Whenever there is change, there is concern.  Medicaid and Virginia have a history or rolling out changes before the systems or community are set up for them. There are a lot of concerns with service facilitation but what has been done to address it?  SF's need to be accountable and follow the rules set forth.  This is not always done so that is an issue.  SF's agencies are overwhelmed and not being timely with completing the required work. Another major issues- but what has been done to address this?  As someone who works in the field, I don to feel the state has done much to address the ongoing concerns with SF.  

That being said- is the state ready to switch to a new system?  Are the necessary checks and balances in place?  

Who will take the brunt of another system that does not work- the individual and the direct support staff providing the assistance will.  They usually do.  Individuals will not get the support they need.  If DSP do not get paid, they have to look elsewhere for work. The constant changes to DSP providing the service is highly disruptive.  

Transportation is a great concern.  Medicaid knows this is an area that has many issues.  The provider just changed so we will see.  This is a vulnerable population so having trust in transportation is extremely important and the state/Medicaid has failed in this area. Allowing a legally responsible person to provide transportation is safe and no one is getting rich off of this. 

Person centered is the focus here and upmost importance to DBHDS and DMAS according to the training everyone receives.  Don't contradict that by putting changes in place that do not allow that.

Freedom of choice is important but so is SF/support brokers doing the job well. 

Do not but in unrealistic restrictions that the system cannot back up.  

If families can no longer provide the care in the new system- who will do it?  I don't think the state is prepared for that if it happens.