I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------With evv for live in caregivers, we will be spending time away from those who need care in order to manage this system that doesn't work. My child's live in caregiver isn't comfortable putting the app on her phone (understandable!). My non-verbal child doesn't use a phone, so we will have to get one. The ONLY thing we will use it for is EVV. We will have to monitor it to make sure the battery is charged and we're keeping up with data requirements and updates. That might not seem like much, but in the lives of parents and caregivers, every second adds up. We will be taking time away from our child to try to get the attendant signed in or out. If it isn't correct, it will take my time on the phone to correct it. Our attendant will not get paid for that time when she will be trying to sign in. The attendant will have to ignore the meltdown, or my child's requests, to manage this faulty EVV system. AND, the system will routinely short her time. Everything about this is designed to punish the disabled and the people who work hard, for little pay, to take care of them - and we will lose them

requesting removal of the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…----------------------------”DMAS is certainly practicing unethical approaches to ignore the disabled and force upon them a program which makes their lives with a disability much more difficult! To think DMAS doesn't have to do this for the live-ins is borderline unethical as well! Or that DMAS claims there is a cost savings. There is no cost the portal is already there to enter time.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------In Virginia stakeholders were not given the opportunity to participate in the process to shove evv down live in caregivers' throats as required by cms. Mandy don't know what dmas is attempting to do to us. We have no one else to complain to. EVV for live ins does not have to be done the way Virginia is attempting to do it. Live in should be exempt and DMAS lies about a cost being associated to do this, how could there be a cost? EVV harms people with disabilities. Actual GPS location does not need to be collected. Attendants are quitting left and right and others will not take the jobs now, mostly because they are not getting paid.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------I am a live in direct support worker. The evv app. sometimes wouldn't let me log in. Every single time, it did buffering when I tried to clock in and clock out. I also got a lot of error messages. I couldn't win for losing with this app. which is why I switched to the portal.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings." 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------What a way to help caregivers by making their jobs twice as hard with EVV for live ins.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Virginia is required to provide a stakeholder process to allow input from providers, beneficiaries, family caregivers, and others about the state's implementation of EVV for live ins. To ensure compliance with federal requirements and best practices for stakeholder involvement, DMAS needs to codify this process in the regulations.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------While the regulations are clear in their expectation that providers ensure selected EVV systems can handle several different staffing scenarios and be accessible for input twenty-four hours a day and seven days a week, there is no clear grievance, complaint, reporting, or investigation process for if and when they are not. The EVV applications already in use in Virginia are filled with bugs and connectivity issues, and these issues are placing many beneficiaries at risk for institutionalization.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ The proposed regulations do not appear to provide any meaningful assurances to beneficiaries regarding the security of their personal EVV data. In fact, the regulations as written in some instances require personal data maintenance for more than twenty years. Given how vulnerable so many cloud servers and web applications are to hacking and other data integrity issues, DMAS should include a formal grievance, complaint, reporting, or investigation process for beneficiaries.

Remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------it is sad you are doing this to live on providers... please continue to exempt live in providers

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------I pay a patient pay; I want a say about EVV for live in caregivers and how harmful it would be. I pay for a portion of my care with my own funds through a patient pay. I have a live in. I want him exempt from EVV.

Please remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------How dare DMAS suggest that EOR's use their phones to install the intrusive EVV app for live in caregivers! EOR's volunteer ALL their hours and their social security numbers, so that the state does not have to be financially responsible for attendants as employees! Many EOR's are not even related to the consumer with disabilities! The majority of EOR's have one or two jobs or businesses to run. How else could they volunteer? Now, the state is asking EOR's to use their personal phones to add a VERY INTRUSIVE app to it!? EVV has already put a strain on volunteer EOR's to the point where some may be lost because of EVV! DMAS is taking advantage of kind hearted people who have already given of their time and their valued socials and asking for MORE yet DMAS shows no compassion or kind heartedness themselves!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------There are several issues, bugs, and problems with the whole program that are displayed on the 2020 townhall, many have written Va state reps with their concerns, and a simple internet search can bring up many reservations regarding EVV for live in caregivers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------The fiscal agents have massive issues with the EVV apps not working. Bottom line, when the app doesn't work, workers do not get paid, and are often not paid correctly. They quit because of this issue. Apparently, this is what DMAS wants.

Please remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Evv for live ins is too stressful. Please stop doing this to us. Thank you.

Remove the language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Evv for live ins in Virginia would be horrible! We would have to clock in and out 6 times a day. Everyday would revolve around alarm clocks going off, so that we don't miss times. Makes me sick that my child will be subjected this every day in their own home the rest of their life just to get daily assistance! EVV for live ins would be a complete and utter disruption to disabled people's attempt at some semblance of a normal life. Why make their lives worse then it already is....geez.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------EVV for live ins is outrageous to even believe is going on. Our lives are so difficult as it is. The bureaucracy of living with a disability is a never ending paperwork nightmare. Year after year. Constantly proving a disability that is obviously never going to improve, only progress! Hiring attendants constantly. How many others will not be able to cope with the additional burden of EVV for live ins? Virginia has driven the consumer and their families to the point of giving up all hope of any semblance of a life that is even OK.

Remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------Are live ins going to be tied to a timed device because of EVV every single day of their lives? This isn't a situation where you are coming or "visiting" a job and you can clock in coming and clock out going - this isn't McDonald's. You live there. You must constantly watch the clock, so that you can clock in and out even though you are on call 24 hours a day and you work more than the set of hours given as a live-in. Your home should be your sanctuary, not an office or a space where you are subject to constant worry about the clock. You worry you will forgot and there will be no pay, wrong pay, loss of services, etc.... You worry you will spend your whole day straightening out payroll issues as a result of EVV for live ins. You worry your power will go out. You worry your device will be lost. You worry the device will break. You worry the device's battery will be broken or uncharged. You worry about being tracked at a minimum of twice a day. You worry about where all this information about you and your location/habits is going. To think all the trouble of EVV for live-ins could be exempted and is exempted at the Federal level, and the state is attempting to force evv on live ins is unbelieveable. To know that decision was made without consulting all stakeholders by those making salaries that are within the top 5% of the nation's government salaries is unconscionable.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------It is very hard for someone working at DMAS making over $150,000 a year, government salaried (typically 40 hours), with all benefits to understand that requiring a person to clock in and out at specific times in their residence is not easy. That is why everyone should have been involved in the decision making regarding EVV for live ins including those required to use it, not just those with comfortable salaries and healthy, able bodied loved ones. The majority of live ins do not even know DMAS is attempting to force this on them. There were no stakeholder meetings involving the very persons who are subjected to having to use EVV.

Remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------------Please continue to exempt live ins. The app. is too hard to work with. There were enough problems. It is too hard to handle a disability along with trying to manage EVV.

Respectfully requesting that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------------Not everyone is qualifying for the free phones. The free phones often do not work especially in rural locations. How is asking someone to drive to wifi to download their times/locations not asking the consumer to pay for secondary services to receive their home care? Tax write off for mileage is currently .725 cents per mile. That is the general cost of wear/tear and gas to get around these days. A trip to wifi could easily cost $20 to $30 round trip. Yes, everyone runs errands, but these errands will rarely coincide with the direction the consumer is going or the consumer's time frame, so it will end up being a purposed trip just for EVV for live ins. How is asking someone to download an app. onto their personal phones not asking the consumer to have to pay for secondary services? How is asking the consumer to buy and use a tablet, phone, or other device to comply with EVV for live ins not asking the consumer to pay for secondary services?

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------As a recipient, I would like to receive Explanations of Benefits, (EOB’s). If Medicaid fraud is a concern to DMAS, a good checks and balance system would include EOB’s so recipients can see what they are being billed for and what is being covered. An article that ran on the front page of The Virginian Pilot on 11/9/2019 reported that a local OB-GYN was being investigated by the Feds for health care fraud for performing surgeries on female patients without their consent. Many of his patients had Medicaid therefore did not ever receive an EOB. One particular patient tried for years to have children and eventually sought fertility treatment. Through the fertility specialist visit, she learned that her doctor had tied her tubes without her consent, nor even her knowledge. I wonder if all of the women that he performed unnecessary and life-altering surgeries on had received EOB’s, if he would have been caught sooner DMAS let that doctor harm many women. This isn't about fraud. This is about giving money to EVV technology companies. This is hurting disabled people.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------NCIL (National Council on Independent Living) has statistics stating that the fraud level in the Consumer Directed program is very, very low. Check out their numbers! DMAS has yet to produce any statistics showing that fraud is rampant in the consumer directed program especially among live-ins. In one of the Roanoke EVV meetings, there were investigators there and when asked how much fraud there was, their unprofessional answer was, "a lot". As DMAS is well aware, the majority of live-ins are working more hours than they are allotted. The majority of live-ins are parents of loved ones caring for a disabled family member. They are making $13 per hour with no benefits. How does keeping track of their hours and whereabouts with EVV show anything? With just two punches (many are required to do more) on EVV GPS system per day, their whereabouts are being tracked and recorded more than any American citizen would want to be tracked! Felons are treated better! It is quite one thing to track a nurse VISITING/EXITING a home versus tracking THE LIVES of a family and their disabled son/daughter or loved one at home and in the community! EVV for live ins is nothing more than a WITCH HUNT that costs taxpayers a considerable amount in additional record keeping, bureaucracy, software, hardware, staffing, cell phones/devices, etc.... and all the taxpayer is going to find out is that these live-ins need more hours and pay! There are bad people in the world, so does that mean we track all law abiding persons because of a few bad? No, that is an expensive witch hunt and nothing more.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------------Many persons want to speak out against EVV for live ins, but are in fear of retribution from DMAS and DBHDS. Then there are those that are dealing with a disability and for one reason or another cannot speak out and are at a grave disadvantage. So, for every person posting on here, please know that there are twice to three times as many wanting to speak out against EVV for live ins and the difficulty will cause everyone.

Requesting removal the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------Evv for live ins will make the job un-doable ... as a cna I can get paid more income without having my location tracked and having to pay a cell phone bill to clock in. Lots of people can’t get the Medicaid phone. My brother will likely end up in a group home. That will cost dmas lots more. It is sad you are doing this to disabled people. Virginia should continue to exempt live in providers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------Our wonderful live in attendant is 69 years old. She will be unable to learn to use the smart device. She has decided she will quit if evv for live ins comes into effect. My adult child won't get attendant care. EVV for live ins will hurt both the attendant and the participant. We will likely be unable to hire a new attendant.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------This it a massive ploy for whatever group is behind this, so it fails. So everyone will end up in a nursing home or something. This is a massive ploy.

Please, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------I was "non-compliant" three times, because I was in the car driving when my "shift" ended. What would you have me do? Enter my time while driving? Do I need to pull over and enter my end time even though, as a live in caregiver, my "shift" never ends? Isn't tracking to make sure you are with the consumer? It is not proving a thing with live ins.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------------------Evv for live ins caregivers violates constitutional rights to privacy. There exists a severe nationwide home care worker shortage. It is almost impossible to find consistent care in many areas of the country. Electronic visit verification has already pushed many employees out of the home care industry, as they are able to find better paying jobs that don’t require them to sacrifice their privacy rights.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------EVV for live ins is easier for everyone except those actually doing the work. That includes those having to deal with EVV for live ins fallout: service facilitators, payroll, dbhds, case managers, etc....

