: At annual planning meetings, providers must have a conversation about how technology may be used as a part of someone’s services.
* Changes to the training requirements and qualifications for the Positive Support Professional, Positive Support Analyst and Positive Support Specialist position: Many changes were made to this service; one highlight is that the Positive Support Specialist and Positive Support Analyst now have 90 days to get their required training.
* Removal of the hourly requirements for Annual Training: The hourly requirements that were in statute for the annual training requirement have been removed. Annual training and Orientation training is now competency based.
Creation of a Technology First Advisory Council:A Technology First Advisory Council has been created with ARRM being granted a seat on the council. The goal of the council is to advise the commissioner on strategies to increase the use of supportive technology in services and programs.
Direction to the commissioner for a Value-Based Models study: The commissioner, in consultation with stakeholders shall study value-based models and outcome-based payment strategies with a report due by October 1^st, 2020.

Not Included in the Health and Human Service Bill that we SUPPORT

No caps to the DD and CADI waivers: A proposal that would have capped the DD and CADI waiver at June 30^th, 2019 levels was not adopted.
No increase to HCBS Licensing Fees: A proposal that would have increased 245D provider licensing fees from 25-300% was not adopted.
No new language relating to the closure of Adult Foster Care beds: A proposal that would have permanently closed one adult foster care bed for every two that are vacant for six months or more was not adopted.

Included in the Health and Human Service Bill that we OPPOSE

New definition of shared respite: New language states that for shared respite, the rate shall be the total payment for one individual divided by the number receiving the service, not to exceed three.
Removal of the ILS Specialist Service from the framework: The ILS Specialist Service has been removed from the framework and no longer available for providers to provide.

Not Included in the Health and Human Service Bill that we OPPOSE

* No language allowing for the expansion of variable rates for ICFs and an increase in the reimbursement for Services During the Day: ARRM’s legislative proposal that would have allowed all ICFs to request a variable rate and would have changed the Services During the Day reimbursement rate from 75% of the DT&H rate to 100% of the DT&H rate was not included.
* No extension of the licensing moratorium exception for adding a 5^thbed: During committee, the Senate amended our language around the 5 bed moratorium extension to 6 beds and removed the sunset language. There was opposition from the advocacy community around the 6 bed proposal and because of that, the entire proposal, including our language to extend the 5 bed sunset date was not adopted.

Included in the Health and Human Service Bill that we are NEUTRALon and Impacts Members

New definition provided for Residential program: A new definition of residential program has been added to 245A.02
New HCBS Documentation and Billing standards: New documentation and billing requirements have been added to 256B.4912. ARRM worked closely with the department on this language over the last several years to ensure that this language is the least burdensome to providers.
New language around change in ownership: The language provides direction and clarity for licensing and providers when a change in ownership occurs
Electronic Visit Verification Language: Language allowing the department to move forward with EVV was adopted. The language states that any penalty that the department receives due to not coming into Federal compliance cannot be passed along to providers.
New Labor Market Reporting Requirements: On an annual basis providers will be required to submit labor market data. Language is included in the bill directing the commissioner to streamline reporting as much as possible.
Report and Proposal requirements for Waiver Re-imagine: A report and proposal to move forward to streamline the four waivers to two is required to the legislature by 2021.

Broader Disability Community Initiatives

TEFRA Parental Fees Reduced by 15%
MA Spend down for individuals with a disability eliminated
Allowance of CDCS shared services
PCA SEIU Labor Contracts ratified
Bulk purchasing incontinence product program repealed
MSOCS Operating adjustment

Possibly More Then You Ever Wanted To Know About Competitive Workforce Factor

June 07, 2019

The 2019 Legislative Session delivered many changes which impact Home and Community-Based Service (HCBS) rate setting, including key provisions targeting the workforce shortage issue. These changes will benefit HCBS providers’ financial stability and ability to invest in the Direct Support Professional (DSP) workforce both in the short- and long-term. It will also require organizations to adjust the way they forecast revenue and the data they need to collect and report to the Minnesota Department of Human Services (DHS).

