To whom it may concern:

I am writing to oppose any changes to the Virginia Medicaid waivers which would prohibit families from being paid as caregivers through consumer directed services.  I have a daughter with the DD-FIS waiver and she requires 24-7, 1:1 care.  While we are not approved for 24 hours of coverage, it is impossible to find enough staff to cover all the waking hours when we do need coverage.  She is also often sent home from school for self-injurious behaviors and has unexpected absences from school due to behavior issues.  Because of her high needs, it is impossible for me to have any type of consistent job outside of being a caregiver for her.  I rely on the income I can make as her caregiver to be able to be there for her and take her to appointments or pick her up from school as is necessary.  It is impossible to have a caregiver who is just "on standby", waiting to see if she needs to work and then be available to care for my daughter.  In order for me to not be paid as a caregiver, I would need DMAS to allow me to employ an attendant during all waking hours (even when she is at school) so that somebody is available should she need to be picked up from school (which is not allowed).