I strongly oppose the proposal to eliminate Service Facilitation and replace Service Facilitators with Support Brokers.

I am writing first and foremost as the father of a five-year-old child with significant disabilities who depends on Virginia’s Medicaid waiver system and consumer-directed services.

My son, Cooper, has Leigh Syndrome, a rare and progressive mitochondrial disease. He is non-verbal, wheelchair-dependent, and requires extensive assistance with his daily needs. Consumer-directed services allow our family to provide care for him in a way that is appropriate for his individual needs and helps keep him safely cared for in our home and community.

Our Service Facilitator is an important part of making those services actually work.

For families like ours, a Service Facilitator is much more than someone who conducts a required visit. They are often our go-to source when we have questions about waiver services, attendant requirements, authorizations, Medicaid processes, or problems that arise with consumer-directed services. We have someone who knows our child, understands our circumstances, and with whom we have built an ongoing relationship.

Just as importantly, families currently have the ability to choose a Service Facilitation provider that works well for them. Consumer direction is supposed to give individuals and families greater involvement and choice in how their care is provided. Eliminating Service Facilitation and limiting families to Support Brokers associated with only two fiscal agents moves Virginia in the opposite direction.

I am particularly concerned about assigning these additional responsibilities to the same fiscal agents already responsible for payroll functions. Our family has experienced difficulty obtaining timely assistance from fiscal-agent customer service for issues within their existing responsibilities. Under this proposal, those organizations would be expected to take on an even larger role involving in-home visits, service authorizations, consumer support, and other responsibilities while continuing to administer payroll.

When my son's care is involved, an unanswered phone call or unresolved authorization issue is not simply an inconvenience. These services affect whether he has the support he needs to remain safely at home.

I am concerned that consolidating these responsibilities will result in less individualized assistance, longer response times, less accountability, and a greater likelihood that families will experience interruptions or lapses in essential services.

Families caring for individuals with significant disabilities already spend enormous amounts of time navigating medical care, Medicaid, insurance, therapies, equipment, attendants, and waiver requirements. Removing a knowledgeable, accessible professional who knows the individual and their family does not simplify that system for us. It removes one of the people who helps us navigate it.

I urge DMAS to preserve independent Service Facilitation and the ability of individuals and families to choose the Service Facilitation provider that best meets their needs.

Please do not measure this proposal only by administrative efficiency or cost. Measure it by what happens when a parent has an urgent authorization problem, an attendant issue, or a question about their child's services and needs a knowledgeable person who knows their family and answers the phone.

For families like mine, Service Facilitation is not unnecessary administrative overhead. It is part of the support system that makes consumer direction possible.