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

I am writing to express my strong opposition to HB 1495. 

I am the primary caregiver for an individual who lives with me in my home and depends upon consumer-directed Medicaid services to remain safely and appropriately in the community. The ability to receive care in our home is not simply a matter of convenience, it is what makes it possible for this individual to remain in a familiar environment, maintain stability and dignity, and avoid institutional placement.

Virginia's current consumer-directed system recognizes the importance of individualized support. Services Facilitators provide more than administrative assistance. They help individuals and their families navigate the Medicaid system, develop and maintain appropriate service plans, monitor changing needs, and address problems that can arise in the delivery of care. Current Virginia regulations specifically recognize Services Facilitation as part of the consumer-directed model and require facilitators to work with individuals and their families to assess needs and ensure that services remain appropriate.

I am deeply concerned that replacing this individualized relationship with a centralized Support Broker model will make it substantially more difficult for people like the individual in my household to successfully remain at home.

For our family, this is not an abstract concern. If the new system disrupts our ability to obtain and maintain the necessary supports, the realistic alternative is institutionalization. I would no longer be able to provide the level of care necessary for this individual to remain safely in our home without an effective system supporting that care.

Institutional placement would not represent an improvement in care. It would mean removing this individual from their home and familiar surroundings and placing them in an institutional setting. It would disrupt established routines, relationships, and community connections and would result in a substantially lower quality of life.

It is also difficult to understand how this change would produce meaningful savings for Virginia with the strong potential for the displacement of individuals currently living successfully in the community to require institutional care. Virginia's own Medicaid regulations recognize consumer-directed services as an appropriate alternative to institutional care and specifically provide for these services so that individuals can remain in their homes and communities.

The Commonwealth should be very cautious about changing a system that allows individuals with significant support needs to remain safely in their homes. Administrative savings should not be pursued at the expense of the community-based care that prevents institutionalization in the first place.

I also believe that the people most affected by this change deserve meaningful consideration. A person receiving consumer-directed services should not merely have services available on paper; they need a system that actually works in the context of their individual life. Continuity, familiarity, responsiveness, and knowledge of the person's circumstances matter enormously when providing care to someone with significant needs.

I respectfully ask that you reconsider the elimination of Services Facilitation and the implementation of a system that could undermine the ability of vulnerable Virginians to remain safely in their homes.

Please preserve a meaningful, individualized Services Facilitation option for people who depend upon consumer-directed care. The goal of Virginia's Medicaid system should be to support people in living safely and with dignity in their communities—not to create administrative barriers that ultimately push them toward institutional care.

For my household, this is not simply a policy preference. The outcome could determine whether the person I care for is able to continue living in our home or is forced into an institution.

Thank you for your consideration and for your work on behalf of Virginians who depend upon Medicaid-funded community-based services.

Sincerely,

Z.Kent
Charlottesville, Virginia