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Electronic visit verification seems to operate under the assumption that people with disabilities have a very limited existence. The government should not have the right to know where I am just because I have a disability. Electronic visit verification for live ins is the equivalent of putting an ankle monitor on people with disabilities and telling us where we can and can’t go.”

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------There is not fraud in community based services. Fraud statistics cited in hearings for the 21st Century Cures Act were later found to be invalid. The GAO report of fraud statistics from the Centers for Medicare and Medicare services only had reports from 35 out of 50 states, and did not include managed care.There is no reason to track the disabled, except, so technology companies can profit on the backs of those most in need.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Tuam, a name that traumatized the whole of Ireland in the spring of 2014, when an unimaginable story was revealed. A hidden mass grave containing the remains of some 800 children was discovered on the former grounds of a home for single mothers, a hell on earth where children died from ill treatment, and were shamefully buried in secret and forgotten. Similar to how the disabled were treated in Virginia from the late 1800s until the late 1980s. It looks like with EVV for live ins we we will be on our way back to being shut away. Stop EVV for live in caregivers; they do not visit.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------DMAS has decided to gps track all AIDS patients with live in caregivers in the state if they want their medication? Does that sound ok to you DMAS? Essentially that is what DMAS is doing to the disabled. Please stop GPS tracking of the disabled. EVV for live ins is a violation of our human rights.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------- One study reported that as many as 24.3% of residents experienced at least one instance of physical abuse while in a nursing home. Another study estimates only 1 in 14 incidents of elder abuse are formally reported. The New York State Elder Abuse Prevalence Study suggests this number is even more severe, with only 1 in 25 cases of abuse reported. It is estimated that these figures are low, as many elder abuse victims are unable or unwilling to report their abuse. EVV for live ins will make consumer directed almost impossible to use. More people will end up in higher cost placements being abused

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------Self directed care is where the person with the disability or their representative is the employer of record (EOR). The government is attempting to force GPS tracking with evv for live in caregivers in their own home on the EOR who should be free to decline it.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------- It was impossible to get APP errors fixed (when the app incorrectly recorded time or magically erased the entries.) EVV was a nightmare.So many people won't take this job without evv for live ins; just think how hard it will be to find someone with evv for live ins . Please stop EVV for live ins.

Requesting removal of the following bad language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------I got red error alerts whenever I submitted hours with evv as a live in. My employer of record said everything looked approved, but after three days, the message would still be there. I couldn't get an answer from payroll, and the button to submit my entire time sheet would disappear. I HAD to move to the portal for peace of mind!

Please, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------Evv is suppose to be for visitors not live in caregivers to prove they *visited*. Electronic VISITOR verification. VISITOR, VISITOR That means someone who does NOT live at home and comes to VISIT your home that needs to go thru all the stress of signing in out in out in out in out in out. I live at home with 3 severely DISABLED people and feel EVV (EVIL) is such a burden We are together 24/7 and it makes me feel soooo stupid clocking in and out of our own residence. It has caused to much stress,ANXIETY and ruins meals on a near daily basis. Taking care of DISABLED people is extremely time consuming and THEN comes EVV IL to further complicate everything. It is NOT GOOD for the DISABLED COMMUNITY. Continue to EXCEMPT LIVE IN CAREGIVERS. Remember electronic VISITOR verification. VISITOR one who visits for business ,social, or other reasons: a caller thats what a VISITOR is. Not resident; a VISITOR

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------------------I will quit being a care provider because of EVV for live in providers. We shouldn't have to be tracked like criminals. Oh wait, it is unconstitutional to track criminals so that makes us worse then criminals.

Please, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------When employees must use their personal cell phones for work-related calls, Labor Code section 2802 requires the employer to reimburse them. https://stormoenlaw.com/blog/2019/9/9/employers-must-reimburse-employees-for-work-related-cell-phone-use?fbclid=IwAR3OT5UZUjz9sUw6co5E3iXXHR94V--2m7ZkschfJ2REX9pV9UE6Au9ZCm8

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

I respectfully request that you remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------Exactly who thought this was a good idea to make live in providers pay to be tracked? OH, the EVV technology companies making money off the disabled. Fraud in consumer directed services is extremely low. DMAS doesn't want those people served in the community.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------Future with electronic visit verification for live in providers: I lost my services. I spend all my time home now. I had waiver and did lots of things. My attendants didn't do EVV. My mom could do portal timesheets. DMAS shut us out of the service.

Remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Everyone is essentially being tracked not just DSP. Live ins live WITH the client. Both are essentially being tracked at the same time. It is a violation of privacy rights and many feel compelled and forced to comply.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------Please keep live in provider exemption in the budget. It is unfair to stop people from getting access to living in the community.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Due to our disabilities, we- the disabled, are either confined, heading towards confinement, and/or realizing a life that is short versus the "abled" populations' life expectancy. Why in the world would we want to spend the precious time we have left without confinement or even in confinement dealing with such a problematic app or being tracked?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------We have a fear of losing services by living a fulfilled life. Are friends, family, and disabled supposed to be home all the time? Are they not supposed to live a free life without fear of being tracked? Are they relegated to the rules of where they should be as well, and not able to be where they want to be in privacy? Can they not have a schedule beyond the border of their home? Can they live a fulfilled life without being worried they can lose services, because they want a life outside their home with privacy and dignity?

Remove poor language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------Federal statistics show that a quarter of all nursing homes nationwide are cited each year for causing a resident’s death or injury. Please help us keep our loved ones out of them. EVV for live ins will cause nursing home placements.

Please remove the language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------People enrolled in EVV programs need to proactively seek assurances that their data will not be repurposed by other state agencies for increased surveillance or law enforcement intervention. Although Medicaid status is protected health data, other forms of information that can be used to infer Medicaid status are not. Is client EVV login data, including geolocation data, a protected category or is it governed by much looser laws around surveillance of employees? Will law enforcement be able to know sans warrant when and where a client confirmed service was provided? Will child welfare services have access to geolocation data for minors who utilize PCA's, and how will that data be used? Are biometric markers used by the EVV device strictly protected? If the state requires that biometric data is provided in order to verify service, does the contract with the third-party provider prohibit repurposing of that data?

Please remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------I had to constantly screen shot hours worked. I can't tell you how many times my hours had disappeared. All my hours with the error messages had disappeared from the app completely. I guess it's good I kept screen shots of all my hours. EVV for live ins was a nightmare.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Numerous parents are trying to keep their children out of nursing homes. DMAS is attempting to make it so much more difficult by EVV for live in attendants. EVV for live ins does not help the disabled in any way, and only helps make EVV tech companies wealthy. Sure home no one is getting kick backs from these EVV vendors.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------More die in nursing homes from the virus: https://www.thv11.com/article/news/health/coronavirus/coronavirus-cases-found-in-3-nursing-homes-across-arkansas/91-b4e1432e-b8ca-486e-88c0-417ce5e11847?fbclid=IwAR0JT0iyI8ZxZItmEVJHWLOfchDnM16wlfPpmdmvBXxEbwrLNo7Y7X-JvYg DMAS wants us there to die. EVV for live ins will cause nursing home placements. Please don't allow evv for live ins, so more of us don't end up there.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------I had my share of problems with the app myself. My EOR was no where near tech savvy enough to fix the problems, nor should they have had to be since he is unpaid and volunteer. We miss the faxed in time sheets. NO one could change those after submission. Every other tech approach, they are changing our hours, shorting, etc.... I have actually been in touch with the tech support for the app. I was able to explain in great detail some of the glitches. They tried to dismiss them as my error, but I had times, dates, and witnesses. I got them to admit to the glitches I reported, they took careful notes when they realized I knew what I was talking about. They read the notes back to me to make sure they got it right. My times etc.. were goofy on the app, but everything was correct on the portal when my EOR signed in and looked at pay periods, etc... with me.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------evv is very time consuming. It makes it difficult for me to hire attendants. I never want to live in a nursing home.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------STOP evv for live ins. Isn't it enough on people that are DISABLED and the attendants caring for them without having extra burdens placed on them such as this restrictive socialistic evv. It is DAMAGING to the DISABLED COMMUNITY.What kind of law is this attacking the DISABLED as if they are CRIMINALS. As my DISABLED child would say WHAT'S NEXT THE MEN IN BLACK,ATTENDANTS FOR ATTENDANTS, OR perhaps DRONES. This is not HELPING the DISABLED COMMUNITY but CREATING more kaos than anything. 99% of the DISABLED COMMUNITY is NOT happy about this invasion of privacy. Again WE ARE NOT CRIMINALS.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------- One of my child’s attendants logged out at the end of the shift but evv kept running after they left. Next morning they were able to notice what happened and wrote a note with correct shift time. However, I can see this as a problem in the future with live ins. This was a system error. We also went on vacation with an attendant but had no WiFi and though we were able to enter time manually later, we were told too many manual entries could cause to lose services. What else can we do if there is no WiFi?The fact that you can only have the EVV on one device per attendant is a problem. The attendant’s phone broke and, therefore, he could not use the EVV for a few days. Also, the APP burns the phone battery quickly and it is also harder to keep track of the hours to make sure you do not go over. After all, the attendant has it on her/his phone. I really think the EVV system will in the end cause more problems than logging in the portal. It definitely is complicating things for people with disabilities. Hope to get some answers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------numerous people have said because of evv their attendants didn't get paid . Virginia should continue to exempt live in providers. we are going to lose good attendants and our loved ones will end up in crowded, higher cost to the state, facilities... please don’t let this happen ... somebody really let the governor know what it really going on...

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------- This evv system for live ins is intrusive to the disabled person. Asking if the attendant was at the persons residence is non if your business especially when they live there (ever heard of home invasion?). Expecting location services to be active ON THEIR PERSONAL phone is intrusive. How dare you want to know the whereabouts? Paper or online timesheets served their purpose and were not intrusive. Our disabled people deserve the same respect non disabled people get.

