I have been in the field over twelve years.  I have yet to see an agency, outside of some nursing providers, successfully staff families.  Now, you would like to increase their caseload (reward) them with referrals of hundreds of families across the state of VA, many of which they have utterly failed before? Families who have finally found their “groove” (survival)? Families who may be somewhat functionally equipped at this point rather than literally drowning to barely survive and still being grateful for the few hours they may have, because they’ve finally found a way to make things work for them? 
Agencies already have a higher overhead and reimbursement rate than CD services - how could this be cost effective? How can this be accessible to those who need it most?

Just last week (last week- think allll of the rate increases in the last three years) a mother opted for CD services - she asked the rate of pay and I happily told her $16.45 (nova) - she gasped, “how can that be?!” - in confusion I asked her how that couldn’t be?! …

The AGENCY, licensed and governed closely by DMAS to be fiscally responsible, had just given this woman a raise in an effort to “retain” her.. to TWELVE DOLLARS PER HOUR.  There is no other way to package that up, they’ve been exploiting this mother for years.  Perhaps it was her presumed lack of education? Her primary language being Spanish?
Or maybe it was just their bottom line.  $12 per hour.   Northern Virginia.  DMAS licensed AGENCY. 2023. 
 If “oversight” and “fiscal responsibility” is the premise for these imposing regulations, I would love to know where the Agency Directed accountability, licensure review, oversight and fiscal responsibility has been for these agencies for the past three years.  

Families of given up careers, lifestyles, basic comforts  after the public schools failed their children, to ensure that the children continue to thrive.  To the expense and comfort of their own families- giving up nursing, banking, small business owners or other careers all for for $12.70/$16.45  an hour. Can you imagine the number of LTC admissions that would’ve occurred if these parents had not selflessly stepped in?  The world can’t find staffing today- “post” pandemic- who would care for them?! 

I would love to see the statistics for the utilization cost of waivered services  3-5 years pre-pandemic, I imagine it was horrifyingly low, compared to finally allowing these kids to use their much needed supports.