As Virginia considers significant changes to Consumer-Directed Services and the proposed transition from independent Services Facilitation to a statewide Support Broker model administered through the Fiscal Employer Agent structure, I respectfully ask the patrons associated with HB 1495—Delegate Kathy Tran, Delegate Laura Jane Cohen, Delegate Irene Shin, and Delegate Amy Laufer—to publicly address what due diligence has been performed regarding the real-world consequences of this proposal.
This is not simply an administrative restructuring. These decisions directly affect Medicaid waiver participants, families, Employers of Record, attendants, and Virginia small businesses that currently provide Services Facilitation.
What due diligence has been conducted regarding the impact on Medicaid participants?
Before advancing a structural change of this magnitude, were participants and families surveyed regarding their experiences with their current Services Facilitators and Fiscal Employer Agents?
Was any analysis conducted regarding:
Continuity of care and continuity of established relationships between participants and their Services Facilitators?
The effect of removing or substantially restricting a participant's ability to select among independent Services Facilitation providers?
What happens when a participant is dissatisfied with the Support Broker assigned or made available through a Fiscal Employer Agent?
Whether individuals with disabilities, older adults, medically complex participants, and families navigating Consumer-Directed Services will have the same practical ability to change providers that they currently possess?
Whether concentrating additional responsibilities within the Fiscal Employer Agent structure creates conflicts between administrative efficiency and genuine participant choice?
The existing public-comment record already contains participants and providers questioning whether consumers will retain meaningful choice under the Support Broker structure and describing negative experiences involving Fiscal Employer Agents.
Are the bill patrons aware of the concerns participants have reported regarding PPL and Consumer Direct Care Network?
Participants and families have publicly reported concerns regarding customer service, responsiveness, payroll and time-entry issues, administrative resolution, and difficulty obtaining assistance from Fiscal Employer Agents such as PPL and CDCN. These are reports from commenters and should be evaluated objectively rather than assumed to represent every participant's experience. However, they are significant enough that policymakers should demonstrate that they have investigated them before transferring additional participant-support responsibilities into this structure.
Specifically:
What customer-service performance information for PPL and CDCN was reviewed before proposing this transition?
Were complaint volumes, call-response times, issue-resolution times, payroll problems, enrollment delays, participant satisfaction, or other performance measures examined?
Were Medicaid participants and Employers of Record who regularly interact with these Fiscal Employer Agents interviewed?
If such analysis was completed, please make the findings publicly available.
If it was not completed, why should Virginia proceed with transferring additional participant-facing responsibilities before that evaluation occurs?
Where is participant choice in the proposed model?
Consumer Direction should mean more than the ability to hire an attendant. It should also include meaningful control over the organizations and individuals providing critical administrative and program support.
Under the current structure, participants may select among qualified Services Facilitation providers. The proposed Support Broker structure raises an important question:
Will participants continue to have a meaningful and practical choice of who provides this assistance, or will their choices effectively be limited to individuals employed, contracted, assigned, or controlled through the Fiscal Employer Agent structure?
If participants cannot freely select and change among independent qualified providers, policymakers should explain how the resulting model advances rather than diminishes the principles of Consumer Direction.
The appearance of objectivity also matters. A system in which the entity responsible for fiscal-management functions also controls or substantially controls the individuals responsible for helping participants understand and navigate that same system deserves careful examination.
Who advocates for the participant when the participant's problem involves the Fiscal Employer Agent itself?
Who independently assists the participant when there is a payroll, enrollment, EVV, authorization, or administrative dispute involving that organization?
Those are not theoretical questions. They concern the practical checks and balances within Consumer-Directed Services.
What due diligence has been conducted regarding Virginia's existing Services Facilitation businesses?
Many existing Services Facilitation providers are small Virginia businesses that have invested in staff, training, compliance systems, professional relationships, and infrastructure specifically to serve Medicaid waiver participants.
Before potentially displacing those providers, has Virginia conducted an economic-impact assessment addressing:
The number of existing Services Facilitation providers that could be affected;
The number of Virginia jobs potentially affected;
The number of Medicaid participants currently served by these organizations;
Whether established providers will have an opportunity to become Support Brokers;
The qualifications and contracting process that will apply;
Whether small businesses will be permitted to contract directly;
Whether the Fiscal Employer Agents have already begun recruiting or contracting Support Brokers;
And what transition protections will exist for participants who want to continue working with their current Services Facilitator?
If existing qualified Services Facilitators can perform the Support Broker function, why has a clear pathway for their continued participation not been publicly established before implementation?
Virginia should also disclose the comparative analysis supporting this structural change.
What measurable deficiencies in the existing Services Facilitation model were identified?
What evidence demonstrates that the proposed Support Broker structure will produce better participant outcomes?
What performance standards will Support Brokers be required to meet?
What independent oversight will exist?
What recourse will participants have when the system fails them?
And what specific evidence demonstrates that consolidating these functions will improve service rather than merely consolidate administration?
A September 2026 Town Hall commenter has already specifically requested publicly available data explaining the rationale for transitioning Services Facilitation into the Support Broker model and questioned what performance indicators support the change.
These questions deserve direct, public answers.
Medicaid waiver participants should not be required to surrender established relationships, provider choice, or independent assistance merely because a different administrative model may appear more streamlined on paper. Likewise, Virginia small businesses that have provided these services under the Commonwealth's existing system deserve transparency regarding the evidence supporting their potential displacement and whether they will have a meaningful opportunity to participate in whatever system follows.
Before this transition proceeds, I respectfully request that DMAS and the associated patrons of HB 1495 publicly disclose the participant-impact analysis, Fiscal Employer Agent performance review, small-business impact analysis, stakeholder consultation, conflict-of-interest analysis, and participant-choice protections that informed this proposal.
If those analyses have not been performed, then that fact should also be disclosed.
The question is straightforward:
What evidence demonstrates that this proposed structure will be better for the Medicaid participants Virginia's Consumer-Directed Services program exists to serve?