Please remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------I voluntarily decided to care for my friend's adult child with disabilities when her family's circumstances changed. I already have a large family, what is one more? Well, it has been a challenge, but through many trials, we have made it work for a decade. Now, comes EVV for live ins?! I thought the most trouble I had would come from handling a disability! Now, I am considering letting this person go to an institution! To think I must even consider this decision is horrendous and heart wrenching! This will be on the hands of the state, since live-ins are not federally mandated! How is Virginia being person centered when IGNORING the federal exemption and the PERSON all at the same time??!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------1.EVV system locations say you not there when you are.It works sometimes and sometimes it doesn't.2.The app always having issues when clock in an out it's always problems.3.I have to turn phone off and on to restart the app.then if try to put password in I got lock out then have to call to get back in.4.It doesn't give you any information for when you do time sheet and summit .5.It needs to call or text to let you know the statues at the end of pay period before getting paid.ex good to pay,denied , or if there an issue with time sheet.they don't do at all. PAYROLL PEOPLE: 1.Never let you know if issues with time sheet. 2.You talk to 3to4 people before you can get the answer you need in the first place. 3.When you have issues with time sheet it takes so long to get paycheck after the issue been resolved like 2to3 weeks to get paid. 4.PPL need to contact people when an issue come up about time.Let you know your hours,and statues.at the end of pay period.Before you wait on check to come and don't get it then you have to call to find why you didn't get paycheck.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------evv for live ins Is going to contribute to the shortage of health care providers. Please exempt live in providers so my adult child doesn’t end up in a group home to suffer a miserable existence until he passes away at a young age . Stop EVV for live ins. Let more of us stay home.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------dont sent my brother away. Virginia said in their agency statement that Va wouldn’t apply any more stringent guidelines then cms required... cms said community locations and live in providers didn’t have to be evv. Please allow live in providers to continue to be exempt. My brother will end up in a group home and due earlier and cost the state more if you don’t exempt live in providers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------------Live in aides should continue to be exempt from this. This system is designed for an aide who comes and goes - meaning that during clock in/out there are two (2) adults in the home to help the disabled person. A live in can be the only adult in the home (1 person). The disabled person has multiple needs that do not happen on a clock and must come before the nuisance of making a call to clock in/out.

Below language is harmful. Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------This evv for live ins will trap my adult child to the hours the live in aid has to clock in and out. So my child can not leave the house before 8am and has to be home by 4pm. My child travels to therapies ( a trip that takes 1.5 hours of travel) for OT, PT and speech and therapies have to be scheduled to allow for the travel time. This means that instead of scheduling all three in one day, my child has to travel 4 days a week. This costs a lot of money in gas and it means that my child can not do the homework the therapists want him to do.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------It's very difficult to hire and maintain qualified live in caregivers and nurses due to low pay rates, no benefits whatsoever, and now add a complicated, burdensome app for them to navigate for someone who is on 24/7 without payment for all the hours over the allotment. How does EVV for live ins really fit in?

Remove language harmful to the disabled under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------Evv for live ins is a complicated, error ridden application, with an impossible clock in/clock out requirement for a 24/7 responsibility. To be readily available at a moments notice for falls, driving, incontinence, daily emergencies, seizures, gtube feeds, 7 times a day medication administration, all ADL assistance, possible elopement, hands on assistance for mobility cleaning, and a miriad of predicable and unpredictable situations during the day and night and be burdened with the EVV complications, clock/in clock out on the exact minute requirement, with no EOR on site to discuss and fix issues is going to be extremely stressful, if not impossible.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------The pay for aides is $13/hr. The pay for aides are way too low. The take home pay aides make either agency or Consumer Directed should be a minimum of $15 per hour. WHY would anyone work the job especially with EVV for live ins now being mulled over? Was this what DMAS was going for? The elimination or culling of cdpa?

Please remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Data analytics collected by one agency for the specific purpose of helping a person receive benefits from the state will place them at increased lifetime risk of punitive interventions from other agencies. Wrong, so wrong. today, the diabled; tomorrow, YOU. I

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------The waiver program was put into place to allow independence and community access to persons with disabilities. EVV for live ins would be a grand hinderance to partaking and enjoying community access. Do not say they can go anywhere with the app and clock in and out! When folks are stuck home dealing with the app, the bureaucracy, and fallout EVV causes, they are NOT in the community! Crippling the disabled by making it more difficult to maneuver their daily lives is not an honorable option. This is the lowest cost care available to the state and it will be eroded by EVV for live ins.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------With the majority of live-ins receiving two in-home visits per month and countless ongoing evaluations, how much oversight is enough?

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------The name is titled Electronic Visit Verification. Live-ins do not visit. Their job is 24 hours a day and yet they are given a set of arbitrary hours to clock in and out to. It is nearly impossible to clock in and out at set times when a person is providing 24 hour care. The clock becomes more important than the person cared for in a situation like this. The last thing a good caregiver wants to do is let down the person they care for, but the state is making a live-in's job so difficult, that they may be forced to quit. Institutionalization will be the ONLY option at that point.

Please, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------- Do not cripple those with disabilities with EVV for live in caregivers. "Person centered planning requires really listening to the person" DMAS stated this and yet they are not listening to the person about EVV! Do not say persons are not being tracked when they are providing location at least twice a day. A minimum of two clock ins and outs a day over a period of time produces documentation of habits. No one wants their daily lives and their habits tracked in their own homes. No one. To have live-ins do this, is essentially having their lives and the lives of the persons they care for tracked in their own home. It is an invasion of privacy.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------US government funded android phones come with preinstalled irremovable malware: https://arstechnica.com/information-technology/2020/01/us-government-funded-android-phones-come-preinstalled-with-unremovable-malware/?fbclid=IwAR3TXS3y-zMkU7-woL9Oph4gyWHm-JI63SfMtjjItIv6Fna2ED3hGDkh2Dc so those free Obama phones DMAS wants live ins to get to enable use of EVV for live ins. Many of the ones people do get are loaded with malware and track you and pull all our data that is entered to the malware app. It seems the price often paid is compromised security and privacy.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------Instead, of draconian steps that will tank the economy for everyone, why don't we focus on those most at risk?Why are you harming the consumer directed consumers with EVV for live ins. It helps nothing .

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------we live rural where the pay is much lower at 13/hr. As a result, there are no caregivers to hire. Anybody who lives here and is in that line of work,drives north where the pay is much more per hour. And yet it is illegal to tip, supplement, or pay for gas to get anybody to drive out here. The system punishes the rural counties by making it impossible to find help. EVV for live ins will add to the rural issues with why people wont take this job.

Please, for the love of God, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------I have read numerous articles where cdpa, the low wages that come with the job and the total lack of benefits, sick leave, retirement, workmen’s comp... are throw backs to slavery according to many of the articles since most of the workers are women of color.. how in home health workers are allowed to be exempt from these benefits and expected to work for basically nothing; drive a client around for no additional reimbursement and now live ins are threatened to be tracked like a criminal via evv... not only will the live in attendants be tracked but the clients will be tracked as well throughout their entire day.. this is going to make it impossible to hire staff... Virginia could easily continue to exempt live in providers and help continue to ease this burden. this isn’t stopping fraud; this is making it impossible for people to utilize the lowest cost service and treating the staff like slaves and criminals.

Respectfully requesting that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------- Here is a future "Want Ad" for finding live in attendant to keep people living in the community and not living in an institution (if evv - electronic visit verification- is forced upon the disabled): Hiring: A job featuring: no health benefits, no vacation pay, no sick time, no disability, no workers’ compensation, no retirement or 401K plan, must be available at all times of day and night with very little notice, GPS monitored time logging that tracks you which you must download on your phone, use your own data plan and minutes to support, The hourly amount is $13/hr set by the General Assembly and there is no negotiation, and Supported individuals must be taken out into the community and no reimbursement for your gas or transportation expenses you spend. Additionally, you need compassion and expect to be mentally and physically exhausted. This is the job for you!! Job requirements: Suitable Candidate must enjoy: Working in an environment with a general sense of mistrust and being treated as guilty until EVV (a broken and unreliable system) proves you innocent? Being overseen by indifferent, abusive and over-loaded caseworkers that let services expire dropping the ball on paperwork and don’t answer the phone or email? (Seriously, you can’t get anyone on the phone.) Working in an environment that when there a problem- the overlords will fix the "glitch" in their software, (we hope) within 60 days. Working hard and knowing that you can't be sure when you will be paid or even if you will be paid or that the amount will be correct. Knowing that your employer will be a stressed-out family who is overwhelmed and under threats by the government to claw back funds the overlords deem invalidly paid. Being required to follow guidelines that are contained in multiple regulations without any clear instructions on how to interpret regulations.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------I wish Virginia had advocates that would have let consumers know about open comment period for evv for live in providers. Evv for live ins will make it really hard to hire people. I might end up in another state facility because of evv for live ins. Every time I have been in state placements I have been beaten up and heavily medicated and abused in every way. I don’t want to live a life like that .. it isn’t living ... please continue to exempt live in providers :( ...

Remove awful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------Once when we used EVV, my attendant had fourteen hours logged that she didn't login. They just appeared. I talked to someone at the fiscal agent and explained it to him and he had to send an email to get the hours removed. It wasn't changed after a few days, so I sent an email. Still no change, so I called and left a message. It's like freaking crickets there when trying to solve a problem. EVV is going to be a nightmare more live in providers.

Remove the harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------The bottom line to me is that this is an invasion of privacy and basically a tracking device for those with disabilities. This isn’t okay. I personally wouldn’t be okay with a tracking device of sorts on me. So why is it okay for the disability population?

Remove bad language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Guess who suffers the most from EVV? Our adult children who have no one to depend on except us. Our live in caregiver is such a blessing they love my son and give him opportunities outside of our home. You know as well as I do that everyone needs friends and you don’t always wanna be stuck with your parents or family. EVV for live ins will keep people with disabilities isolated.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------EVV for live in attendants would be a nightmare. I know this is the ultimate plan by the government to weed out those who can’t jump through all the hoops but they are making it so damned impossible. Who would want to go through all this BS for $13/hr when you can go work at Target or McDonald’s for $16-$20 an hour?

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------The answer to preventing fraud, waste, and abuse in home care is having support staff (SC,FA, and SF) who do their jobs and care about attendants and consumers. They address questions and concerns expeditiously. The also treat persons with disabilities with respect and as the competent adults they are. They support attendants by paying them a wage that reflects their skill and hard work. ****If we took all the funds attempting to be wasted on EVV for live in caregivers and used it to increase attendants' incomes, we could greatly reduce fraud, waste, and abuse by attracting a higher caliber staff.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------People with disabilities have a right to privacy like all other law abiding citizens. Tracking our movements and chaining us to our homes like criminals is unconstitutional. We will fight this attack and preserve our human rights to life, liberty, and the pursuit of happiness.

Respectfully requesting that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------I am at Walmart right now and dmas will know because of evv for live in providers. Every move you make dmas will be watching you.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------My friend Josh’s case worker came out and he was talking about evv for live in caregivers and his fear of ability to get workers because of it. the caseworker said he should accept the inevitable and go on psy meds to tolerate it, but it looks like he will be going back to a nursing home. Gee just like the government. Let’s kill low cost solutions that offer better quality of life. Let’s spend more of the tax payers money and make the disabled as miserable as possible.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------EVV systems often involve GPS tracking or telephone based systems for the healthcare workers to call into a system to verify their shift. EVV is less effective than peer review systems that involve a common timesheet which require sign-offs from multiple attendants and from the consumer to verify that an attendant has completed their shift. EVVs rely on the mistaken belief that electronic systems are more reliable or less able to be tricked than other forms of verification when in fact phone numbers and other purely electronic systems are less secure than systems that require multiple sign-off.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------Violation of Olmstead/4th amendment and did y’all forget we are RURAL??? No satellite. Landline that goes in and out. 1 cell carrier that works when you drive into town. This is what RURAL looks like. What gives the government the right to know where my children are anyway? How is it legal to require this information to receive services they’re eligible for due to their medical and developmental disabilities? Olmstead says they must receive them, 4th amendment protects from unreasonable search and seizure. Even if it says they’re tracking the attendant, if the attendant is with the consumer then they’re tracking the consumer. What gives the government that right? Our PCA who have been with us for many years has given notice that if evv for live ins comes, they will leave. We are on our own very soon. We’re just stuck. We can choose to sell or give up our home and move to a city where EVV works or give up the PCA and do what we can on our own for our kids. We won’t let you institutionalize them. We (and they) have worked too hard to avoid that. Shame on you.

