Subject: Public Comment on Proposed 1915(c) HCBS Waiver Amendments — Services Facilitation, Caregiver Hours, and Family Protections

To the Virginia Department of Medical Assistance Services and Centers for Medicare & Medicaid Services:

I am submitting this public comment as a Virginia Beach resident and family caregiver who depends on Medicaid consumer-directed services to help care for a loved one with significant disabilities and complex needs.

I have serious concerns about the proposed amendments to the Commonwealth Coordinated Care Plus (CCC+), Community Living (CL), and Family and Individual Supports (FIS) waivers.

These changes affect far more than administrative procedures. They affect the stability, dignity, independence, and well-being of vulnerable individuals and their families.

Elimination of Services Facilitation

I am particularly concerned about the proposal to eliminate Services Facilitation as a standalone service and incorporate those responsibilities into a statewide Support Broker model.

Our family has developed an invaluable relationship with our current service facilitator. He understands our loved one’s individual needs, knows our family’s circumstances, and consistently helps ensure that necessary services are properly coordinated.

His dedication and compassion are so important that our family has chosen to remain in Virginia Beach partly because of the support he provides.

That relationship cannot simply be replaced through an administrative reassignment.

Before proceeding, DMAS should explain whether families will retain meaningful provider choice, whether existing relationships can continue, and how continuity of services will be protected.

Proposed 56-Hour Weekly Soft Cap

I am also concerned about the proposed 56-hour weekly soft cap for personal care and assistance under the CL and FIS waivers.

Although exceptions may be requested, families need clear information about how those requests will be evaluated, how quickly decisions will be made, and what protections will prevent interruptions in essential care.

Previous restrictions on payable caregiving hours have already created hardships.

For example, the 16-hour daily payment restriction does not change the fact that many live-in caregivers provide care and supervision around the clock.

I found the suggestion that families could simply hire another caregiver to cover additional hours deeply insensitive to the realities of caring for individuals with complex disabilities.

Qualified caregivers are not always readily available. Trust, familiarity, communication needs, medical routines, and individual comfort must all be considered.

Our loved ones’ needs do not disappear when payable caregiving hours end.

Individualized Care and Community Living

During one conversation about my loved one’s care needs, I was told that if my family member required 24-hour care, they needed to be placed in an institution.

That statement was deeply troubling.

The need for extensive assistance should not automatically be treated as justification for institutional placement.

Individuals with disabilities deserve appropriate consideration of their needs, preferences, rights, and available community-based supports, consistent with the principles of the Americans with Disabilities Act and Olmstead v. L.C.

Not every individual has the same disability or requires the same level of assistance. Policies and exception processes must account for those differences.

Oversight and Accountability

The proposed amendments also change certain Employer of Record responsibilities, eligibility review procedures, and service-plan quality measures.

I request clarification regarding the safeguards that will remain in place, how families can challenge adverse decisions, and how independent accountability will be maintained.

I am particularly concerned about removing higher-level reviews when an individual is determined no longer to meet the required level of care.

Requested Action

I respectfully request that DMAS and CMS:

1. Delay the Services Facilitation transition until a complete implementation plan is available and affected families have been meaningfully consulted.
2. Preserve meaningful provider choice and continuity of established service facilitation relationships.
3. Establish a clear, accessible, timely, and individualized exception process for the proposed 56-hour soft cap.
4. Evaluate the cumulative hardships caused by previous caregiver-hour restrictions and administrative changes.
5. Explain how eligibility protections, service-plan oversight, and accountability will be maintained.
6. Provide clear safeguards for individuals with complex disabilities and substantial daily care needs.

Closing

Behind every Medicaid case number is a human being. Behind many of those individuals is a family making extraordinary sacrifices to provide safe, consistent, compassionate care.

We are not opposed to meaningful improvements. We are concerned about changes that may create additional hardships without clear evidence that they will improve services.

Families should not have to continually fight a system that was created to help them.

Please listen to the individuals and families who depend on these services before making changes that could fundamentally affect their lives.

Respectfully,

Randall Kemp
Family Caregiver
Virginia Beach, Virginia