I am writing in response to the proposed changes to Virginia’s Medicaid 1115 Demonstration Waiver, as outlined in Notice GNID 3024. On behalf of ForKids, I would like to express our concern regarding the potential impact of these changes, particularly as they relate to the reimbursement for critical services provided by Tribal providers.

It is our firm belief that Virginia should take full advantage of all available federal funding to support its residents, particularly those most in need. Maximizing these resources ensures that we can continue to provide vital services and strengthen the programs that serve our communities. In particular, Tribal providers play a pivotal role in addressing healthcare gaps, offering essential services in areas that are often underserved by standard providers.

Fishing Point Healthcare, for example, has been an essential partner in our efforts to deliver services to families and children facing homelessness and poverty. Their pharmacy, transportation, and dental services have been transformative for our families, providing access to physical, mental, and dental health services—resources that were nearly nonexistent before this partnership. Their wrap-around model of care has helped families establish primary care, attend follow-up appointments, adhere to medications, and access reliable transportation. Without these services, many of our families would be left without care, exacerbating their struggles with homelessness, unemployment, and food insecurity.

Dismantling or limiting the infrastructure that allows Tribal providers to utilize federal Medicaid dollars would create unnecessary barriers to care and exacerbate existing health disparities. Beyond direct healthcare services, these providers contribute to economic stability and preventive care. Additionally, restricting access to these funds could lead to greater reliance on emergency rooms and crisis care, ultimately increasing costs for the state.

The ability of Tribal providers to access federal Medicaid dollars is crucial to ensuring that these essential services remain available and accessible to Virginia’s most vulnerable populations. Reducing reimbursement rates or imposing restrictions on these services would not only place a financial strain on providers but would also create cascading negative effects for the patients they serve. In many cases, these providers are the only ones meeting the unique health needs of underserved populations, including Indigenous communities and rural Virginians.

We respectfully urge the Department of Medical Assistance Services (DMAS) and Governor Youngkin's administration to reconsider these proposed changes. We encourage further engagement with Tribal providers and nonprofit partners to find a path forward that preserves access to these essential services.

Thank you for considering this input. We welcome the opportunity to share additional data and insights into how these services are vital to the families we serve.

Sincerely,

Thaler McCormick