Serious Conflict of Interest, Care Disruption, and Regulatory Non-Compliance in the Proposed Support
I am writing as a dedicated caregiver and family member navigating the consumer-directed Medicaid waiver system in Virginia. I strongly oppose the elimination of independent Services Facilitators and the mandatory transition to a corporate, state-contracted Fiscal/Employer Agent (F/EA) Support Broker model.
This proposed model introduces a severe, structural conflict of interest that directly compromises independent advocacy. Moving Support Brokers directly under the employment of the F/EAs (such as CDCN or PPL) means our "advocates" will now be paid by the very corporate entities they are supposed to hold accountable. A broker cannot independently protect a family's rights when doing so conflicts with their employer's corporate goals.
Furthermore, this proposal appears to violate key federal Medicaid regulations:
Federal "Conflict-Free" Mandates (42 CFR § 441.301): Federal law requires a strict separation between entities managing direct administrative/financial services (like payroll and tax data) and those handling care coordination or service facilitation. Merging these roles under a single corporate F/EA umbrella creates an institutional conflict of interest.
Federal "Freedom of Choice" Rules (42 CFR § 431.51): A foundational pillar of Medicaid law guarantees waiver recipients the freedom to choose among any qualified, willing providers. Ending standalone Services Facilitation destroys a competitive market, eliminates consumer choice, and forces families into a dual-corporate monopoly with no recourse if an assigned broker fails them.
Finally, this transition represents a traumatic disruption of care for vulnerable individuals. Individuals on the developmental disability (CL and FIS) waivers rely heavily on routine, stability, and trusted relationships. Our current independent facilitator has spent time building rapport with our family, understanding our complex medical needs, and meticulously managing specialized administrative protocols. Forcing individuals to abandon their trusted facilitators will cause immense anxiety and lower the quality of oversight.
DMAS must halt the elimination of independent Services Facilitation. If the state insists on moving forward, it must legally mandate that existing, independent facilitation agencies be allowed to act as autonomous subcontractors, preserving choice, independent advocacy, and vital relationship continuity for Virginia's most vulnerable citizens.