Competitive Workforce Factor

As previously reported in “What You Need To Know About Competitive Workforce Factor”(05/28/2019), a new Competitive Workforce Factor (CWF) of 4.7 percent has been added to the Disability Waiver Rate Setting system (DWRS). This policy, a key priority of ARRM and the Best Life Alliance, was crafted and passed by legislators with the explicit intention of supporting wage increases for DSPs. It’s important to keep this in mind as we walk through how CWF will work.

Calculation

System wide, the CWF will add an estimated $64.2 million to HCBS waiver revenue over the next four years, or an average 4 percent increase to service rates.

But wait…we said the CWF is 4.7 percent; why the difference? Because CWF is a component factor of the DWRS formula which applies only to direct staffing costs and not a flat rate increase. Therefore, it will generate a different increase for each individual rate based on the specific direct staffing costs associated with that service agreement and the other factors which compose the overall rate. To determine how much new revenue will be generated by the CWF, providers should:

Look at the DWRS framework worksheet for an individual rate
Insert the 4.7 percent CWF after the direct support costs are compiled, but before any other service factors are added
Complete the rate worksheet and calculate the difference between the new final rate and the current rate
Repeat for each rate under contract

Encumbrance, or lack thereof

Beyond understanding the business impact, why is it important for providers to start calculating this?

Remember how we said earlier that the intent of this provision was to support DSP wage increases?

While the new legislation DOES NOT REQUIRE an encumbrance of any new revenue for DSP wages and benefits…
It DOES REQUIRE providers to identify what additional revenues are generated from the CWF and prepare a written distribution plan for them, which must then be available and accessible to all direct care staff for at least a year.

DHS is also directed to provide an analysis of the CWF to the legislature every two years, and the department will certainly be tracking the comparison of revenue increases from CWF to changes in wages during that time (as will ARRM).

To ensure your organization stays ahead of questions from legislators, DHS, and your staff, it will be important to complete these internal analyses. ARRM is developing a webinar for additional guidance this issue which will be free for members and tentatively scheduled for July 19. Watch for more details.

Timing

The CWF will not change any rates until at least January 1, 2020. After that date, two milestones must have occurred for the CWF to begin delivering increases to a service rate:

The federal Centers for Medicaid and Medicare Services must have approved the new DWRS changes, including the CWF
That particular rate must not still be banded (because banding will officially end for all rates in 2020, this will only apply to individuals with banded rates who have not yet had their 2020 service renewal)

Because the timing of these two factors will vary, again we cannot say exactly when providers will begin to see revenue increases but still encourage all providers to begin analyzing what the impact will be once CWF goes into full effect.

Download the accompanying fact sheet on CWF

Legislative Update: ARRM Outlines Priorities to HHS Conference Committee

May 14, 2019 By HCO

Last week, ARRM sent a letter to each member of the Health and Human Services (HHS) Conference Committee, the group which will combine the House and Senate versions of HHS budget bills into one for final passage. This committee has several provisions in front of it related to critical issues for the home and community-based services (HCBS) more than 35,000 Minnesotans with disabilities utilize to support their independence and community inclusion.

ARRM, on behalf of its more than 160 provider members and the HCBS industry as a whole, sent a letter to conference committee members outlining its guidance on several issues. Two provisions stand out for our organization and many aligned stakeholders in this field:

Workforce investments (ARRM supports): Both bill versions introduce targeted re-investments in the reimbursement rates for services, directed to increase the wages of the support professionals who work directly with clients, up to a projected $133 million over the next four years (current statewide average just over $13/hr). This would begin to address the structural 17 percent wage gap between these jobs and other positions competing for similar workforce talent; ARRM strongly supports these measures, with a preference for the House language.
Caps on support (ARRM opposes): Language in the Senate bill would place a cap on the number of qualifying people who could receive Medicaid waivers. ARRM and other aligned stakeholders strongly oppose this measure: reducing access to the primary source of financial support for people with intellectual and developmental disabilities to receive services which help them stay out of institutional settings and maximize their abilities is not the answer to solve concerns over costs or capacity.

