Leslie W. Simpkins

Pembroke, Virginia

Parent, Caregiver, and Advocate for Nathaniel “Nate” Simpkins

October 16, 2026

 

To:

The President of the United States

Members of the United States Congress Representing Virginia

The Governor of the Commonwealth of Virginia

Members of the Virginia General Assembly

Virginia Department of Medical Assistance Services (DMAS)

Service Facilitators and Medicaid Waiver Stakeholders Throughout Virginia

 

Subject: Urgent Request to Protect Virginia’s Service Facilitators, Defend Dedicated Professionals, and Preserve the Rights of Medicaid Waiver Recipients

 

Dear Elected Officials, State Administrators, and Community Leaders:

I am writing today not only as a concerned citizen of the Commonwealth of Virginia but as a mother, a caregiver, and an advocate for my adult son, Nathaniel “Nate” Simpkins, who depends on Medicaid waiver services and the professionals responsible for helping our family navigate them.

I am writing with a deep sense of disappointment and concern regarding the possibility of eliminating or significantly changing the service facilitator role in Virginia. More importantly, I am writing to defend the professional integrity, dedication, and outstanding service of our family’s service facilitator, Reece Vanhoozier, who has consistently demonstrated what this profession is supposed to represent.

For families like mine, service facilitation is not simply an administrative function. It is a critical part of ensuring that individuals with disabilities receive the services, guidance, oversight, and support they need to remain safe, supported, and cared for in their homes and communities.

I refuse to remain silent while dedicated professionals' risk being penalized for the failures of others, and while families who have followed the rules face the possibility of losing essential support.

A Professional Worth Defending: Reece Vanhoozier

I want to recognize Reece Vanhoozier publicly and unequivocally for the exceptional job she has done advocating for my son and supporting our family.

Throughout our experience working with Reece, she has proven professionalism, reliability, accountability, compassion, and an unwavering commitment to the individuals she serves.

She has shown up when expected. She has completed her responsibilities on time. She has communicated with our family, helped us understand requirements, and consistently worked to ensure that our services and necessary documentation remained on track.

We have never had reason to question her work ethic, her dedication, or her willingness to advocate for Nate.

We have never experienced missed responsibilities, preventable lapses in our services resulting from her performance, or the frustration of having to chase down a service facilitator who failed to do his/her job.

In a system that can already be complicated, stressful, and overwhelming for caregivers, having someone like Reece makes an extraordinary difference.

She understands that behind every case file is a real person. Behind every service authorization is an individual with needs. And behind every caregiver is a family doing everything possible to provide safety, dignity, stability, and quality of life for someone they love.

Reece has never made our family feel like just another number.

She has been present. She has been dependable. She has been accountable. Most importantly, she has been an advocate.

That is the standard every service facilitator should strive to meet, and it is precisely the kind of professionalism Virginia should be working to preserve.

 

Do Not Punish Every Family for the Failures of a Few

I understand that accountability is necessary in any publicly funded program. Medicaid waiver services involve taxpayer dollars, federal and state regulations, documentation requirements, and an obligation to ensure that individuals receive proper services.

If there are service facilitators who have failed to complete required visits, neglected their responsibilities, falsified documentation, failed to submit paperwork on time, or otherwise violated established policies, those matters should be investigated and addressed through proper administrative or legal processes.

Individuals found responsible for misconduct should face consequences consistent with the facts, applicable laws, and due process.

However, the misconduct or deficient performance of some individuals should never be used to justify punishing every qualified professional or every vulnerable family taking part in the program.

That is not accountability. That is collective punishment.

Why should my son lose access to a trusted professional because someone else did not perform their duties?

Why should families who have followed every requirement suddenly face uncertainty, added administrative burdens, or disruptions to their care?

Why should professionals like Reece Vanhoozier, who have consistently done their jobs correctly, be placed at risk of losing their roles because of failures they did not cause?

And most importantly, why should individuals with disabilities bear the consequences of decisions made by people who are supposed to protect their interests?

These are questions that deserve direct answers from the Commonwealth of Virginia and every agency involved in administering these programs.

 

Families Like Ours Already Carry an Enormous Responsibility

Caring for an adult child with disabilities is not a responsibility that ends at five o’clock in the evening. It does not stop on weekends, holidays, or when a caregiver becomes sick.

It is a responsibility that continues 24 hours a day, seven days a week.

As Nate’s mother and caregiver, I understand firsthand the physical, emotional, and administrative responsibilities that come with ensuring that he receives the support he needs.

Families like our coordinate attendant care, respite services, appointments, authorizations, paperwork, and countless other responsibilities that many people never see.

We must plan for emergencies, unexpected illnesses, changes in caregiver availability, and circumstances that can affect our ability to provide care safely.

We depend on Medicaid waiver programs not because they are convenient, but because they help make home- and community-based care possible.

Service facilitators are an important part of that process. They provide guidance, help families understand program requirements, and support compliance with the rules governing consumer-directed services.

