My child has a severe form of muscular dystrophy, requiring specialized care to manage their progressive muscle weakness and prevent complications. I have developed a detailed care plan that includes physical therapy, respiratory support, and meticulous positioning to avoid pressure sores. A new caregiver may not fully understand the specific needs of my child, leading to improper care and accelerated disease progression. I should be the first option to continue providing the specialized care that my child’s condition demands. My role as the LRI is critical because I ensure that every aspect of my child’s care is tailored to slow the progression of their disease and maintain their quality of life. Any amendment that removes me as the first option would expose my child to inadequate care, potentially hastening their decline. I strongly oppose the Application for 1915(c) HCBS Waiver: Draft VA.004.05.03, which focuses on finalizing rules when an (LRI) is the paid aide/attendant for the personal care service as it threatens the consistent and expert care my child requires.