There are several other issues ARRM is fighting for and asked the committee to consider in its letter:

Supporting the ability for all Intermediate Care Facilities (ICF) to seek service rate exceptions for the people they support to ensure they are able to meet their changing needs
Supporting additional investigation capacity for reviewing complaints to ensure a quality and timely process, but ensuring fee increases to pay for this are recouped in cost-of-service reimbursements and do not become additional unfunded expenses on provider organizations
Preventing policy from passing which would reduce the capacity of adult foster care through the forced closure of resident slots

The scope of legislation related to this field currently under consideration will have significant impacts to this sector serving tens of thousands of vulnerable adults, and employing more than 100,000 statewide.

Legislative Update: HHS Omnibus Bills Released

April 10, 2019 By HCO

Last week saw both the House and Senate releasing their Health and Human Service Omnibus bills. While each of the bills contain quite a few changes important to Home and Community-Based Service providers, below are a couple things that ARRM is watching in each of the pieces of legislation.

House Health and Human Service Omnibus Bill

Changes to the Disability Waiver Rate System

4.7% Competitive Workforce Factor with automatic 2% changes in 2022 and 2024
Moves the inflationary adjustment from every 5 years to every 2 years and uses the most recently available data
Includes new workforce reporting requirements
Includes rate encumbrance language
- For residential providers: 66% of your rate must be used for direct care wages and employee related expenses
- For day service providers: 45% of your rate must be used for direct care wages and employee related expenses
- For unit based service providers: 55% of your rate must be used for direct care wages and employee related expenses

245D Licensing Fees

The bill includes the Licensing Division of the Department of Human Services’ proposal to increase licensing fees for 245D providers. The new fee schedule would raise fees based on revenue with changes ranging from 20%-300%.

Last week ARRM contacted members who would see their fees go up by more than 29%, with specific messaging to use when reaching out to their House member.

Senate Human Services Reform Finance and Policy Omnibus Bill

Changes to the Disability Waiver Rate System

Includes a Competitive Workforce Factor set at 4.7%
Moves the inflationary adjustment from every 5 years to every 2 years, using data that is 30 months old
Includes new workforce reporting requirements for providers
Includes encumbrance language that states that any new revenue received from the Competitive Workforce Factor must be used to increase Direct Support Staff wages

ICF Legislation

Removes the restrictions on applying for a variable rate, allowing any provider to request a variable rate for their ICF
Changes the Services During the Day rate from 75% to 100% of the DT&H Rate

ARRM’s Policy Provision

Moves the sunset date for adding a fifth bed to a home to 2021 (Note: The language was also changed from 5 beds to 6 beds)
Requires an annual conversation on the use of technology
Clarifies the Annual Training Competency based requirements
Includes changes to the Positive Support Professional Training

245D Licensing Fees

The bill does not include language that would increase licensing fees for 245D providers.

Adult Foster Care Bed Closure and DD/CADI Waiver Caps

The bill includes language that would mandate that for every two beds that are permanently vacated for over six months, the Commissioner would reduce adult foster care bed capacity by one. The bill also implements DD and CADI waiver caps as of June 30, 2019, not allowing any new waiver recipients unless someone leaves the waiver and prioritizing those waiting for waiver services by need.

ARRM’s Response

ARRM provided testimony in both the House and Senate to these bills, highlighting the provisions they support and putting on record the provisions that they have concerns or are opposed to. In the House, ARRM attempted to remove the licensing fee increase through amendment, but the amendment was not adopted. ARRM also worked in the House to draft an amendment which stated that DHS would need to study the feasibility of creating a rate system for ICF/DD similar to that of DWRS. DHS testified that the amendment would have a cost and therefore it was not adopted.

ARRM is anticipating that amendments will be taken in the Senate this week and will work with key Senate leaders to craft amendments that would work to address the concerns they have with the bill as drafted.

