Title: Strong Opposition to Proposed Virginia Medicaid HCBS Waiver Amendments — Protect Children, Young Adults, Families, and Essential Disability Services
To the Virginia Department of Medical Assistance Services (DMAS) and the Board of Medical Assistance Services:
I am writing to express my strong opposition to the proposed amendments to Virginia’s 1915(c) Home and Community-Based Services (HCBS) Medicaid waivers, including the Commonwealth Coordinated Care Plus (CCC Plus), Community Living (CL), and Family and Individual Supports (FIS) waivers.
I urge DMAS to reconsider these changes, protect essential services, and ensure that people with disabilities and their families are meaningfully involved in decisions that directly affect their lives.
1. Oppose the proposed 56-hour soft cap on personal assistance.
The needs of people with disabilities cannot be reduced to a uniform number of hours. Many children and young adults with intellectual disabilities, autism, physical disabilities, and complex support needs require assistance with personal care, daily activities, safety, supervision, and participation in their communities.
Their needs do not stop after 56 hours a week. Some require support throughout the day and night. A narrow exception process may fail to recognize the full extent of a person’s needs, especially when their primary challenges involve cognitive functioning, communication, behavioral support, or safety rather than physical dependence alone.
Please do not impose an arbitrary limit that could leave vulnerable individuals without adequate assistance. Preserve individualized assessments and establish a transparent, accessible exception process that recognizes both physical and nonphysical support needs.
2. Preserve services facilitation and meaningful consumer choice.
Services facilitators play an important role in helping individuals and families navigate consumer-directed care, understand their responsibilities, manage caregiver arrangements, and resolve administrative problems.
Replacing independent services facilitation with a centralized support-broker model raises serious concerns about continuity, accessibility, accountability, and conflicts of interest. Families should not lose trusted professionals who understand their individual circumstances simply because the administrative structure is changing.
Please preserve access to independent services facilitators, or demonstrate through meaningful consultation and evidence that the proposed replacement will provide equivalent or better support. Existing participants must have a voice in choosing the professionals who help them manage their care.
Please also explain how current services facilitators will be treated during the transition and what protections will be available for workers and families.
3. Protect children and young adults with lifelong disabilities.
A disability is not necessarily a temporary illness that a person will recover from. Many developmental and intellectual disabilities are lifelong conditions. Children with significant support needs grow into young adults who may continue to require assistance throughout adulthood.
Eligibility reviews and service decisions must recognize the person’s actual functional needs, not assume that a person will become independent simply because time has passed or their condition is not expected to improve.
Families should not have to fear losing essential support because of a change in review procedures or narrowly defined eligibility criteria. Please preserve appropriate clinical oversight, individualized assessments, due process, and clear appeal rights whenever waiver eligibility is questioned.
4. Protect family caregivers and the stability of consumer-directed care.
Family members often provide essential care, advocacy, supervision, and coordination. They may also serve as paid caregivers when permitted under applicable Medicaid rules.
Please clarify how each proposed amendment will affect existing caregiver arrangements, including enrollment requirements, employer responsibilities, transportation services, and payments for authorized care. Families need clear written guidance before any transition occurs.
No family should be left without adequate support because of confusing paperwork, administrative changes, or a lack of information.
5. Protect disability professionals and the services they provide.
Services facilitators, support coordinators, case managers, and other disability professionals provide essential assistance to individuals and families. Changes to service delivery and quality-review procedures should not undermine access to knowledgeable professionals or remove important safeguards.
Please disclose how DMAS will evaluate the effect of these changes on service quality, staffing, access, and continuity of care. Administrative efficiency should not come at the expense of people who depend on these services.
6. Require transparency, evidence, and meaningful public participation.
Before implementing these amendments, I ask DMAS to:
My request is simple: Do not weaken the support systems that allow Virginians with disabilities to live safely, with dignity, and in their own communities.
Please reconsider the proposed amendments, reject changes that could reduce necessary care or weaken safeguards, and ensure that any administrative reforms demonstrably improve outcomes for the people Medicaid waiver programs exist to serve.
Behind every waiver, service authorization, and administrative decision is a real person and a family whose daily life depends on reliable support. For children and young adults with lifelong disabilities in particular, these services can make the difference between meaningful participation in their communities and unnecessary hardship for the entire family.
Please listen to the people most affected before making decisions that could shape their lives for years to come.
Thank you for considering my comments.
Respectfully,
A concerned Virginia resident