I am a resident of central Virginia but also provide medical care to children living with medical complexity as a pediatrician. We continue to face a shortage of trained home nurses who can provide care for children in the home setting. Children are surviving with rare diseases, complications of prematurity, genetic mutations and metabolic diseases.  The special care these children require cannot be provided in a traditional daycare setting or by untrained family members. During the covid-19 public health emergency, parents and caregivers were able to be paid through consumer directed agencies in order to provide that care in the home setting and stave off financial hardships from reducing or leaving the workforce.  With the end of PHE, families are facing the impossibility of not having anyone trained to care for their child and not being able to financially support their family. It is critically important for these protections to continue in order to ensure these children have no gaps in their care and support family well-being.