ARC/ARRM Days at the Capitol

March 25, 2019 By HCO

HCO self-advocates, staff, and family members recently visited the Minnesota State Capitol to attend disability services rallies for ARC and ARRM Days at the Capitol. Two buses of 45 people (90 total) signed up to attend one (or both) of the trips. Advocates attended and spoke in support of the Best Life Alliance Bill SF6/HF179. On both trips, advocates: attended the rally in the rotunda, held appointments with local legislators, and dropped off information packets to those who were unavailable to meet.

ARC Day: Tuesday, February 19th

During meetings with legislators at their morning appointments, various HCO representatives shared their experiences and concerns:

Two individuals and one support staff spoke on their specific care needs and how staff assist them in their daily lives
One individual living independently talked about the importance of the few hours of service she receives each week and how it helps her to remain independent
One staff spoke on supporting an individual with end of life care and the toll it takes on staff (watch the video here)

ARRM Day: Tuesday, March 12th

At ARRM Day, an individual served by HCO introduced Senator Miller at the rally on stage in front of over 1,000 people! When meeting with legislators at their afternoon appointments, HCO representatives spoke on numerous topics:

One individual shared how they are able to live independently because of staff support
One staff spoke on her experiences currently supporting 13 individuals who live independently and how the people she has supported for the past 18 years have impacted her life. She now has two daughters that also work for the agency.
One staff spoke on providing care to a young man with challenging behaviors and how they support him in order to keep him out of crisis so that he can continue to live in his community

Video Link for ARRM Day at the Capitol/Best Life Alliance can be found here.

February Legislative Update

February 15, 2019 By HCO

After the Minnesota Department of Human Services (DHS) reviewed and denied requests for a contested case proceeding to appeal the 7% rate adjustment under the Disability Waiver Rate System (DWRS), ARRM, MOHR, and 4 individual waiver recipients returned to the federal appeals court to file suit again. The case was back before Judge Wilhelmina Wright to review, and she had 60 days to respond with a verdict. On February 15th, Judge Wright dismissed the lawsuit, citing that there were multiple points where plaintiffs lacked the standing to push the case forward in federal court – particularly centered on whether irreparable harm from the cuts was truly significant and unavoidable. She did not, however, issue a ruling as to whether the overall action by DHS overstepped its authority or the law, leaving the possibility open for future litigation in either state or federal court.

From ARRM:

Business is speeding up dramatically at the State Capitol on a host of legislative priorities for ARRM, as well as new related legislation.

On Monday, February 11^th, the Best Life Alliance Legislation (HF 179) was heard in the House Health and Human Service Policy Committee. ARRM author, Rep. Laurie Halverson, presented the bill and Judy Marder, chair of the Best Life Alliance group, provided testimony in support of the bill. The bill was referred to the Ways and Means Committee through a unanimous roll call vote and has now been re-referred to the Health and Human Services Finance Committee.

In addition to the Best Life Alliance proposal, an alternative proposal was also heard during committee on Monday. HF 168, which is carried by Rep. Jennifer Schultz, was heard and amended. The amendment does the following:

Moves the inflationary adjustment from every 5 years to every 2 years and accesses the most recently available data when making the adjustment
Officially removes the 7% from statute, effective retroactively to July 1, 2018
Requires providers to pay Direct Support Professionals, at a minimum, the amount that is listed in the Base Wage within DWRS for that particular service
Puts new reporting requirements on providers focused on workforce

As written, ARRM and the Best Life Alliance have concerns with the amendment because it puts new requirements on providers for compensation but does not provide any new funding. The bill’s author has indicated that additional amendments will be presented during future committee meetings that work to address these concerns.

During committee, ARRM and MOHR members were able to testify and bring forth their concerns about the bill as drafted. ARRM member Butch Karcher of Karcher Foster Services offered testimony on the workforce crisis and the struggles he, along with other providers, are facing around staffing. MOHR member Lynne Noren of Rise provided testimony outlining concerns with the mechanics and implementation of the bill language as written.

