I am extremely concern about the proposed changes that would reduce attendant care hours and eliminate Service Facilitator services for families like mine.
My son is 22 years old, and has severe autism, OCD, juvenile arthritis, and fragile X syndrome. He requires a very high level of  supervision and assistance with his daily activities and safety. 
The hours he has now, approved for attendant care are not excessive or unnecessary, they are actual based on his needs and the level of supervision to keep him safety. My son has severe safety risks. 

My son has severe safety risks. He can leave the house or run away from caregivers without understanding the danger. He does not understand traffic or street safety and could walk into a street or be struck by a vehicle. He may also leave public places unexpectedly, requiring constant supervision.

He needs supervision while eating because he eats very quickly and may stuff food into his mouth, creating a serious choking risk. He cannot safely prepare his own meals. He also needs assistance and supervision with showering because he can fall and cannot independently complete his personal-care needs.

There are also situations where he may vomit without understanding that he needs to turn his head, creating another choking concern. He needs ongoing supervision because he does not recognize many everyday dangers that other adults would understand.

For these reasons, reducing his approved hours based on a general limit rather than his individualized needs could leave him without adequate supervision and place him at risk.

I am also very concerned about proposed changes affecting Services Facilitators.

My son’s Services Facilitator has worked with our family for years and visits us regularly. She knows him, understands his disabilities and individual needs, and understands the services he receives. She also helps our family communicate with DMAS and navigate the Medicaid waiver system.

This relationship is extremely important. Replacing or eliminating this support would create an additional burden for families who are already providing intensive care every day.

A Services Facilitator is not simply an administrative position for our family. The continuity of someone who knows my son’s  history, needs, services, and challenges helps ensure that his care remains coordinated and that important information is not lost.

I respectfully ask DMAS to consider the real-life consequences of these proposed changes.

Please do not reduce individualized attendant-care hours solely because of a general cap or limitation when a person has documented, significant safety and care needs. Please also preserve access to Services Facilitators and allow families to maintain continuity with facilitators who know their loved ones and their care needs.

Medicaid waiver services should be based on the individual’s actual needs, safety, and ability to function—not simply on a standardized number of hours.

As a single mother providing care for my adult son, I already carry an enormous responsibility. I cannot safely reduce the supervision my son requires without putting him at greater risk.

I respectfully ask DMAS to listen to families and caregivers before implementing these changes and to protect the individualized services that people with significant disabilities depend upon.

Thank you for considering my comments and for recognizing the importance of protecting the safety, dignity, and quality of life of Virginians with disabilities.

Sincerely,

Mother and primary caregiver