Remove irreparable under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------I am Humiliated for needing help to be active and productive in society. I am a wheelchair user who needs help to be as independent, active, and productive in society as possible. EVV for live in attendants threatens to steal the hard won independence of millions of people with disabilities like me. With the use of EVV for live ins, Virginia wants to track my movements. They want to know where I go, what I do, and who is with me every day. They are tracking people like me right now. I'll have to carry a special device, hope to not forget it, hope it is charged, hope it can find signal, and I won't be able to leave my home without notifying the government. I haven't been arrested or committed a crime, and yet, my feelings can be summed up as sheer humiliation, as if I have done something wrong for being a law abiding citizen with a disability. I know persons who collect disability claiming they can't work who are, for the most part, abled. They work up to three jobs collecting funds under the table. No one tracks them. No one asked them if they have three jobs with illegal funds coming in. No one. Yet, Virginia wants to ask me, as someone who cries for assistance just to be independent and productive, to be treated like a criminal. The sheer humiliation of it all!

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------Live in attendant care isn’t like other jobs... you just don’t clock in and out... the tasks vary each day... sometimes their are no breaks. This job comes with no extras. Just the pay of 13/hr. No time off can be taken as a live in or you could be charged with negligence. My client worries for his life if evv for live ins is enforced, and his social workers just said this week he is going to have to go back to a nursing home if he can't find people to do evv. Incredibly sad. This isn’t fair or right.

Remove wrong language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Electronic Visit Verification (EVV) for live in providers is a tracking system that requires electronic verification of when a person receives Medicaid-funded personal care or home health services. Many people with disabilities worry that EVV for live ins will violate their privacy and limit their independence. They are particularly concerned about systems that use GPS, cameras, or other intrusive tracking systems. They are concerned it could limit their ability to go out into the community and confine them to their homes. Because it does do this, it also makes it impossible to hire staff.

Please remove poor language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------Many people are happy with online time-cards, which they say are accessible and work well. EVV doesn't address fraud or quality of services. A ton of money will go to the EVV vendors, who just happened to spend a lot of money lobbying for EVV

Remove bad language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Why didnt we have stakeholding meetings? Virginia did not invite or get the word out that this life altering restriction for live ins and the disabled was coming to consumer directed services. In fact, they buried it in bad language.

Please remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------- The purpose of evv (electronic visit verification) is supposedly to prevent fraud, although fraud in home care services is extremely rare. Although the Center for Medicare and Medicaid Services has stated that GPS tracking is not required for electronic visit verification, many states have wrongly interpreted the law and have chosen to use GPS to track people with disabilities and their caregivers. This means if you have a disability and need personal care attendant services, you will be forced to disclose your exact location to the government every time your attendant clocks in and out. This is wrong and taking us back before ADA and civil rights for the disabled.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------Live in Caregivers are, for all intents and purposes, salaried. They receive a specified sum based on what little hours the government "will" pay them and NOT based on the fact that they work around the clock. They are with the disabled 24 hours per day, including living with them. How does a live in clock in and out? It is impossible for them to clock at the small amount of hours given. It is like asking a salaried policeman to clock out in the middle of arresting someone and clock in in the middle of booking the same person. It is impossible to do.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------Today, it is the disabled (the easiest population to pick on). Tomorrow, it is YOU.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------Commenter: Rooted in Rights, a part of Disability Rights Washington "Fraud is more commonly the result of bad billing practices at agencies, not a consumer-level issue" From Rooted in Rights' Electronic Visit Verification: a Threat to Independence for Disabled People: "EVV proponents claim this will reduce fraud by confirming that people actually worked the hours they say they worked. "You're putting in a technological solution that they're not asking for, for a problem that doesn't exist," says Borel. Anti-EVV campaigners say there's no strong evidence for fraud in these settings, and that the cost of EVV far overrides any potential fraud-related savings. Fraud is more commonly the result of bad billing practices at agencies, not a consumer-level issue."

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------live ins don't visit. STOP EVV FOR LIVE INS.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------EVV for live in attendants turns having a disability into a crime. The government should not have the right to know where I am at all times just because I have a disability and need attendants to help me manage living. Electronic visit verification for live ins is the equivalent of putting an ankle monitor on people with disabilities and telling us where we can and can't go. It turns having a disability into a crime.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------one thing DMAS forgot... most of the people willing to take this job have zero skills. They are usually and hopefully nice and kind people who want to help others. But in reality if they are willing to work a 13/hr job with no benefits, they often don't have skills that would get them a higher paid job. They don't own the smart device required to log into the app. This added technology requirement is will make it impossible for live in attendants to keep this job. I don't know if DMAS did this on purpose or not, but you made CDPA obsolete.

Many caregivers and clients oppose EVV for live ins and for good reason: our jobs are hard enough without having to add another layer of reporting and oversight. For people on DD waiver, we already have a SC and a SF coming out one time a month to see the client. We are also monitored by the fiscal agents every two weeks. For people using EPSTD or CCC+ waiver they have an intrusive MCO case worker and a SF and the FA monitoring their situations. They have constant evaluation meetings. EVV for live ins actually makes it easier for attendants to cheat time and sign off on their own hours. This is impossible without evv. All this oversight is agencies making money off the disabled when the funds are directed away from the disabled every time another agency oversight is forced on the disabled. Now, with evv for live ins, evv vendors will have their hands in the cookie jar. This constant addition of oversight costs the taxpayer and the disabled every time.

Remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------I support my consumers. I agree that live in providers should continue to be exempt from evv. It interrupts the daily lives of consumers and the ones living with and providing care for them.

Respectfully requesting that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------EVV will ruin any trust relationship I, as EOR, have with my live in PCA's. It is hard enough to develop a lasting relationship of trust with a live in PCA. EVV for live in caregivers will ruin that for me. Electronic Visit Verification (EVV) will interfere in the relationship between me and my live in PCA's. It will treat them like criminals who must be monitored *****in their own residence. This creates an environment for distrust from the start. Once trust is lost, it is never regained. Thanks EVV for live ins for attempting to make my life harder than it already is. Maintain the live in caregiver exemption from electronic visit verification.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------- I care for a consumer-directed person who does not want their privacy right infringed. When they signed up for these much-needed services, nowhere did it state that their whereabouts at the beginning and end of their attendants' shifts would be recorded especially in their own homes. End EVV for live in caregivers now now.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------We really need this to happen. We can’t keep our child home all the time without regular community access with the added stress of evv for live ins and not knowing if we are going to have money to pay bills due to glitches with evv.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------EVV for live ins is just not right. I have been caring for my family member for 9 years after he was beaten up severely by a roommate in a group home. He doesn’t want to go back to a group home. The way pay would be negatively affected by evv for live ins (read testimonies below about how evv purposefully shorts people on hours), we will no longer be able live. It sounds like this will only get worse. Why won’t dmas continue the exemption for live ins? Why did dmas try to change the law exempting live ins by slipping language in that is buried amongst other budget items? Why? It shouldn’t cost a thing as they are already using what works: the portal.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------I don’t like evv for live in caregivers. I don’t like being tracked everywhere especially not in my own home.

Respectfully requesting Removal under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------Who thought this was a good idea? The whole idea of consumer directed care was to give people independence with limited interference from the government. It was supposed to help people stay home and take in the community at lowest cost for the taxpayer. Evv for live ins will make consumer directed care obsolete. It would add a significant burden to our lives.

Remove harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------EVV is a nightmare. I wasted hours and hours trying to get the free phone to put the app on, installing updates, logging in, computing minutes so as not to go over what is approved. doing portal entries because the app. doesn't work if you are too far away from home, etc....

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------As an live-in attendant for my child, I find it unnecessary to use EVV when we live together and I put more hours in than actually paid. Please support our request to continue to exempt live-in attendants from EVV!

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------When I attempted to use evv one year, Payroll denied time on 2-29 since the new year starts 3-1 and I guess someone forgot to make the old one go to 2-29 due to Leap Year. What a cluster.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------The disabled are too costly to keep funding? The agencies and homes and caseworkers are the ones committing the fraud that exists now, not the families. One should not have to trade basic human rights, trade basic human dignity, and privacy for evv for live-ins. This is no different than the mindset that set socialist Germany against it's disabled, and that led to the idea that the disabled were too costly to keep funding. EVV for live-ins is of the same thinking.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------VA proved they'd be more inclusive. Right. I find it entertaining that the DBHDS website reads that in 2011 VA negotiated with the DOJ to avoid an expensive trial with the federal government. But even after the DOJ settlement, VA is failing their people with disabilities by enforcing stricter EVV requirements than the federal government even enforced by attempting to force evv on live in caregivers. But Virginia proved they'd be more inclusive? Right.

Please remove the following bad language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------Please continue to exempt live ins from electronic visit verification. They do not visit. This just makes a difficult life of trying to survive daily that much more difficult. Plus, CMS (federal gov't) has exempted live ins from the very beginning, so it should be at no cost to the state to continue to exempt live ins and have them continue what they have been doing for many years: using the portal to log in time. Thank you for your time and your prompt attention to this matter!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------------EVV for live ins is in direct violation of the Americans With Disabilities Act which does not permit programs to be more complex and "beyond the competency" of the participants as well as adding "barriers to care." (so according to ADA DMAS shouldn't be forcing a system that will disqualify the majority of being able to utilize it ) EVV is discrimination ...

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------"I am the legal employer...a right my community fought for and one I will never willfully give away. Since 1997, I have hired my own PCAs through the consumer-directed service model. I train my staff how to help me. I manage their work schedules. I supervise the work they complete. I sign off on all timesheets. I submit timesheets to a third-party responsible for payroll processing called a fiscal intermediary (FI). And, when necessary, I have the difficult task of firing individuals. As a consumer in this model, I am the legal employer. Navigating these work relationships in a very intimate environment is difficult yet *****a right my community fought for and one I will never willfullly give away." Kendra Scalia, CDPAANY

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------We are headed to a police state. Today EVV for live ins in their own homes. Tomorrow, it is going to suck to get old in 2050 or 2060. Every moment of your life is going to be monitored or videoed. We are headed to a police state.

Asking for removal of the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------Errors on evv app are a breach of privacy. I am an attendant and once when I used the app. it displayed two employees and 5 clients on my screen that I have no relation to, and listed their names and contact information. I was actually able to call the numbers listed. This isn't just a breach of privacy, it violates HIPPA by disclosing disabled individuals' medical information to complete strangers. If it hands that info. to me, I wonder what hackers are doing with this app.?

