Medicaid needs to keep consumer directed care by families without agency interference. 
 
We have had this right to choose providers without being forced to become
an employee of an agency.

Our family members require consistent, specialized care that we are able to provide.  
Inconsistent staffing makes it difficult to maintain The level of care needed and undermines gains by Disabled individuals that require established relationships. It also makes it difficult for parents to be reliable as workers outside the home. 
An artificial limit of 40 hours a week does not reflect the actual waiver
services the individual needs nor does it follow the service authorization
process. The changes also deprive caregivers of needed respite services.  Studies have shown that respite is necessary to maintain caregiver health.
Also, many agencies won't allow employees to drive a client to activities.  It is detrimental to Deprive recipients of community engagement and illogical to forbid a parent from driving their own child.

Thank you for your attention.