There is a clear need to continue the 1115 Demonstration waiver in Virginia. Virginia is home to over 5,000 children in the foster system as of Spring 2024 (Virginia DSS). Substance use rates of use vary by estimate with approximately 5.6% of Virginians abusing alcohol and 7-9% abusing illicit drugs (SAMSHA/hhs.gov & Kaiser Foundation). As a medical social worker who witnesses daily the intersection of mental and physical health, I support renewal of the application to CMS as one tool to provide the most possible resources for Virginians who find themselves facing potential or actualized mental illness.