Workforce Hearing in the Senate
Also on Monday, Senator Jim Abeler held a hearing in his committee, Human Services Reform, Finance and Policy, focused on the workforce crisis in long term care services. ARRM staff and members provided testimony. Additional testimony was taken from the advocacy community and the older adults community. While there was no direct outcome from this hearing, it was a good opportunity to be able to get important messaging in front of the committee and continue to push for legislation to help address the workforce crisis.

You can watch clips of the hearing on ARRM’s Facebook page.

Progress on other ARRM Bills
ARRM’s ICF bill (SF 909) was heard in the Senate Human Services Reform, Finance and Policy Committee. ARRM’s Director of State and Federal Policy, Sara Grafstrom, testified on behalf of the bill along with lead author, Sen. Bruce Anderson. The bill was laid on the table until a formal fiscal note is available.

ARRM’s Policy bill (HF1256) was introduced in the House on Thursday; carried by Rep. Hunter Cantrell. ARRM is working with leadership to obtain a hearing for this bill in both the House and Senate.

Looking Ahead to Next Week
On Tuesday, February 19^th, the Governor’s budget will be released. Please watch for information from ARRM and the Best Life Alliance on any potential actions that may be needed from our grassroots advocates in response.

Stay tuned for more updates as they become available through HCO’s Grassroots Blog or at ARRM’s website.

ARRM: January Legislative Recap

January 23, 2019 By HCO

Best Life Alliance Legislation: (SF 6/HF 179)

The Best Life Alliance bill has been introduced in both the Senate and the House. The bill received its first hearing this past Wednesday in the Senate Human Services Reform and Finance Committee. ARRM Board member Cindy Ostrowski from Hiawatha Homes offered testimony to the importance of ending the 7% cut.

In addition to the Best Life Alliance legislation, alternative legislation has been introduced in both the House and Senate. SF 92/HF 168 would set the Competitive Workforce Factor at 4.55% which would buy back about 3.8% of the 7% cut. SF 92 was also heard in the Senate Human Services Reform and Finance Committee this past Wednesday.

It is important to remember that while there are alternative proposals being introduced, the Best Life Alliance, as well as ARRM is committed to advocating for the full buy back of the 7% cut. Please watch for future action alerts for guidance on how you can lend your voice to the efforts!

ARRM Policy Bill: (SF 174/HF XXX)

ARRM is once again bringing forward a policy bill that contains similar provision to the bill that was contained within the Supplemental Spending bill last year and was vetoed by Governor Dayton. The bill was introduced in the Senate this last week and will hopefully be introduced in the House next week.

In addition to the stand-alone bill, Senator Abeler has introduced SF 74, which is a “mini omnibus” bill of policy provisions from last session that had agreement on. All of the policy provisions that ARRM brought forward last session are also contained within SF 74 – ARRM will continue to monitor the progress of that bill.

ICF Legislation and Unfunded Mandate Legislation:

ARRM is in the process of gathering authors for these two pieces of legislation and they hope to have them introduced within the next couple weeks.

Service Termination Legislation:

ARRM has a small group of members that are working on service termination legislation. The legislation would tighten the timelines for judicial review when a service termination is appealed and clean-up language within the current service termination statute. They are still in the process of meeting with stakeholders about this legislation and addressing concerns with the language that are being brought to them. ARRM hopes to move this language forward to the drafting process within the next few weeks.

Stay tuned for more updates as they become available through HCO’s Grassroots Blog or at ARRM’s website.

HCO Acknowledges 2018 Self-Advocate of the Year: Milton Topness

December 11, 2018 By HCO

Milton and Guests

Home and Community Options is excited to honor an individual who has been a leader in self-advocacy for many years: Milton Topness.

Milton has become a recognized self-advocate within many circles of self-advocacy. He remains one of the longest standing members of the Winona People 1^stgroup, spanning over 20 years. Milton has served as a member of the SAM SE (Self Advocates of Minnesota- SE Region) for almost 10 years. In 2010, he received the Self-Advocate of the Year award from ARC Southeastern Minnesota. He is also an active member of the Home and Community Options-Grassroots Advocacy Task Force which has been in place for many years.

