Our family supports ending Services Facilitation and moving to Support Brokers. This comment explains why from one family’s experience, and asks DMAS to build into the new model the protections the old one lacked.

ABOUT US

My brother Tom has an intellectual disability and, since August 2025, a diagnosis of dementia. He has been on the Family and Individual Supports Waiver since July 2023. He lives with me in Virginia Beach. I’m his sister, his power of attorney, and his consumer-directed attendant, providing 42 hours a week of personal assistance. An outside agency provides 38 hours a week of community-based supports, and our brother serves as Employer of Record. Moms in Motion has been Tom’s services facilitator since fall 2023.

WHAT SERVICES FACILITATION HAS LOOKED LIKE FOR US

Our first facilitator was excellent. She walked us through a confusing enrollment and was very responsive to questions, even answering email on Thanksgiving Day. She left her job in late 2024. Since then we have had a series of named facilitators, most of whom never visited Tom. As I write, I have no idea who Tom’s current Moms in Motion service facilitator is. We have had no contact since July.

The regulation is clear. Under 12VAC30-122-500, the services facilitator must monitor the plan quarterly and meet with the individual in person at least every six months. I do not know how quarterly monitoring is done but they are barely meeting the twice-a-year visits - never the same person twice in a row - and they are completely unresponsive to my requests for assistance.

Some specifics:

• In summer 2025, delays by Moms in Motion as we were coming to the end of a plan year resulted in a gap in the approval process. Though I was providing exactly the same care, I could not enter hours into the CDCN system. I spent months attempting through Moms in Motion to understand and resolve the issue. On July 17 I contacted CDCN directly, and on July 28 I contacted my Delegate’s office. By August 4, DMAS had investigated and resolved it. Months of inaction were undone within days of one contact with a state legislator. That was the second time our family needed a Delegate’s help to fix an administrative failure we did not cause.
• In August 2025, after Tom was hospitalized with seizures and diagnosed with dementia, I wrote to a Moms in Motion supervisor. I said I did not know who Tom’s facilitator was, that he had new diagnoses and changing needs, and that I needed guidance on coding my hours. I received no response.
• In spring 2026, Moms in Motion did not respond to requests to send someone to Tom’s April planning meeting. They sent a new staff person on May 22 who took notes but apparently entered bad information into the system. On June 1, they emailed a draft with numerous errors, having never asked us to review it. Over the following weeks they filed six or more documents: the plan, corrections to the plan, and answers to the state’s questions. All of it came after the plan year had begun.
• The cost fell on me. My pay was suspended during the gap, and $700 of my wages was never restored. In the prior year, appeals to backdate plans and restore attendant pay were granted. This year they were not.

Through every one of these failures, the outside agency staff who support Tom were paid without interruption. They filed the required paperwork in a timely way. Only the CDCN wages were ever suspended - because Moms in Motion failed to file the paperwork in a timely way, and CDCN declined to resolve the issue. 

THE PROBLEM IS STRUCTURAL

I don’t believe this is only about one agency. Under the current model, when a facilitator files late or files wrong, the facilitator bears no consequence. The state absorbs extra review time and the attendant loses pay. (To be clear, as Tom’s sister I am standing in the gap to make sure he has what he needs.) When there is no consequences for the party making the errors, the errors don’t get fixed.

It is easy to see why the state wants to make this change.

Some families have strong facilitators so they rarely experience these problems, which is why the family community is divided about this change. Families without a good service facilitator have little leverage. We’ve explored changing service facilitators, leaving MIM for another agency, but switching mid-plan risks the very gap we are trying to avoid, and complaints feel dangerous when that agency controls your next submission. Even submitting this comment feels dangerous – will MIM retaliate? It would not surprise me.

DMAS has recognized that service facilitators are often the cause of the gaps. In its response to comments on the previous waiver amendment, which is included in the current application, DMAS said it was disheartened that facilitator backlogs had kept service authorizations from being submitted and caused interruptions in services. I am disheartened that the state has stopped reviewing cases like ours, allowing us to recoup wages lost due to service facilitation troubles.

WHAT SUPPORT BROKERS NEED TO GET RIGHT

A new title will not fix a structural problem. The amendment describes what support brokers will do, but not what happens when they don’t. I ask DMAS to include the following in the waiver, the Fiscal-Employer Agent contract, or program guidance:

1. Submission deadlines. The Plan of Care and service authorization request should be due some number of days before the plan year begins (I suggest at least 30), and the broker should be accountable for meeting that deadline.
2. Protection for attendant pay. When a delay is caused by the broker, the Fiscal-Employer Agent, or the state, and not by the family, the authorization should be backdated and the attendant paid for hours actually worked under the existing plan. Attendants should not be the shock absorber for system errors.
3. Family review before submission. The Employer of Record should receive the draft Plan of Care, with a reasonable window to correct errors, before it is submitted.
4. Transparency with the reviewer. The Employer of Record should be copied on submissions, on questions from the reviewing agency, and on the answers. Right now we play a game of telephone: anything we say passes through someone who met Tom once, and it rarely survives to the decision maker intact.
5. A named broker and a way to escalate. Each family should have a named broker with direct contact information, a required response time, and a clear path to the Fiscal-Employer Agent and to DMAS when the broker does not respond. Families should not need a state Delegate to get a plan approved.
6. Visit records shared with the family and case management. Each visit should produce a written summary, signed in person, with a copy to the Employer of Record and case manager (supports coordinator) so families can confirm that the visits recorded are the visits made.
7. Public performance reporting. DMAS already evaluates its contractors every six months. Please publish broker performance: plans submitted on time, authorizations that lapsed, and required visits completed. You might consider requiring them to use a GPS-enabled device to record their visits – subject them to the same level of scrutiny we personal care attendants are subjected to.
8. A safe transition for spring renewals. Tidewater moves to Support Brokers on May 1, 2027, and Tom’s plan year begins May 23. Please confirm that families whose plan year renews during or soon after their region’s transition will not face a lapse, and that the 90-day authorization extension described in the application covers them.

QUESTIONS ON THE 56-HOUR SOFT CAP

Tom’s personal assistance hours are below 56, which could change as his dementia progresses, but the proposed language leaves families like ours unsure how the cap will be applied. Please clarify:

1. What counts toward the cap? Does it apply only to the personal assistance service, or to an individual’s combined waiver hours? Tom currently receives 80 hours a week in total: 42 of personal assistance and 38 of other supports.
2. Agency and consumer direction. For someone who receives both agency-directed and consumer-directed personal assistance, are the two combined toward the 56?
3. Exception criteria. The application says the exception criteria will be the same as in the CCC+ Waiver. Please publish them in plain language for DD Waiver families. Explain how progressive conditions such as dementia will be considered, and how quickly exception requests will be decided.
4. Continuity during review. Will current hours continue while an exception request or appeal is pending?
5. How supervision is counted. Most of what I do for Tom is not a task that can be checked off. It is keeping him oriented, safe, and engaged through the day, especially as his dementia progresses. The CDCN task categories and the Plan of Care goals are built around discrete tasks, so I log most of my time as “supervision,” the closest available fit. For people with dementia, supervision often is the core need. Please make sure the exception review recognizes it, and that the forms used to document need can capture it.

CLOSING

We are grateful for this opportunity to comment on the proposed changes. 

Tom worked and lived independently for 28 years. Our family supported him entirely at private expense for the first 55 years of his life, and never applied for Medicaid until 2023. We are not asking for more than his plan provides. We are asking for a system that delivers what it already promises, on time, and does not make the attendant pay for its mistakes.