“If God is for us, who can be against us?” — Romans 8:31 (NIV)

Not everyone reading this will share my faith or my worldview, and I understand that. But I believe with all my heart that there is a higher authority than any government agency, any policy, any regulation, or any person sitting behind a desk making decisions that affect the lives of others.

And I believe that with authority comes responsibility.

Throughout the centuries, I believe we have slowly lost something very important. We have lost the ability to truly see people.

We see numbers. We see budgets. We see policies, procedures, regulations, deadlines, and reports. We see what needs to be changed, what needs to be eliminated, and what might make a program easier to administer.

But somewhere along the way, we stop seeing the people whose lives are affected by those decisions.

Virginia has a remarkable history. This Commonwealth was home to some of the earliest English settlements in America, and it played a central role in shaping the principles of representative government that helped form our nation.

We were pioneers. We helped establish the foundations of a nation. And although our history was far from perfect, the principles of representation, responsibility, and the right of people to have a voice are part of the legacy we inherited.

I believe that legacy should still mean something today.

I want to hold my head high and be proud that I live in Virginia. I want to know that when people in our Commonwealth need help, they receive it. When they have questions, someone answers. When they raise concerns, someone listens. And when our government makes a mistake, someone has the courage to acknowledge it and make it right.

I have taken the time to read the public comments being submitted regarding these proposed Medicaid waiver amendments. I have read the concerns, the frustrations, the fears, and the heartfelt pleas from people who depend on these services and from those who have dedicated their lives to helping them.

And quite frankly, it breaks my heart.

These are not simply comments on a government website. These are people's lives. These are families. These are individuals with disabilities, elderly Virginians, caregivers, and people who already face challenges that many of us cannot begin to understand.

Shame on anyone entrusted with reviewing these comments who chooses not to read them, hear them, and truly listen.

What a disservice that would be to the people of Virginia and to the principles of representative government that our forefathers worked to establish.

I am not saying change is unnecessary. I can clearly see from these comments and from my own experience that changes need to be made.

But there is a tremendous difference between making corrections and simply removing something.

There is a difference between improving a program and dismantling a service that people and their families have come to depend upon.

And there is a difference between leadership and simply exercising authority.

DMAS, you have been given authority. But authority does not automatically make every decision the right one.

You have an obligation to the people you serve.

When people have questions, have answers.

When people need assistance, respond.

When providers identify problems, investigate them.

When policies and procedures are not being followed, correct that.

And when something is broken within your own organization, have the courage to look inward before deciding that the solution is to eliminate something outside of it.

Someone once told me, “You cannot fix what you do not know is broken.”

I believe that is true.

But I also believe that once you know something is broken, you have a responsibility to understand WHY it is broken before deciding HOW to fix it.

Policies and procedures are written for a reason. Oversight exists for a reason. Accountability exists for a reason.

Have we truly exhausted the opportunity to improve the existing Service Facilitation model? Have we examined where oversight failed, where communication broke down, where policies were not followed, or where corrective action could have made a difference?

Have we given the people who actually perform these services an opportunity to help create the solution?

Or have we simply decided that eliminating Service Facilitation and moving its responsibilities into another structure is the easier answer?

I do not believe that removing an established service, placing families through another transition, and expecting everyone to adjust once again is necessarily progress.

Not when there are unanswered questions.

Not when people are frightened about losing relationships with those who have helped them navigate an already complicated system.

Not when providers themselves are still seeking clarity about how this new model will operate.

And certainly not when the very people affected are asking to be heard.

There seems to be far too much change and not nearly enough correction.

I understand that budgets matter. I understand that program integrity matters. I understand that fraud, waste, and abuse must be addressed. I support accountability, and I believe anyone who serves Medicaid members should be held to high standards.

But eliminating a service should never become a substitute for correcting the problems that exist within the administration of that service.

If there are failures in oversight, strengthen oversight.

If there are failures in documentation, improve documentation requirements and enforcement.

If there are failures in accountability, hold those responsible accountable.

And if there are failures within DMAS itself, then DMAS should be willing to examine those failures with the same determination it expects from everyone else.

We are all human. We all make mistakes. Even those in positions of tremendous authority can get things wrong.

But I believe it takes a truly strong leader to stand before the people and say:

“We have listened. We have reconsidered. We recognize that our original approach may not be the best path forward. We are going to correct what needs correcting, strengthen what needs strengthening, and work together to build something better.”

That is leadership. That is accountability. That is something I could stand behind.

I would gladly support a government agency willing to acknowledge that a different approach may better serve the people of Virginia.

I would gladly work alongside DMAS, other Service Facilitators, Medicaid members, families, managed care organizations, and advocates to strengthen the system we already have.

Because I believe there are good people within DMAS. I believe there are people who genuinely care. And I believe those people can help lead meaningful change if given the opportunity.

But leadership requires listening, even when what people are saying is difficult to hear.

It requires humility.

It requires courage.

And sometimes it requires setting aside a plan that has already been made because the people you serve deserve something better.

Virginia should be a leader in Medicaid services. We should be setting an example for other states of what responsible oversight, compassion, accountability, and genuine collaboration can accomplish.

We should be showing the nation that a government agency can recognize problems without abandoning the people and relationships that make a program work.

DMAS, become the leader that Virginia needs you to be.

Take up the reins.

Listen to these voices.

Read every comment.

See the people behind the words.

Do not allow administrative convenience, financial pressure, or the desire to move forward with a predetermined plan to overshadow the very reason these programs exist.

These services were established to help people live with dignity, independence, and support in their own homes and communities.

Please do not lose sight of that.

I believe God has blessed Virginia with opportunities to lead throughout its history. And I believe those entrusted with authority today have an obligation to exercise it with wisdom, compassion, humility, and justice.

You do not have to share my faith to understand the responsibility that comes with holding the lives and well-being of others in your hands.

Honor the authority you have been given by honoring the people you have been called to serve.

I am waiting, DMAS.

I am hoping that you will listen.

And I am praying for every person involved in these decisions, including those with whom I disagree.

My prayer is not that anyone should fail. My prayer is that wisdom will prevail, that hearts will be softened, that mistakes will be corrected, and that the people of Virginia will come first.

Because at the end of the day, I do not want to see DMAS defeated.

I want to see DMAS do better. I want to see Virginia do better. And most importantly, I want to see the people of Virginia treated better.

God's will be done.

“Speak up and judge fairly; defend the rights of the poor and needy.” — Proverbs 31:9 (NIV)

Respectfully,

Stephanie Estes
OnBoard LLC
Virginia Medicaid Service Facilitation Provider   Director@onboardva.com