My son has a severe metabolic disorder that requires precise management of their diet, medication, and daily routines to prevent life-threatening crises. I have become an expert in balancing these complex needs, ensuring my child’s metabolic levels remain stable. A new caregiver unfamiliar with the disorder could easily make a mistake, leading to a dangerous metabolic imbalance. I must remain the primary caregiver to maintain the delicate equilibrium that keeps my child healthy. Being the first option as the LRI is crucial because I have the knowledge and experience to prevent catastrophic metabolic events. Any amendment that changes this priority could result in serious harm or even death for my child, as caregivers without my expertise may not recognize the early signs of imbalance. I strongly oppose the Application for 1915(c) HCBS Waiver: Draft VA.004.05.03 section that focuses on finalizing rules when an (LRI) is the paid aide/attendant for the personal care service as it endangers the lives of children with severe medical conditions.