Respectfully requesting the removal of the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------EVV for live ins will make nationwide caregiver crisis worse. Our nation is in a caregiver crisis. There is a fear of losing caregivers due to EVV for live ins. Caregiver positions are already hard to staff due to low pay rates, low staffing pool due to background check elimination, and zero benefits. EVV for live ins is another layer of of CD staffing peril. EVV for live ins will cause many to be at risk of involuntary institutional placement.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------NEW YORK (Reuters) 2020 - Less than a year after Constantine Valhouli moved his 85-year-old father into a Massachusetts elder-care facility, he is considering bringing his dad back home, his confidence rattled by a deadly coronavirus outbreak at a Washington state nursing home. The deaths of four residents at the LifeCare long-term care facility in Kirkland has stoked Valhouli's fears that the virus could spread quickly and quietly in facilities such as the home where his father resides after a series of strokes. Why is Virginia trying to end low cost homebased care? Please maintain the exemption from evv for live providers.

Please Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------As a live in, having to do electronic visit verification is nonsensical! I am here taking care of my sibling 24 hours a day. Our lives literally revolve around the care. There is no clocking in/out. I am always on duty. Thankfully, I am able to be paid for taking care of them or they would not be able to be at home.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------It is time that Va promote pride in a job well done. Stop treating family caregivers and those who have opened their homes to persons with disabilities like common criminals. How can they be proud of the work they do or want to do it all with an invasive system like EVV tracking them in their own homes and community as if they can only offer bad and irresponsibility. The majority are very kind, mature, and reliable folks working hard to make sure our community is taken care of.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------ARC, Independent Living, consumer directed service facilitators, Virginia Autism Project, and SEIU are begging DMAS please exempt live ins from electronic visit verification.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------Between the case manager issues, the payroll issues, the service facilitator issues, montly meetings, evaluations, etc.....I am spending literally the equivalent of a part time job just sorting out problems. Community? What community? With evv for live ins, we will be stuck at home dealing with EVV issues all day long! This is time we really don't have! I am beginning to wonder if this waiver stuff is even worth it. I am wondering if the state wants me to drop the waiver as well.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------when we tried evv, the app was down a lot. Payroll would send a note saying it was down. They also constantly threatened us with being flagged and loosing attendant care, which can result in a loss of waiver, which can also result in a loss of Medicaid. All so an EVV lobbyist was successful in getting a senator/congressmen to buy their product and profit off the disabled. Consumer direct care is lowest fraud level. High fraud level: public schools, nursing homes, & group homes.

For heavens sake, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…” CDPA without EVV for live ins is a wonderful service. Forcing evv for live ins will make that service unusable.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------I don’t understand. Why does Dmas think they need to waste money and pay evv vendors when the portal works for the disabled community just fine the way it is? Why do they want to threaten the community living form of care with evv ? Make it make sense!

Please, remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------I take medication that lowers my immunity. I am very frightened of the Coronavirus and other viruses and what it could do to me. Luckily, I am in the home of my live in caretaker. This person helps me to keep the home sanitized and practices prevention, so I am at much less risk of being exposed to viruses and bacteria. I am becoming more fearful every day about EVV for live ins and the threat of an institution as my only option. Please don't do this to me! Please reach a solution and quick!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------How can we force each individual's difficult, disabled life in a scheduled box by forcing EVV on live in caregivers? We have two live ins. We schedule when we can. We can't schedule seizures and, all too often, bad days. "Sorry Johnny, we're not going out to eat today. You should have told me 4 days ago you weren't going to have a seizure or any health problems today. You needed to let me know 4 days ago you wanted an impromptu lunch at the diner, because you were feeling good for once. Oh, you want to go shopping? No can do, we decided to dust today!" How can we force each person's life, their very difficult lives, into a scheduled box?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------The current system of attendant care has rules such as not more than 8 hours per day and not more than 40 hours per week. How can you use a time card system (EVV) when you cannot pay every minute worked? ****Employers should pay every minute worked, yet with EVV for live ins ,if you make a mistake in their system you are not paid for the time worked. A time card system is designed to pay hourly workers. The system does not match the type of work being performed by live in caregivers. The employer of record does a better job of managing the time than this system; since we are dealing with individuals with different needs. Now time clocking has become the priority, not the needs.

I respectfully request that you remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Dmas is telling the elected law makers of Virginia that forcing evv on live in caregivers will save money. This is bull crap or an administration not using common sense. EVV vendors charge dearly for their services AND evv will eliminate many live ins which will erode the most affordable care service available to VA taxpayers! Do taxpayers want to pay massive extra for institutionalization?? I don't think so. Live ins could simply use the portal which they are already using and dmas doesn’t need to waste money by losing affordable care and paying for EVV service. If Dmas doesn’t know, then this can simply be an agreement between the fiscal agencies, the eors and providers . Problem and a massive one at that solved ... no cost

There is some bad language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------- So frustrating to write DMAS about problems/frustrations with the app and EVV in general for a live in companion only to get a canned response quoting the 2016 Cures act every time. I can't be compliant with the CURES act if you don't give me an app that works and has features that make sense for the user. Better yet, give me the PORTAL. It has been tried, tested, approved, and works.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- EVV for live ins make it go. Continue to exempt live in providers.

Remove damaging language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------There is no reason not to continue to exempt live in providers from evv. I have no idea where DMAS is coming up with the need to spend tax payer money or to create a new system to enter time when the online portal works GREAT. whereas the apps don't work. Stop the lies DMAS.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Equal treatment is a fundamental purpose of the ADA. People with disabilities must not be treated in a different or inferior manner. Yet, EVV does just that... tracks us like dogs.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------There is not a day that goes by that I'm grateful for keeping my mother at home and out of nursing homes. The waiver that allows us help to do so is a Godsend. That is where it ends. With evv for live ins being forced, we will constantly be trying to set alarms to remind ourselves to clock in and clock out at the forced, allotted hours. As a live in caregiver to my mother, i struggle daily just to provide good care. I am constantly on duty and will find myself more times than not breaking the rules by forgetting to sign in or out. With EVV for live ins, I will find myself having to run to my moms room if she's ringing her bell then to bath and dress her and get breakfast and toiletries all while trying to lug my phone around to stay compliant in a system that works SOME of the time. The Evv should be for someone coming in and out of the home not for a person who is truly on duty 24 hours a day.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------The disabled using consumer directed services just want to stay home and not in an institution. EVV is taking the option of consumer directed services away. EVV apps don't work. They capture the wrong location. They are down most of the time. We should track all the CSB workers and all the DMAS workers with it. See how they like it when their pay is cut for no reason cause an app isn't working right. Pay them $17,000 a year and expect them to work full time with no benefits.

Please Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- The online portal has a history of working well for live ins. The portal works the best for the majority of live ins. The portal is what live ins prefer. The portal has a history of working well for live ins. Maintain live in exemption for electronic visit verification, so that the disabled and their live in caregivers can continue to use what works best for them: the portal.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------The force of electronic visit verification (EVV) for live in caregivers has created a “firestorm” of complaints. That is ok to DMAS because they just think we are too stupid sheep to understand how to use an app... They don't understand we can't afford smart devices or services and that NO... Medicaid didn't pass out everyone a free smart phone with unlimited service. Maybe DMAS is the stupid sheep.

Requesting that you remove the following very harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------This was an error code I often got when trying to use evv: "unable to read data from transport connection socket not connected." what the heck did this mean? why did we get errors like this and like "token expired"? none of this is in any of the user guides. then you have the location 300 miles away from where we are. GPS magically doesn't work. just stop this crap. I can't keep an live in attendant over EVV.

Remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------NO NO NO NO NO NO NO… EVV FOR LIVE INS KEEPS ME FROM BEING ABLE TO HIRE ATTENDANTS... I DONT WANT PLACED IN A NURSING HOME. NO NO JUST STOP IT

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------What happened to delegate Tran's amendment to exempt live ins? She worked hard on this in 2020. Virginia has exempted live ins since 2020. There was good reason to exempt live ins. Why do we have to go over how harmful EVV is to live ins all over again? Maintain the exemption for live in caregivers!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------evv Is going to contribute to the shortage of health care providers. Please continue to exempt live in providers so my grandson doesn’t end up in a group home to suffer a miserable existence until he passes away at a young age.

I respectfully request that you remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------Virginia said in their agency statement that Va wouldn’t apply any more stringent guidelines then cms required... cms said live in providers don't have to do evv. Please continue to have live in providers be exempt. My sibling will end up in a group home to suffer and die earlier and cost the state more if live in providers are not exempt.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------How can you threaten a disabled person's medicaid status because of an arbitrary system of red flags? How can you put the health and safety of a disabled person in jeopardy so an live in aide can clock in/out so they don't get a "red flag"? This system is severely flawed and punishes a disabled person for being disabled and needing help. Instead of encouraging and removing barriers so the disabled can thrive, this system is trapping them in home, tracking their movements and threatening their health and safety.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------Live in caregivers can are exempt under the CURES Act, by CMS (fed government), and by Virginia itself. However, Virginia is now choosing not to exempt?! Let me explain two situations SO FAR to help you better understand WHY live ins should continue to be exempted. First, meal preparation will get interrupted a minumum of twice daily to clock in or out. On several occasions, it takes a long time to get clocked in: stiff fingers on the keyboard, an app update needing to be installed before a log-in is even possible, trying to find a place in the house where there is internet, tech difficulty, or the app not working after several attempts. So many meals will be ruined because of the time away from the stove just to to clock in or out. The second situation involves travel. I've had to pull off the interstate and highway to clock out in the past. Ridiculous.

I respectfully request that you remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------The waiver program was put into place to allow independence and community access for persons with disabilities. EVV for live ins is a grand hindrance to partaking and enjoying community access. Do not say they can go anywhere with the app and clock in and out! When folks are stuck home dealing with the app, the bureacracy, tech issues, and fallout EVV causes, they are NOT in the community! If they only have a landline to clock in, they are stuck at home for having to call in at forced time. ****Crippling the already disabled by making it more difficult to maneuver their daily lives is not an option. This is the lowest cost care available to the state and it is being eroded by EVV.

Plan remove the following ill-gotten language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------With the majority of those with disabilities and live-ins receiving two in-home visits per month and countless ongoing evaluations, how much oversight is enough? EVV has created unnecessary burdens and additional bureacracy just to CLOCK IN AND OUT. This is not a simple clock in and out procedure. There is always some difficulty with EVV which can be attested to simply by using a search engine and reading complaints readily available online. Letters have been written to many state officials as well concerning this cumbersome, burdensome process.

I respectfully request that you remove the following harmful language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------"Person centered planning requires really listening to the person" DMAS stated this and yet they are not listening to the person about EVV! Do not say persons are not being tracked when they are providing location at least twice a day. A minimum of two clock ins and outs a day over a period of time produces documentation of habits. No one wants their daily lives and their habits tracked. No one. To have live-ins do this IN THEIR OWN HOME, is essentially having their lives tracked. It is an invasion of privacy.

Remove bad language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------The Cures Act states EVV is for "visits". The name is titled Electronic Visit Verification. Live-ins do not visit. Their job is 24 hours a day and yet they are goiing to be given a set of arbitrary hours to clock in and out to? It is nearly impossible to clock in and out at set times when a person is providing 24 hour care. The clock becomes more important than the person cared for in a situation like this. The last thing a good caregiver wants to do is let down the person they care for, but the state is making a live-in's job so difficult, that they may be forced to quit. Institutionalization will be the ONLY option at that point.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ I have heard countless complaints regarding this evv. The app freezes constantly. It freezes the phone at times. Entries that should be shown disappear. It automatically clocks you out before midnight then requires a "manual entry" and a "reason" when the attendant was clocked in the entire time. Attendants are not getting paid. Therefore, they are leaving families without care and the consumer is at risk for being institutionalized.

