Thank you for the opportunity to submit these comments /recommendations – on behalf of the Office of the State Long-Term Care Ombudsman and the long-term care recipients we serve. We appreciate this invitation to give input concerning how Virginia might best utilize American Rescue Plan Act (ARPA) funding to enhance HCBS.  We offer the following comments:

• Above all, we urge that the Commonwealth invest significantly in supporting the expansion and enhancement of the direct care workforce, which is the hinge pin to enabling individuals to obtain needed long-term services and supports so that they can exercise their preference to age in place avoid more costly institutional care. With the long overdue increase in minimum wage that is so essential to making the critically needed roles of our direct care workers a viable, sustainable employment option, there is a clear need to increase the reimbursement rate as well.   Specifically, on a temporary basis to mitigate the current care workforce shortage, fund a wage and benefit pass-through for home care providers, ensuring strong accountability mechanisms.    
• Expand support to increase the range community-based options that can enable individuals to choose or transition to community-based care – e.g., in-home personal care assistance, adult day care, caregiver/ respite support, transportation, greater access to telehealth services, in-home technologies to support greater independence, support for necessary home modifications/ repairs, and mental health services/supports.
• Provide targeted multi-faceted support/ assistance to enable individuals in LTC facility settings to successfully transition back to the community. Such supports should be geared to the model that was lost with the elimination of “Money Follows the Person” - a critical gap-filling resource that helped make transitions possible through flexible funding to absorb transition costs and enable beneficiaries to secure and ‘set up’  affordable housing alternatives.
• Fund statewide models (like Northern Virginia’s “RAFT” model) that provide training, consultation, and support to providers to improve care for individuals with mental health/behavioral challenges. Wider availability of that model to support providers of community-based care (e.g., home health, day health respite, etc.) - to more successfully train and support care providers in person-centered care techniques - could enable more individuals (e.g., with dementia, brain injuries, and other cognitive, emotional, and health challenges) to maintain life in community.  
• Revise DMAS website materials related toe Medicaid eligibility rules and processes to increase usability by beneficiaries – in order to improve coverage access and support beneficiaries’ capacity to understand and exercise their rights and self-advocate.
• Enable funding assistance options for those whose lack of access to the internet/ electronic technologies impedes telemedicine/ other services to support home and community-based care options.