I am writing as a family member of an individual who receives Medicaid waiver services and who has personally experienced the positive impact that Services Facilitation has on families like mine.

I strongly oppose eliminating Services Facilitation as a standalone service and replacing the current model with a statewide Support Broker model.

A Services Facilitator is not simply someone who completes paperwork or conducts required visits. For many families, our Services Facilitator becomes one of the few people within this complicated system who truly understands our loved one's needs, daily challenges, care requirements, and history. They help families understand Medicaid requirements, navigate consumer-directed services, address problems, obtain necessary documentation, and advocate when services are threatened.

That advocacy is incredibly important.

When an insurance company or managed care organization proposes reducing a loved one's personal care hours, the people making that decision often do not see what happens inside the home every day. They do not see the assistance required with bathing, dressing, eating, toileting, mobility, behaviors, safety, supervision, elopement risks, or the many other needs that families manage around the clock.

Services Facilitators see the bigger picture. They know the individual and family. They can identify what information is missing, explain what documentation may be needed, help families understand their options, and guide them through an extremely difficult system when services are reduced, denied, or questioned.

Removing this relationship risks removing an important layer of advocacy and continuity from consumer-directed services.

Families in the disability community already spend enormous amounts of time navigating Medicaid, managed care organizations, authorizations, assessments, appeals, schools, medical appointments, caregiving, and countless administrative requirements. We should be strengthening the people who help families successfully navigate these systems not removing them.

I am also deeply concerned about what happens when families are moved into a centralized statewide model. How will DMAS ensure that Support Brokers have manageable caseloads? How quickly will families receive assistance when an urgent problem occurs? Will families have consistent contact with the same person who knows their loved one's history? Who will help a parent understand their options when personal care hours are suddenly reduced? Who will notice when an assessment does not accurately reflect what is actually happening inside the home?

These questions need clear answers before Virginia dismantles a system that many families currently depend upon.

Efficiency and administrative restructuring should never come at the expense of individualized support. People with disabilities are not files, authorization numbers, or cases. They are human beings whose ability to remain safely in their homes and communities often depends upon having knowledgeable people helping their families navigate an extraordinarily complicated system.

It is deeply unjust that major administrative changes so often place the greatest burden on individuals with disabilities and the families caring for them.

I urge DMAS and CMS to reconsider eliminating Services Facilitation as a standalone service. At minimum, Virginia should preserve meaningful choice and continuity by allowing families who have established, successful relationships with qualified Services Facilitators to continue receiving that support, or ensure that existing experienced Services Facilitators have a meaningful role in whatever system replaces it.

Please listen to the families who actually use these services. Decisions about disability services should not be made solely based on administrative efficiency. They should be evaluated based on what protects individuals, supports families, preserves independence, and allows people with disabilities to remain safely in their homes and communities.

Services Facilitators have made a positive difference in our lives. Please do not remove a support that is working for families like mine.