Milton is modest but not shy when it comes to speaking up. He wants to be heard, and expresses what is important to him. Milton understands the importance of the voices of the self-advocacy movement and the need for our legislators and state representatives to hear these voices. He is strong in his beliefs, while at the same time sees himself as a learner who welcomes input and ideas from others. He is very proud of how far he has come in his self advocacy and enjoys the many connections he has made with other self-advocates around the state.

Milton has served in a variety of capacities within the self-advocacy circles. He has been a member of the SAM leadership council and has served as the Media and Legislative Specialist and the Sargent of Arms. He currently is taking a step back from elected positions as he feels others need to step up and have the opportunities he has had, but he continues to work diligently in helping to plan many regional and state self-advocacy conferences. Milton continues to be an eager leader within the People 1^stof Winona group and will often volunteer to lead the meetings, provide input, and assist others.

Home and Community Options has a long-standing history of self-advocates who are actively engaged in advocacy at both the local and state level. While Home and Community Options has had a strong self-advocacy presence for many years, this is the first year for this Self-Advocacy award.

September Update: DHS Denies HCO appeals

September 10, 2018 By HCO

The Minnesota Department of Human Services (DHS) reviewed HCO’s request for a contested case proceeding to appeal the July 1, 2018, 7% rate adjustment under the Disability Waiver Rate System (DWRS). DHS determined that Minnesota Statutes do not authorize a contested case proceeding in this circumstance, and have denied the request.

We are currently working to determine future courses of action, which may include potentially returning to the federal appeals court to file suit. HCO continues to work closely with ARRM and MOHR to explore all avenues available to address the 7% adjustment, and more information will be released as it’s made available.

7% Cut: Update

August 6, 2018 By HCO

HCO’s August Update:

The appeal for an emergency injunction was denied by the Judge, in part because she determined that providers must pursue state administrative remedies before seeking extraordinary relief. HCO will use the administrative appeal process to contest the 7% cut.

Rate cuts, along with the staffing shortage and the increased number of unfunded mandates have had a huge impact on services. For the past five years, HCO has shouldered the brunt of these expenses. HCO teams are diligently working to develop modified service plans to maintain unit-based programming. This will impact the minimum length of shifts or the need to come to licensed sites for services.

We hope that by making these modifications, we will be able to mitigate the effect of the 7% cut and other issues to continue to provide quality services to the individuals we support.

August 17th:

Senator Abler was recently interviewed on the Capitol Report and shared the importance of restoring funding for disability services

You can find additional information about the 7% cut and how you can get involved at:
Best Life Alliance
ARRM

Get to know William. Despite some challenges, William is thriving.

March 10, 2018 By HCO

William has been self-employed for over 30 years. At 65 years old, he does all his own repairs on lawn and snow equipment, as well as on his own vehicles. He runs his own mowing and plowing business and has provided this service to his customers for many years. Though he is active in the community, he also has some challenging medical needs. William has diabetes and stage 3 chronic kidney disease.

William’s support staff, Jeni, has worked with him for 12 years. Jeni works diligently to ensure he gets to his numerous medical appointments, helps him monitor his blood sugar levels, and makes sure he takes his daily medications at the appropriate times. She assists him in filling out his MA paperwork every 6 months, and also helps him establish and maintain his own health care directives. Because he owns his own business, Jeni helps William track his income and expenses so that he can do his taxes at the end of the year, and she also acts as his rep payee for Social Security. William comments:

“I’m so happy and pleased to have Jeni. She is a wonderful help to me.”

There’s something you should know:

If William didn’t have the 4 hours of support he receives each week, he would not be able to live on his own. He would most likely have to move in with his closest relative, who lives almost 2 hours away. He does not want to leave the life he has built here in Winona, or say goodbye to those he has formed relationships with over the years.