A backlog at the Minnesota Department of Human Services has kept some lower-income people with disabilities from daily support services. Others are at risk of a gap in those services.

Hundreds of applications related to that care, known as Integrated Community Supports (ICS), sit unprocessed.

Justina Blatterman has been waiting for one such application to be processed. She relies on round-the-clock care, including a personal care attendant (PCA).

Those services are managed by non-profit Accessible Space, Inc. (ASI).

Blatterman has plans to move to a new apartment closer to her community in Roseville, a move that required ASI to send an application to DHS for approval to continue to care for her in the new location.

Josh Berg, Director of Minnesota services and strategic growth for ASI, said the organization already provides services at that facility for several residents but needs approval to expand the number of units it’s authorized to support.

ASI sent that application to DHS in April 2024, and it hasn’t been processed more than a year later, according to Berg.

Blatterman has been on a waitlist for the Roseville apartment for four years. Now, she has to decide whether to take it and risk losing the care she relies on, or turn it down and get kicked back to the bottom of the wait list.

“It’s so simple. But they’re making they’re making it harder,” Blatterman said.

DHS declined multiple interview requests, saying they were “unable to accommodate it.”

So, we asked in an email why it has taken more than a year to process her application.

DHS did not answer that question directly. Rather, the agency said it’s prioritizing applications “outside the metro” where services are “limited,” adding that people can live where providers are already authorized or “…receive services from a different provider.”

“I can do that, but I’m asking them not to force me to do that, because there are no PCAs out there,” Blatterman said.

“ASI is the only one I found that can provide 24-hour service,” she added.

As of the end of May, DHS had a backlog of more than 400 applications dating back to at least 2023.

Asked why they’re behind, DHS said, in part, these reviews “…intensive and DHS has limited staffing resources.”

“So they haven’t processed an application, it’s my understanding, since October of 2023 in these counties, and we don’t know when or if there’s any light at the end of that tunnel,” Berg said.

“And in this particular location, we have staff available. We already have staff on site 24/7, we have nurse availability. We are ready to go aside from the one-page application update.”

According to Berg, DHS initially told ASI that the application would take up to six months to process. That was 14 months ago.

Asked if DHS is or has taken any effort to improve its ability to process these applications, a spokesperson responded, “There were legislative proposals related to ICS capacity and ICS setting application prioritization in 2025; none were passed by the legislature.”

Asked if he was satisfied by that response, Berg said, “No, it’s not good enough. And I think our system defaults to the barriers and, ‘Well, we can’t do anything about it,’ and, ‘We don’t have the legislation,’ ‘We don’t have the statutes,’ ‘We don’t have the cover to do what we need to do.’ I think we do, and I think we have the will and we have the ability, and we have the commitment from our legislators and others to be able to make this work.”

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See DHS’s full response to some email questions below:

Why has it taken more than a year for DHS to process some complete applications?

“Every proposed ICS setting going through an ICS setting review is addressed individually and intensively to ensure providers meet compliance with the HCBS settings rule and providers must comply with all requirements for HCBS settings in 42 C.F.R. 441.301(c). Setting reviews are intensive and DHS has limited staffing resources. There is a lot of availability for the service in the metro area. DHS has prioritized settings outside the metro area to ensure service availability in greater MN.“

Is there a reason(s) that Justina’s case, which is referenced in my initial email, has been delayed beyond 90 days? (I’m told it’s roughly 14 months delayed.)

“Individuals do not have ICS cases, providers do.  Please see the above answer regarding the extended timeline for provider processing.Individuals and their county case managers identify which services fit the individual’s needs. A person may move into open units where a provider has a pending application to deliver ICS. If a person chooses to utilize home and community-based services while residing in that unit, the waiver services must be delivered by a different provider than the provider who is applying for the integrated community supports setting. People can live in a setting in which a provider is authorized to deliver ICS and receive services from a different provider.“

Would you consider DHS delayed and/or backlogged in processing these applications? Why or why not?

“Yes. There is a long wait for potential new providers or providers who would like to make changes to existing ICS settings in the metro area. DHS is focused on review and approval of ICS settings in greater MN. As part of our waiver plan requirements with the federal Centers for Medicaid and Medicare Services (CMS), DHS must assure that services are available statewide. Provider demand exceeds services needed in the metro counties while availability of the service in greater MN is limited.”

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