Dear Members of the Virginia General Assembly and Kathy K.L Tran, 

I am writing to ask you to reconsider HB 1495 and the broader changes Virginia is making to the way Services Facilitation is provided to individuals receiving consumer-directed Medicaid services.

This issue is deeply personal to my family. An individual who depends upon Medicaid-funded consumer-directed care lives in our home. The current system allows this person to remain in a familiar home environment with people who know their needs, routines, and circumstances. That arrangement provides stability, dignity, and a quality of life that cannot simply be replicated by moving someone into an institutional setting.

I am particularly concerned about the Commonwealth's decision to eliminate Services Facilitation. I understand the Commonwealth's responsibility to oversee Medicaid spending and ensure that public funds are used appropriately. I also understand the need for accountability and effective administration. But those goals should not come at the expense of the individualized support that allows vulnerable people to remain in their homes.

The person living in our home is not a line item in a Medicaid budget. This is a real person whose ability to remain at home depends upon a functioning network of care and support.

Services Facilitation currently provides an important human connection within that system. Services Facilitators help individuals and families identify their needs, develop support plans, manage consumer-directed services, monitor whether those services are adequate, and identify changes in functioning or other circumstances. Those responsibilities are particularly important for people whose care needs are complex. A centralized administrative model may be capable of processing paperwork and monitoring compliance, but that does not necessarily mean it will provide the same continuity, familiarity, and individualized attention.

The potential consequence for our family is serious. If this transition makes it impossible for us to maintain the supports necessary for the individual living in our home, that person could be forced out of our home and into an institutional setting. That would be devastating to our family, but more importantly, it would significantly diminish the individual's quality of life. Remaining at home provides familiarity, stability, personal relationships, and the ability to participate in ordinary community life. Institutionalization would take those things away.

There is also a significant public-policy concern here. Virginia's own Medicaid regulations recognize community-based consumer-directed services as an alternative to institutional care. If changes to the administrative structure of consumer-directed care make it harder for people to remain successfully at home, the Commonwealth could ultimately shift costs from community-based services to considerably more expensive institutional care.

I respectfully ask Virginia's policymakers to consider the real-world consequences of this reform before eliminating Services Facilitation as an independent service. Please preserve an individualized Services Facilitation option for people who rely upon consumer-directed care and who can remain safely in their homes with the appropriate support.

The success of Virginia's community-based care system should be measured not only by administrative efficiency, but also by whether people with significant needs are actually able to remain safely, independently, and with dignity in their communities.

We want the individual who lives with us to continue living in our home, surrounded by familiar people and a familiar environment—not to be forced into an institution because the system supporting their care was changed. Thank you for taking the time to consider the perspective of families who live with the consequences of these decisions every day.

Sincerely,

E. Kent
Charlottesville, Virginia