Remove wrongful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------EVV is not applicable to live in attendants. They are on call twenty four (24) hours a day, so it is very difficult to clock in and out for a prearranged shift. Also, they become engrossed in their life/work combination and forget to log in at the exact time. As a result, they have to manually enter time. Manual entries may cause prosecution. Live in providers need to be granted exemption from EVV as the federal regulations and Virginia already permit.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------This is an attack on CDPA. DMAS is not recognizing that if everyone of these people in CDPA had to get services from traditional home care, the cost would be 1.5 times or more the cost of CDPA. DMAS is not recognizing that these services would cost double or triple in a nursing home, group home, or other placement. EVV kills CDPA.. so DMAS wants to pay more money for crappier services.

Remove wrong language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------My concern is live in caregivers and patients who are not computer literate. The requirements of pca are to be physically able to administer the task of IADL'S and ADL's. Being able to operate a EVV computer system and deal with all the app issues, reception issues, battery issues, hardware issues, etc.....should not be the responsibility of of patients and live in caregivers.

Please remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------These live in workers are underpaid. They can't find any reprieve. Please find a more appropriate course of action than EVV for live ins. Learning about this application system has increased everyone's awareness of the tribulations placed on the disabled and those that back them. Work hard and come up with a better solution. Thank you for your time.

Remove bad language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------Up working again dmas.But this time is one of the thousands of hours off clock ... someone has to be with here 24/7. You don’t pay all those hours. But yeah evv tech companies are making a bundle.

Remove bad language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Request for a Forum/meeting involving the ultimate consumer of EVV for live ins. No threatening training meetings; a real forum where folks with disabilities subjected to EVV directly can speak out! We are very intelligent and can make important decisions. We need to be involved in how government decisions affect us personally. We were never given a forum to give our observations or be involved in the whole process EVV for live ins. Stakeholders are supposed to be involved and there were no meetings involving us: the ultimate consumers! Give us a forum and a real chance to speak out against EVV for live ins. Call a meeting. Show you care for our input and care about us as human beings!

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Middle of cleaning poop, and now I have to concern myself with my life revolving around evv for live ins? Wonderful to think about.......I am in the middle of cleaning up head to toe poop, and now I have to stop and think did I clock out? This mess is going to take another 20 min to fix... stop to clock out or be a reportable irregularity and not get paid the whole shift....what a wonderful thought DMAS.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------NCIL believes that EVV threatens decades of advocacy work: People with disabilities have the right to control our own lives and destinies. EVV in all forms erodes consumer rights and eliminates consumers’ ability to direct their care. GPS and biometrics are further shrinking the chronically inadequate pool of available home care workers, as personal assistants leave the field completely due to privacy violations, and inadequate wages and benefits. The burgeoning EVV industry is not forthcoming about the data it collects and stores. Threats to identity protection and digital privacy breaches should be eliminated where possible. Stakeholder groups must include and empower people with disabilities to be drivers and experts in the development of EVV systems and policies that uphold the freedoms, rights, dignity, privacy and independence of people with disabilities. The federal EVV mandate is a massive financial giveaway to technology vendors of EVV systems. While many vendors tout the need for EVV as a method to reduce fraud, data demonstrates consumers and personal assistants are not a warranted source of these allegations.

remove the following horrible language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------The data breaches in all hcbs agencies is bad enough, but making something stressful and frustrating on top of an already stressful and difficult job makes everything so much worse. The children and adults who count on our assistance need us to be fully there for them, not distracted, worn out, and paranoid because of a user unfriendly and non secure app. Not copacetic!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------These are disabled individuals and their support system: live in caregivers. Are the lives and challenges that the disabled community deal with daily taken into consideration at all? The disabled members and their support system have ten fold paperwork to complete to prove they are disabled. Most of their day consists of accomplishing IADL and ADL tasks "abled's" take for granted. The disabled must constantly work with government agencies just to secure and maintain their benefits. Now, it's been decided with EVV for live ins that they should also spend time repairing an app, time sheets, be on hold for hours, hope for a call back from the fiscal agents, hope the attendants will still work even if they don't get paid for six weeks or longer. If you want to put an app in place then the app should work. If you demand that the policy is in place then make sure the program works prior to the start date.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------EVV Compliance for live ins requires very expensive, 24 hours support from the fiscal agents hired by DMAS.Enforcement of compliance requires reliable, trustworthy, and expensive tech support for EVV tech issues which arise all day and night long. The fiscal agents' IT/Tech departments are not available to the consumer/EOR/attendant, so that issues can be resolved. Federal policy gives the states the ability to individualize the program designs. If you are going to mandate that your state citizens must abide by the rules or be fined or face legal action, then I suggest you also mandate that the fiscal agents you approve to work in the state with Medicaid must abide by the same rules. The threat to the public who are just trying to work within the state's expectations should be imposed on all parties involved in the policy that you made law. The fiscal agent does not offer evening or Saturday hours and, yet, the disabled are clocking in and out round the clock and needing tech assistance round the clock. Why is it that everything app. related is "tech issue" and they have to give a call back or an email back and the call and emails never come back? We as the attendants can't talk to tech, but the customer service rep. also can't talk to tech. So we are left to hope that the rep wrote the correct thing and hope that a tech person gets it and follows up.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------When I clock in and clock out as a live in, I should be doing my real time based on the law right? If I am working, I am supposed to be paid based on the law and not on a few hours you give me right? I can't be forced to clock out and in at certain times if I am still working right? That is the law right? So I guess when EVV (electronic visit verification) starts up for live ins that all of us will be getting paid a lot more?

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------It shows bad faith for Virginia to now remove the electronic visit verification exemption, and it will make caregiving feel punitive and distrustful. Especially when DMAS stated they would never go above the requirements of the Federal Government and the federal government has issued an exemption for live in caregivers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------Overnight and on-call hours are hard to document. Live-in caregivers must remain available at all times and may be awakened multiple times per night for seizures, medical needs, or elopement. Live-in caregivers are tied up with all too common urgencies and emergencies around the clock, day and night. They shouldn't be forced to direct their energy to a time clock and away from the person receiving care. EVV was established for visiting caregivers only which live ins are NOT.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------Live-in caregivers respond to unpredictable needs such as: seizures, elopement, behavioral crises, toileting, medications, and much more. EVV is for a set number of hours for visits where a person arrives and then does their hours and leaves. Live ins never arrive or leave.

Please remove the following wrong language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------EVV (electronic visit verification) does not add anything to the quality of care or even accountability, since care recipients and families can easily verify that care occurred without EVV. Many live-in caregivers are family members who left paid employment to provide care and save Virginia significant institutional care costs. Requiring these live-in caregivers to use EVV will push many toward institutional care instead. Institutionalization will be a massive cost to the virginia taxpayer.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------Live-in caregivers are working around the clock far more hours than they are being paid. Live-in caregivers provide care intermittently throughout the day and night. There is no room in their schedules for electronic visit verification (EVV).

remove the following bad language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------Live-ins are on call 24/7. Shift workers are not on call and clock out at the end of a shift. Live-ins cannot clock out. ******It’s unreasonable to expect a live-in caregiver to clock in and out for every issue addressed around the clock.

Please remove the following detrimental language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------EVV (electronic visit verification) tracks location. The live-in caregiver will be at the location, so there is no point in the location tracking aspect. The task tracking is easily verified by other means.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------EVV (electronic visit verification) is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------The EVV (electronic visit verification) system was created to track shift-worker attendant time and movement to help prevent fraud. There is no potential fraud component for live-in caregivers.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------Live-ins are on call 24/7. Shift workers are not on call and clock out at the end of a shift. Live-ins cannot clock out. It’s unreasonable to expect a live-in caregiver to clock in and out for every issue addressed around the clock. Maintain the live in caregiver exemption from EVV.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------EVV (electronic visit verification) is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks.

remove the following detrimental language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------Live-in caregivers do not "visit," and the use of a "visit" monitor system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually happens and forces caregivers to log artificial “shifts” that don’t reflect reality.

Respectfully requesting the removal of the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours in an EVV device for live-in caregivers. Since you passed legislation granting live-in caregivers this exemption effective January 1, 2021, live-in caregivers have been able to provide care without the constant interruption of clocking in and out. EVV electronically verifies that home and community-based services are delivered to the client. This is easily verified by a live-in caregiver by other means than using EVV to clock in and out for shifts and tasks. Requiring a live-in caregiver to use this system is burdensome and takes the focus away from providing care.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------------Requiring live-in caregivers to use electronic visit verification (EVV) would return Virginia to a system it dispensed with for live-in caregivers in 2020. CMS recognizes that EVV is a burden for live-in caregivers and allows this exemption. Please remove this harmful language from the final Budget.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------Live-in caregivers are tied up with all too common urgencies and emergencies around the clock, day and night. They shouldn't be forced to direct their energy to a time clock and away from the person receiving care. EVV (electronic visit verification) for live in caregivers is a dangerous consideration.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------------Many live-in caregivers are family members who left paid employment to provide care and save Virginia significant institutional care costs. Requiring these live-in caregivers to use EVV will push many toward institutional care instead. This will ultimately cost the taxpayer more than the supposed "savings" DMAS is touting.

Remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-------------------------------------

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------------- It shows bad faith for Virginia to now, suddenly and without warning, remove live in caregiver exemption, and it will make caregiving feel punitive and distrustful.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------We do not use EVV (electronic visit verification), but our Community Coach friends do, and I know a bit about how our friends' lives have been unnecessarily disrupted by this terrible technology and concept. At the very least, live-in providers MUST be continue to be exempt. It makes no sense for a live in caregiver to stop what they are doing to clock in or out, especially since live-in providers typically are never off the clock. For our friends living with unstable epilepsy, as we are, this requirement is actually dangerous. When the software doesn't work, as people can amply attest to, it actually causes them to lose their precious caregivers, who don't like getting spied on, but especially don't like getting their already paltry paychecks delayed because they can't enter their hours. If the fiscal agents cannot fix the technological problems, then they MUST allow alternate ways for the caregiver to record their hours. It's hard to believe this requirement was rolled out without apparently any input from the community and obviously no Beta testing of the software. The state owes a huge debt to the burden and sacrifice that EVV has placed on the disabled, their families, and their caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ Virginia, wake up. You are harming the disabled with EVV for live ins and they do not deserve it. In fact, this was already sussed out in 2020 when Virginia followed CMS and enacted the exemption for live in caregivers. Practice humility. Realize that caring and loving come before pride and ego especially in public service. The next to need help may be you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------We went with a live in attendant because of this:The app failed multiple times a day. some days, it didn't allow for log in or clock out, shut down to the point that it had to be deleted & reinstalled( at which time you had to call CDCN & have them unregistered the device & register it again) All of this for location!When these issues happened week after week, I had to adjust the time on the web portal. Therefore by that action, that is entirely the fault of EVV, I was being flagged non compliant.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Thank you for your time.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------When we took emergency custody of our disabled relative after he was severely neglected by his parents, we knew it would require sacrifice from ourselves and our children. We stretched finances to purchase a larger vehicle, and paid sitters so my husband could work . When I was told that attendant/respite care was available, it was a light at the end of a very dark and draining tunnel. Unfortunately, finding someone who was over 18, willing to work full with no benefits, and who didn't need to pay childcare ($13/hr doesn't much support paying typical bills, much less child care and health insurance) quickly proved difficult. When I finally found an attendant willing to work under those circumstances, she went months without pay as her paperwork was mishandled and excuses were made. Many errors were made among our local social services department which resulted in this consumer losing his insurance entirely with no warning. It wasn't until I emailed the Director of our local DSS that his Medicaid was reinstated, but we lost his MCO for the 40 day waiting period (due to no fault of ours- it wasn't a renewal issue, etc), thereby expiring his approved hours. Again, I had to beg our attendant to stay on unpaid while we sorted this out-- on the hope that I would be able to get retroactive approval and back pay. (This didn't happen.) When the DMAS7 was introduced, our service facilitator was no help, showed up with a personal cell phone to record our sensitive information/fill out forms, and left me with the massive stack for the doctor to fill out "oh, and it's due in 7 days or you'll lose services". Have you ever tried to get a wellness visit with forms back in your hands in 7 days? Nearly as quickly as it was forced upon us, DMAS7 was repealed. Now we have EVV for visiting attendants. If you've made it this far, I'll let you know we lost our visiting attendant and have been unable to replace her. When I approached her about returning, the moment she heard about "Cell Track", she apologized and stated she'd not be willing to put such an untested, invasive app on her phone. As I watch other's experience errors, inability to log time, pay delays, battery drain, etc, I have no way to reassure her except to give her a place to live and do live in which does not require evv at the moment; however, DMAS appears to be trying to take that away. We are doing everything in our power to see that this person doesn't end up in an institution, as both are already overwhelmed systems, but to what end? I can't help but think we are costing the state much more in an institution than making attendant/respite care a straightforward process would cost.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------Why weren't stakeholders consulted? EVV for live ins comes as a slap in the face to those with disabilities. Are persons with disabilities not able minded enough to make valuable decisions and be involved in how government waste/spending involves them directly? (Is this 1935 Germany?!) That is the message the state is sending out loud and clear especially to live-in (CMS and currently Virginia consider them exempt). Since when were the disabled end users, who are also stakeholders, warned/notified of evv for live ins? Certainly without enough time to give input or be involved in this whole process. No, the state slipped this in the backdoor. It appears folks with disabilities, the end users (the actual ones using the system) were completely left out of the evv for live ins decision. Stakeholders are supposed to be involved and there were no genuine stakeholder meetings involving the end users (those with disabilities)! Some disabilities do limit communication. So those persons with disabilities that can express their concerns speak most accurately for those that can't. Their input should be measured at least two-fold as to how the disability community feels about evv for live ins as a whole. Stop leaving us out!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------EVV for live ins will take valuable time away from disabled.I am a live in attendant.I get 30 hrs a week allowed to take care of my disabled parent. Of course I take care of my parent 24/7.I have not had a social life for 8 yrs now.It is very stressful being an attendant as it is,and it will be even worse if I have to take time and care away from my mother when I have to set an alarm to clock in and clock out. I will care for my mother to no end,but evv is not built for live ins! So is this app really going to stop fraud? You are only treating us honest ones like criminals, and the dishonest ones like queens.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- I live on the border of North Carolina & we travel there for recreation, museums & other outings just as much as we do in Virginia. With EVV forced on live in caregivers we will be unable to clock in or out in another state. We also travel to a Pennsylvania Hospital 1-2 times a year. How in the world is that going to be possible with our live in attendants, if we can not clock in ? Looking at a future of issues with EVV for live ins only adds more stress and frustration to an already heartbreaking life. Not to mention, our privacy is completely stripped from us if we have to explain the above outings on a regular basis all due to EVV for live ins.

Remove under Item #291; REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------Endless timeclock questionnaire???? why the questionnaire when clocking in and out every,,,,,,,,, single,,,,,,,,, time?,,,,,,,,,, why?? Don't force this on live in caregivers. No one on earth has to answer questions when clocking in and clocking out. What a time vampire.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------The most insulting thing to me is the suggestion that I can’t be trusted with the well-being of my family member, and that academics and ivory-tower types who have never met my family member hold her best interest in higher regard than I do. Maintain EVV exemption for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------It is baffling how officials and DMAS staff sleeps at night knowing the position they are putting consumers and their live in caregivers in. Virginia is going backwards and pushing institutionalization. Now DMAS is pushing EVV for live ins after saying they wouldn't do anything more than CMS requires and after they made the rule that follows the federal government and exempted live in caregivers from evv. Waiver recipients and visiting caregivers will be framed by evv because when the evv app doesn't work, caregivers get blamed. Where are you, Governor? Do better for your people that need the most support!

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------- When we tried evv it didn't work half the time. You could never reach the fiscal agent in a timely manner by phone or email to help with EVV . No fiscal agent staff knew anything about how to fix it and they never had answers. I hope we're not expected to always be at our house. What do you guys really expect? Stop making families jump through hoops to keep and maintain services when we already have enough on our plates.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ Live in attendants should not be tracked by GPS in their own home, or be required to clock in and out when they, in fact, provide care 24-7 and above the approved number of hours. It's intrusive and unnecessary. Additionally the app doesn't work right. It freezes up. Then we get nasty e-mails saying those exceptions are not compliant. You can't call and get a hold of a person. You can only call, leave a message, and hope they don't call you back while you are at work. IF.....they call you back.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Token expired. What does that mean? That was an error code given when I tried to use evv in the past. We're given tokens? Can we use them other places ?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------The disabled are not pets. Va EVV for live ins mandates electronic devices that are not supplied. This program has been nothing, but a disservice to those who need the utmost, mindful ministration. We have yet to see that with this program or in the treatment by the state of the disabled. Please consider maintaining EVV for live ins. EVV for live ins will strip individuals of their basic human rights and is tracking them like micro-chipped animals.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------We are ALL temporarily abled. Everyone making regulations will need help one day. Is this what administrators would want for their family as live ins? Virginia is setting a precedent for their very own lives.

if evv for live ins happens, we wont even have times to go shoping or even go out for a nice diner because we have to ride home to the evv. my home will be an offace now. I have seazures. I take medicin every day. me and my family will have to stays home 247 cuz of the evv. While you sit and rake in the money, we will sit home in pains. You will enjoy every bit of it. the evv don't care about the disabled. the only thing they care about is there selfs and that makes me sick. the disabled hav a life to. we will be going crazy just sitting here doing no thing. what is wrong with you people. people are aw ready saying the hell with this evv for live ins. i won't enjoy it we the disabled people don't belong in a cage. What is nex star trez or ufos? this can't go on like this. I am afrade i might end up in a home and i don't want that to happen.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------EVV poses some issues for the live in attendant. Setting timers to punch in and out is impractical for live ins, but it will be their only option. These are timers to remind them in the middle of an injury, toileting accident, slip, fall, vomiting, smearing, feeding, cooking, elopment, driving, doctor's appointment, bathing, outing, meeting, etc....when their minds and hands are full to clock in and clock out by the assigned hours they are paid and NOT BY THE HOURS THEY WORK (they work more than they are paid). These attendants are going to forget and will remember when they have a free moment which is way past the time they are allotted to be paid. So, only one thing will ring true with evv for live ins...they need to be paid around the clock as employees. Maintaining the live in exemption would clear up a lot of EVV issues.

My past experience with EVV (electronic visit verification) was not good and I doubt I will continue working if EVV for live ins is forced on individuals. The EVV app froze at times and wouldn't do anything. It wouldn't let you clock in or out at times. When it would crash after time entry, it would report the previous entries as manual entries. Sometimes, you couldn't sign out. It states strange things like, "tokens have expired" (no one knows what tokens are). If nothing would work with the app at all, you had to uninstall the app and reinstall it which was a lot of stress and loss of pay when you were trying to clock in or out (this can also mean more manual entries which can mean you will be accused of fraud). Rounding was confusing; no one understood it. The reported times on the paycheck and in the portal were often different from the app times.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”----------------------The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours in an EVV device for live-in caregivers. Since you passed legislation granting live-in caregivers this exemption effective January 1, 2021, live-in caregivers have been able to provide care without the constant interruption of clocking in and out. EVV electronically verifies that home and community-based services are delivered to the client. This is easily verified by a live-in caregiver by other means than using EVV to clock in and out for shifts and tasks. Requiring a live-in caregiver to use this system is burdensome and takes the focus away from providing care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------I have been more depressed in 2026. I have a significant physical disability and need attendant care to keep me out of a nursing home. EVV for live ins will have a negative impact on my life and I won't be able to find attendants willing to work because of it. This has caused my depression to get worse. I won't go into the rest of it cause I don't need a CSB worker "not helping me." But if DMAS really cared, or is the Olmstead Settlement really meant anything then EVV for live ins wouldn't be added to make it even more difficult to hire attendants. Virginia should take a stand for all the disabled people in our great state and refuse to track them like criminals.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------I am a glorified EOR (employer of record). I donate my time and my ss#, so that an attendant can work for peanuts at caring for the most vulnerable and the state is off-the-hook as employer of record. NO one, including the state wants to be these caregivers' EOR, because they would cost too much if they were paid overtime, taxes, benefits, etc. I feel badly when I tell them there are no benefits, and they must pay all their taxes on their own. They even drive my child to outings and that expense comes out of their $13 per hour. To top it off, they are now being asked to use their personal devices and data for EVV for live ins? For the amount of expense these live in attendants bring to the table and the round the clock care they provide, they are, for all intents and purposes, independent contractors. As long as they produce a product, and take care of their taxes, benefits, overtime, etc... they are independent contractors. I am, technically, not their EOR because I have no say in this EVV for live ins issue (and very little else for that matter). The state is demanding accounting of hours down to the last minute with an impossible system, and then providing these persons with no benefits. The state does not give themselves the title of EOR, because it would be too costly. Seems in this circumstance, the state is "having it's cake and eating it too". These live in attendants have spoken out against EVV on many occasions (including with state officials). They cannot continue to give without some giving by the state. Treat these persons as independent contractors and maintain EVV for live ins or the state will find themselves HAVING to treat them as employees with all the benefits that entails. The state cannot continue to "have it's cake and eat it too".

