I am writing as a parent of a child who receives Medicaid consumer directed attendant care in Roanoke, Virginia. My fiancé serves as our child's paid attendant through our Services Facilitation provider, Moms In Motion. I oppose the proposal to end Services Facilitation and replace it with Support Brokers hired through the Fiscal Employer Agent.

Our Service Facilitator knows our child. She visits our home, sees how our child's needs change over time, and helps my fiancé understand plan of care rules, hours authorizations, and paperwork that would otherwise bury a working family. What matters most is that she is independent. She works for our family, not for the Fiscal Employer Agent. When we have a dispute or a question about what our child is allowed to receive, we have someone on our side.

We tried to find attendants outside the family. The pay for this work is not enough for anyone to take it on, and our daughter is not a light case. She needs 24/7 care. That is why my fiancé is her paid attendant. It was not a casual choice. Nobody else would come, and she cannot go without care.

Under this proposal, the broker who replaces her would be hired by CDCN or PPL, the same company that handles our attendant's pay. A Support Broker hired by the payroll company is not the same thing as an independent facilitator. You cannot ask the payroll company to be your advocate. Quarterly visits from a broker employed by the Fiscal Employer Agent do not replace a facilitator who knows your family and answers to you.

Roanoke is in the Western and Southwestern region, so my family faces this change on March 1, 2027, before most of the state. We are being asked to give up a relationship that keeps our child's care stable and take a broker assigned by the payroll company instead. That is not an upgrade.

I also ask you to reconsider the proposed 56 hour soft cap on personal assistance. Children's care needs do not fit a flat number, and families waiting on increased attendant hours should not see a new ceiling put in place.

Please keep Services Facilitation as an option for families who choose consumer direction.

Respectfully,

Anthony Poindexter Jr

Roanoke, VA