Funding for:

1. Vision services in the home.  Many are homebound and require glasses to see but can’t get to an office for vision exams.  Like we have dental services- bring vision services into the home.  
2. Include the cost of maintenance contracts and batteries for Durable Medical Equipment.  These small/large costs are often beyond the budget of individuals living on SSI and Medicaid services.  This will save money in the long run by keeping equipment functioning so it doesn’t have to be replaced as often.
   1. Stair-lifts and generators are multi-year contracts- 3 yrs at a time. They need 3-4 times a year cleaning, seat and battery repair/replacements. Generators are also 1-3 year contracts. They come out 3-4 times a year for oil, testing, battery replacement.
3. Many nursing agencies no longer take Medicaid Waiver cases. The large ones with more staff especially like Maxim and Continuum- say too much red tape and rule changes from DMAS in addition to low pay rates for nurses.
4. Address the disparate pay rate for higher-tiered consumers.  Group homes and Day Supports pay higher rates. Home and community-based caregivers need to attract PCAs with pay rates and benefits and currently- no one will work for what Consumer-Directed Home care rates pay.  So effectively- it is a hollow promise and your system is directing people back into the institutional setting by not making home and community care possible.
5. Strategies to build workforce capacity, including recruitment and retention—partner with a training program to offer scholarships (have them enter with an essay about their commitment to this area of care) Understanding that you can’t force someone into servitude by requiring they stay in a certain workforce category…. Believe that bringing more people with a commitment to this population into the workforce can only be beneficial.  Also, look to the immigrant and ESOL community to offer these services for training and certification with scholarships.  Then more employment options to these populations is a win-win. 
6. Improvements in access for Medicaid members:  I assist a Medicaid recipient who lives in the community with support but is unable to use a phone to communicate or type long emails of explanation or requests.  We need to expand options for communication supports.  Train Support coordinators and Support Facilitators on how to support someone with communication limitations.  FLAG their files with this and stop asking the individual to call them or file out a form.  Ridiculous. 
7. Investments in technology: Pay for updated communication technology and data storage.  Data storage costs money and files/medical records/ assessments are digital and need to be kept for the verification of benefits.
8. Give all Nurse Practitioners Independent Practice:   Virginia cut out the Certified Nurse Anesthetists from independent practice due to a turf battle.  Well, I don't see any anesthesiologist doctor asking to provide in-home care so let's get these services in the home through the Nurse Practitioners.