56 hours.
That number needs to be understood before Virginia places it into the Community Living and Family and Individual Supports waivers. The proposed amendment introduces a 56-hour weekly threshold for personal assistance under the CL and FIS waivers, with a process allowing services above that threshold when applicable exception criteria are met. Virginia already uses a 56-hour soft-cap structure in the CCC+ Waiver.
A soft cap is not necessarily an absolute prohibition on care above 56 hours. The word “soft” matters because additional hours may still be authorized when the applicable criteria are satisfied. But that raises an important policy question. Care that is currently based upon assessed need would encounter a new administrative threshold at 56 hours.
For individuals whose needs exceed that threshold, the question is no longer simply whether the care is medically and functionally necessary. The system must also determine whether the individual's circumstances satisfy the requirements for services above the threshold.
That distinction matters. 56 Hours is eight hours a day. Divide 56 hours across seven days, and you get eight hours per day. A person's need does not operate on an eight-hour shift. Someone may need assistance getting out of bed, bathing, dressing, toileting, eating, transferring, managing daily routines, accessing the community, and getting back into bed at night.
Some people need assistance intermittently throughout the entire day. Some cannot safely be left alone. Some tasks take substantially longer because of physical, intellectual, developmental, behavioral, communication, or medical needs.
The clock reaching eight hours does not change any of that. The number should therefore never become a substitute for the individualized assessment. But Whose 56 Hours Are We Talking About? This must be communicated clearly. The public needs to understand precisely how the 56-hour threshold operates. Does it limit the individual's total personal-assistance authorization? Does it limit the number of hours one attendant may provide? Does it operate through some other calculation? Those are dramatically different policies with dramatically different consequences.
If an individual is assessed as needing 80 hours of personal assistance each week, does that person retain all 80 authorized hours? Does an existing authorization above 56 automatically trigger additional review? How are current authorizations treated during implementation? These answers should not be left for individuals and families to discover when an authorization, schedule, or paycheck changes.
What Happens to Care Above 56? This is where the word “soft” will either have meaning or become semantics. Suppose an individual has an assessed need requiring 70 hours of personal assistance. The first 56 hours do not somehow satisfy 70 hours of need.
Fourteen hours of need remain. If services above the threshold are approved, those hours can potentially continue. But what happens while that determination is being made? Does the existing authorization remain in place? Can services continue without interruption? If additional authorization is denied, when does the change take effect? What appeal rights are available?And while an appeal is pending, what protections exist to prevent a disruption in necessary care? Those are not minor administrative questions. They determine whether a “soft cap” actually functions as one.
Grandfathering Matters: Virginia also needs to address individuals who are already authorized for arrangements exceeding 56 hours. A person whose disability and assessed needs have not changed should not suddenly face instability simply because the administrative rules surrounding their care have changed. Existing arrangements deserve particular protection during implementation.
If someone has already been assessed, authorized, and successfully receiving necessary services above the new threshold, Virginia should clearly explain how that existing authorization will be treated, whether there will be an expedited transition process, and what protections will prevent interruption while any required determination is pending.
Families should not wake up in 2027 and discover that yesterday's authorized care has become today's administrative problem.
The Transition Period Must Protect Continuity of Care: A soft launch or transition period should do more than give the system additional time to implement a new policy. It should protect the people affected by it. Virginia should use the transition period to identify individuals with existing authorizations above 56 hours, communicate directly with them, explain what if anything, they are required to do, provide adequate time for necessary documentation, and ensure that existing care is not interrupted simply because an administrative process has not been completed.
The burden should not be on individuals and families to discover that a new requirement applies to them after something has already gone wrong. There must be policies in place to measure What Happens. If Virginia proceeds with a 56-hour soft-cap structure, the Commonwealth should publish the results of its implementation. Transparency is key!
Those numbers will tell us whether Virginia created a genuine soft cap that protects individualized care or an administrative ceiling that becomes increasingly difficult to cross.
And those numbers should be made public before the transition period ends, not months or years afterward when the consequences can no longer be prevented.
There is a simple principle that should guide this policy: The number of hours should follow the person's assessed needs. The person's needs should not be forced to follow the number. Fifty-six is an administrative threshold.
Remove the 56-hour cap because it is not a measure of disability nor need!