The information being provided states that Support Brokers will be hired through the Fiscal/Employer Agents.

If there is a way for an existing Services Facilitator or established Services Facilitation company to contract with PPL, CDCN or another entity as a Support Broker provider, please make that opportunity known to us.

Please explain what the qualifications will be, what the contracting requirements will be and whether our existing businesses will have an opportunity to participate.

If there is no contracting pathway and Support Brokers will only be able to work as employees of the Fiscal/Employer Agents, then I respectfully ask DMAS to make that clear as well.

Existing providers need enough information and enough time to make responsible decisions.

For some of us, this is much bigger than simply having to find another job.

There are Services Facilitation companies that have hired and trained multiple employees to go into the field and serve Medicaid members. Those businesses now face the possibility of losing experienced staff and dismantling operations that were built specifically to serve Virginia’s consumer-directed population.

Those employees have learned this program. They have developed relationships with individuals and families. They understand the documentation, the responsibilities of consumer direction and the challenges that can occur within the system.

I would hate to see that experience simply disappear.

There are also real financial obligations involved.

Existing providers have made substantial investments in order to operate properly.

Many of us have entered into contracts for HIPAA-compliant systems, electronic documentation and recordkeeping platforms, software services and other systems necessary to operate our businesses appropriately and protect the information entrusted to us.

Some of those contractual obligations extend three years or more into the future.

We have paid for business insurance, credentialing, technology, training and other operational expenses because we wanted to follow proper protocol and meet the standards expected of Virginia Medicaid providers.

Those were not unnecessary business expenses.

They were investments made in good faith for the betterment and protection of our clients, our staff and our businesses.

We made long-term decisions based upon the program Virginia established and the requirements we were expected to follow.

That is why it is difficult not to feel let down.

After approximately 21 years in this field, I have continued adapting every time the program changed. I have invested in my business, invested in compliance and technology, trained staff, entered into contracts necessary to operate responsibly, and through all of it, continued serving Virginia Medicaid members.

Now I am faced with the possibility that the service my business was built around may simply no longer exist.

I am not asking that programs never change.

I am asking Virginia to consider the people who have spent years doing what Virginia asked us to do—and, even more importantly, the individuals and families who depend on us.

If there is a reasonable way for experienced and qualified Services Facilitators and established Services Facilitation companies to transition into contracted Support Broker roles, please give us that opportunity and make the pathway known.

Doing so could preserve experienced professionals while also preserving something incredibly important for the individuals receiving services: continuity of relationships and meaningful choice.

After 21 years, I have accumulated a tremendous amount of knowledge about consumer-directed services. There are many other Services Facilitators throughout Virginia who bring that same experience and dedication to this program.

I hope that knowledge is not simply lost.

There are real people behind these changes.

There are individuals with disabilities and older Virginians who rely on these services to remain in their homes and communities. There are families trying to navigate a complicated Medicaid system. There are attendants providing their daily care. There are employees whose livelihoods may be affected. And there are small business owners who have invested years of their lives into providing these services.

But above everything else, there are individuals who deserve to remain at the center of consumer direction.

I sincerely hope DMAS will consider whether the new model preserves their ability to choose who supports them, whether they will continue to have access to someone who can help advocate and mediate when problems occur, and whether the relationships they have spent years developing with trusted Services Facilitators truly need to be lost in order for Virginia to move to a Support Broker model.

I have genuinely tried throughout my career to represent what I believe Virginia Medicaid’s Services Facilitation program should be. I have tried to serve people well, do things correctly and be someone individuals and families can call when they need help.

Twenty-one years is a significant portion of my working life.

I simply hope there is a place for that experience, for the other experienced providers across Virginia, and most importantly, for the relationships we have built with the individuals and families we serve in whatever Virginia builds next.