My family previously used consumer-directed services, and our experience with Services Facilitation was very positive. Our facilitator was knowledgeable, independent, accessible, and genuinely helpful in making consumer direction work.

I have read many of the comments already submitted, and others have raised important questions about continuity, consumer choice, broker qualifications, caseloads, and the relationship between Support Brokers and the Fiscal-Employer Agents. Rather than repeat those concerns, I want to ask what I think is the most basic question.

What problem with the existing Services Facilitation model is this change intended to solve, and what evidence does DMAS have that the proposed Support Broker model will produce better outcomes for Medicaid members?

This should not be answered simply by describing how the new system will operate. The question is why the change is necessary in the first place.

Services Facilitation was not perfect, and experiences undoubtedly varied. But in our case, it worked. Before eliminating a service that has worked well for many individuals and families, DMAS should be able to explain clearly what is wrong with the present model, what evidence supports replacing it, and how the person receiving Medicaid services will be better off afterward.

That is ultimately the measure that matters. Not whether the new administrative structure is cleaner or easier to manage, but whether it improves the life and experience of the person receiving the service.