Removing or weakening that support without an effective replacement risk creating more confusion, administrative failures, delayed services, and unnecessary hardship for families who are already doing everything they can.

Our loved ones are not budget line items. They are human beings whose lives, dignity, independence, and well-being matter.

A Call for Accountability, Not Elimination

I am asking Virginia’s leadership to consider a more responsible approach to addressing any documented concerns involving service facilitation.

Rather than eliminating the role or penalizing every provider, the Commonwealth should strengthen oversight, improve training, prove meaningful performance standards, and investigate specific instances of noncompliance.

If service facilitators do not perform required duties, address those failures individually.

If paperwork is not given correctly, identify the cause and prove corrective action.

If oversight is inadequate, improve the oversight.

If fraud or misconduct occurs, investigate it and impose proper consequences.

But do not dismantle an essential support system because some participants did not meet the standards of their profession.

Virginia should recognize and keep professionals who prove exceptional performance, compliance, and dedication.

Reece Vanhoozier is exactly the kind of service facilitator whose work should be recognized as an example of what effective service facilitation looks like.

 

My Requests to Virginia and Federal Leadership

I respectfully ask that our elected representatives, DMAS leadership, and all agencies involved in Medicaid waiver administration:

1. Protect the service facilitator role and oppose its elimination or reduction without a thorough, transparent evaluation of the impact on Medicaid waiver recipients and their families.

2. Investigate individual cases of misconduct or noncompliance rather than imposing broad consequences on professionals who have fulfilled their responsibilities.

3. Recognize and protect high-performing service facilitators, including professionals like Reece Vanhoozier, who have proven consistent accountability and effective advocacy.

4. Include families and waiver recipients in every major policy discussion affecting consumer-directed services and service facilitation.

5. Provide public transparency about any proposed changes, the reasons behind them, the supporting evidence, and how those changes would affect individuals with disabilities.

6. Ensure continuity of services and protections for waiver recipients, so that no individual experiences unnecessary disruption, confusion, or loss of support because of administrative restructuring.

7. Require meaningful legislative and administrative oversight before changes are made that could negatively affect individuals receiving Medicaid home- and community-based services.

8. Preserve the ability of families to receive knowledgeable, accessible, and dependable service facilitation, particularly when navigating complicated care needs, emergencies, and program requirements.

 Personal Appeal to Our Congressman, Governor, and President

To our congressional representatives, I ask you to stand with families like mine and ensure that federal Medicaid policies and oversight protect the individuals these programs were created to serve.

To the Governor and members of the Virginia General Assembly, I ask you to listen to the voices of families living with the daily realities of disability caregiving before allowing changes that could undermine their support systems.

To DMAS and the organizations administering these services, I ask you to remember that compliance and accountability should strengthen a program, not become a justification for eliminating the very professionals who help families comply.

And to the President of the United States, I ask that your administration recognize the importance of protecting home- and community-based services and the professionals who help individuals with disabilities remain in their homes, surrounded by the people who love them.

Our families deserve more than policy decisions made without our voices.

We deserve transparency, fairness, accountability, and a system that recognizes the difference between professionals who neglect their responsibilities and those who consistently go above and beyond.

In Closing: I Stand With Reece Vanhoozier

I want there to be no misunderstanding about my position.

I stand with Reece Vanhoozier.

I stand with every dedicated service facilitator across the Commonwealth of Virginia who shows up, follows the rules, completes the required work, advocates for clients, and treats families with dignity and respect.

I stand with the individuals with disabilities who depend on these services. These programs are built to keep them from being another state departments burden. What if advocates such as us didn’t exist. The state would be paying for his care around the clock multiplied by thousands of dollars.

And I stand with the parents, spouses, siblings, guardians, and caregivers who work tirelessly to ensure that their loved ones receive the care they deserve.

I am not asking anyone to excuse wrongdoing. I am asking leadership to recognize the difference between wrongdoing and dedicated public service.

I am asking for fairness.

I am asking for accountability where accountability is warranted.

And I am asking that Virginia not sacrifice an entire profession and the families who depend on it because of the actions of a few.

Do not punish the professionals who did their jobs. Do not punish the families who followed the rules. And above all, do not punish individuals with disabilities for failures they did not create.

Reece Vanhoozier has earned our family’s trust, respect, and gratitude through her actions. She deserves to have her professional integrity defended, and her work deserves to be recognized.

I respectfully request a written response explaining what changes, if any, are being considered regarding service facilitation in Virginia, what steps are being taken to protect existing waiver recipients, and how families like mine can participate in the decision-making process.

Our voices matter. Our families matter. And the professionals who faithfully serve us matter. When you as leaders have the authority to make this right please do so.

 

Sincerely,

Leslie W. Simpkins

Mother and Advocate for Nathaniel “Nate” Simpkins

Medicaid Waiver Family and Caregiver

Pembroke, Giles County, Virginia