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------I will have to quit because of EVV for live ins. I liked working for my client. But I know my pay will be messed up so often and the EVV apps won't work and they were always cutting people's pay. Guess I will go to target for $3 more an hour and have less of a headache about pay. Plus, I hate video games and EVV is a never ending video game that takes away all your time. Not for me. At least I know with Target, DMAS can't screw me over any more.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------------stop treating people like criminals when all they want is the loved one safe. It is criminal what the state gets away with paying live-ins to provide the state's most affordable one-on-one care service. These live-ins have no benefits, do not make a decent salary, or have a chance at a career. Live-ins shouldn't be treated as criminals; the only criminal here is the state demanding more and more from live-ins until there is nothing left to give; until they are forced to stop caring. Stop demanding more from live-ins and follow the federal government example and continue to exempt live-ins. They are not criminals, and they are not guilty until proven innocent.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------------Electronic Visit Verification (EVV) for live ins only complicates an already difficult situation for individuals receiving services as well as their family caregivers. It is extremely difficult to get and keep good attendants and the changes are proving to add to the difficulty. This interferes with privacy and turns away more prospective employees. It is only harming those who need and use services.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- Is it possible to consider the policy that other states(including this state currently) and CMS have implemented which states that if the attendant lives in the home with the consumer, then they can use the web portal to submit times? For many of us, our members have emergencies and urgent needs or our care does not run on an exact schedule and it's very easy to forget to sign in and out. Our priority is the safety and health of our client, not signing in and out.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------This is one more burden we do not need. And our aides - who are very poorly compensated for their hard work - aren’t able to get paid. We have a live in aide for our daughter who is NOT tech savvy. She doesn’t have a phone, computer or the ability to navigate these issues. If evv for live ins is forced, I will find myself racing home to check her in and out, so she can get timely credit for her work. As it stands now, you can’t get through on the phone lines for payroll, and it takes days or weeks to get an email response. I will spend hours on troubleshooting every week. It is stressful thinking about staff not being paid, and constantly having to navigate these issues and trouble shoot. This will seriously impact our lives in a way I trust no legislator or bureaucrat intended for our most vulnerable families. Something has got to give!!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291; REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------l will quit being a live in attendant as soon as evv is forced on me., My only regret is the person I will leave behind and my hopes that they will be ok, but I will have to make a choice. EVV would make the job extremely undesirable and a person would be a fool to keep the consumer directed live in attendant job under these circumstances. I have used evv and it is nothing but trouble. A few times, I clocked out early, because I was driving the person on the highway and was unable to clock out at the actual end of shift due to the danger of pulling over at night. My pay was cut each time I did this. I was never paid correctly when I used evv. I also had the additional cost of data usage and roaming charges on my cell phone plan because of the evv app. The job will just not be worth the troubles with evv for live ins.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------EVV is a roadblock to a paycheck for live ins. Who has time to deal with all these evv application problems? It should not be the EOR or the attendant. This is hours having to work to correct the payroll fallout from EVV. This will never be a simple clock in and out procedure. Why include live ins just to get paid when they do not visit? The portal works and is not a road block to being paid.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------Good Samaritans would be better off working in soup kitchens or in some other form of altruistic employment than in consumer direct care. In the state's litigious and power hungry environment, it would be better to be a DMAS decision maker with a six figure income: all the money, the "appearance" of caring, and no responsibility. With EVV, for live ins, attendants must be more aware of their actions even when they believe it to be an emergency situation. Good Samaritans can now be liable for "not complying with EVV". If that was not bad enough, the app. adds or subtracts time the attendants didn't post and live in caregivers can now be accused of fraud due to this (perhaps this is the goal)? The most surprising part is that the live in attendants will be required to choose between the clock and an emergency or risk posting too many manual entries and being accused of fraud. People's lives are clearly endangered by EVV: attendants' lives for fraud accusations/jail and the individual receiving care for the attendant having to make quick, impossible choices and for the risk of institutionalization. It is a lose/lose situation. "Use of reasonable care" lawsuits could be on the rise due to EVV alone. Citizens of Virginia will be discouraged from helping, and with pay rates as low as they are for live in attendants, anyone who takes the job is "helping". The EVV limitations for live ins will keep people from helping if they consider the possibility that it could land them in court. The average person may have trouble determining what the reasonableness standard would be when they are distracted by the chaos of an emergency and the almighty clock. Live ins will be hit the hardest by the serious decisions that must be made when considering the risk. Care for your own child and risk them going into an institution, being injured, or yourself going to jail. It is unbelievable that they are being asked to make such a decision at all. Head for the soup kitchens Good Samaritans (or work at DMAS). That is my best advice in this situation.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------EVV for live ins is not a simple punching of a button. It is a horrible video game. It is loss of privacy due to the requirement of GPS tracking on the device for evv to work. EACH time you clock in, you must answer questions. Forget it being 3am when you clock in and you can't even see the screen. Each time you submit the hours, you must answer a series of questions. The monotony and repetition alone could cause errors. Add to that all the glitches. It is not a simple clock; it is a video game with many chances for error.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ I worry about being stuck in a nursing home with this evv for live ins. I have lived in my own apartment for years with help from my attendants. All the attendants I had that visited quit due to evv, and one quit due to a letter sent by payroll a few years ago. I only have one live in now. I am afraid they will quit when evv is forced on them too. I need help to live on my own. DMAS is taking away my help.

I am a parent and caregiver of my son who is multiply disabled and visually impaired. I am in favor of maintaining the EVV exemption for live-in caregivers. Live-in caregivers do just that. They live with the disabled person and provide continous care. There is no "shift" because we are always on duty. EVV does not reflect how care is delivered and does not reflect the reality of living with a person with disabilties who needs care. Please make sure that the EVV exemption for live-in caregivers is maintained so that people with disabilities can continue to live in their communities receiving appropriate care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- EVV for Live-In Caregivers needs to never start. We had used evv for live ins years ago and here was our nightmare just to clock in and out: Payroll sent us an email about non-compliant "shifts" for a live-in provider due to phone not working and app not working. I took them up on their offer to "help" us become compliant in situations where the phone or app are not working. Here is their response to my request: "Although it is frustrating and time consuming it is important that those minutes are watched so as not to exceed the number of allowed hours for the client’s caregivers. As the employer of record, you should make sure that you are only approving time that is equal to or less than the number of allowed budget units assigned to the CL, which is manageable if the hours submitted by the caregivers are reviewed prior to approving them." I understood my role and responsibilities as EOR. What I didn't understand is how we were non-compliant when a phone or app doesn't work. I also don't understand why DMAS said we were non-compliant when we fixed the total hours if the live-in caregiver exceeds the 8 hours max allowed. As long as we reduce the hours and don't submit more than 8 hours, we are within the service authorization. Why does this app have no flexibility in adjusting?99% of the time I was not home when the hours were submitted. So I couldn't "watch" the minutes in real time and I couldn't "review" before submission. In addition, the app did not show how many total hours have been submitted for the day -- until after you clocked out. So, I had to use the portal when there are multiple "shifts". We adjusted back down to 8 hours/day if he went over whether it was because the app or phone didn't work or he just got involved in supporting our son and forgot to log out. He is a live-in provider. Out of 24 hours/day he can submit any 8 hours when he is with our son. I only ever approve that amount of time. It is the app and the total inflexibility in understanding that sometimes people don't have a phone in their hands to "clock out" when working with a disabled child that is causing the problems. App and phone errors are not non-compliance -- they are app and phone issues. Human error in logging out after the 8 hours max is the reality of home life. He doesn't clock out and leave the house at 8 hours.Please do something to provide some relief from this nightmare.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------Dmas just wants to hurt people and waste money. Consumer directed attendant care is the lowest cost option for taxpayers for people to stay in the community. Dmas is eroding that by requiring evv for live in providers. Numerous family and friends give up good paying jobs to survive on poverty level helping a loved one through consumer directed attendant care. Dmas is making this impossible by requiring live ins to do evv. More people will be placed in group care and suffer and the taxpers will suffer too.

REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I am a parent and caregiver of my son with Autism and maintaining the EVV exemption for live-in caregivers is important to me because live-in caregivers do not "visit," and the use of a "visit" monitor system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually happens and forces caregivers to log artificial “shifts” that don’t reflect reality. EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks. If there is a need for oversight, care recipients and families can easily verify that care occurred.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------This note took a while to compose due to my disability. EVV while being a necessary system for clocking in, is not a good system for adult children like myself whose parents live with us. My parents are constantly working and I need them so much. It is hard to remember the clock because my needs just don't match a clock. I don't even sleep by normal time. If EVV is forced on live ins, I will need to set alarms to remind me to check sign ups, but even that is hard to remember. The number of manual time entries will cause them to lose pay if this system is enacted for live ins. They quit good jobs to help me. They don't need this. I am fearful of them being accused of fraud from manual entries as well. At their age, they don't need this. Please consider maintaining the exception for live ins caregivers. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- My adult child has been using CDPA for a number of years. There is a nursing home in Norfolk that my child is now on the wait list for because of EVV for live ins being forced on folks. Our live in attendant is quitting over it. She had been working with my child for 5 years. My child will go to live out the last years in the nursing home as soon as there is room. I was planning on keeping my child home, but since EVV for live ins will make CDPA no longer an option; I am out of choices.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------House Arrest For the Bedridden? EVV for live ins will do nothing more than attack the most vulnerable group of people. Is EVV a punishment for having a disability? House arrest isn't necessary when one is bedridden. It is illogical to have these expectations. I live rural and am a caretaker for a family member. I have been doing this over 30 yrs. If EVV for live ins is introduced, our lives will dramatically change for the worse. I feel with EVV for live ins that I will be working for the state more than for my family member. The added problems it would put on the disabled is a slap in the face. The demands of evv on the disabled and their live in caregiver are impractical. Multiple agencies descend upon the home taking notes and reports on a monthly basis. Enough invasion is enough!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- EVV was so wrong for my life that I ended up losing a visiting attendant because of EVV, and replaced them with a live in attendant. it causing excessive stress thinking about this EVV being forced on my live in attendant. EVV is invasive to my life. This EVV for live in is going to make it harder on me to keep friends to care for me. I just found a new live in attendant. I'm worried they are already wanting to quit. It is impossible trying to get in touch with the people doing payroll. why can't things just stayed the same? The portal and time sheets were manageable. why does everything have to go from what worked to not working?

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------here is not a law saying shifts cannot start at 10 min past the hour... and the really stupid thing CDCN is doing is now you can only log on shifts at 00, 15, 30, 45 … but then if the EVV picks up the time at 10:07... they still freaking cut your pay 7 or 6 min... I guess for that ever thing fits the computer program at the time. Sure EVV gonna save money cause you are short changing the workers who work for bad pay and no benefits … in the long term more people are going to suffer and it will cause DMAS more cause more of them will be in facilities . Great idea. Please stop saying this is improving quality of care. It is harming thousands of people.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------- Are state employees app & tracked? Threatened if they can't use their computers because of tech glitches they will be fired and left unpaid for work they did? Told in meetings it's because they are abusing and guilty of fraud and need to be caught? why are live in attendant who care the most for the disabled being so unfairly treated?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------EBB is torcher to use. That is all. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Please don't add this trouble to my live in attendant; there is no way we can recover if that were to happen. This past week, my child's live out attendant got an email from payroll about being non-compliant with EVV system. This was very frustrating, especially since the majority of the reasons that my attendant had to correct time entries was because the app was not working. For example -our live out attendant could not log in yesterday - the app just kept spinning and not loading.He had to uninstall the app and reinstall. We had to call payroll (spent 20 minutes on the phone) and have them reset him on their admin side as well. Then today when the attendant went to clock in - the very same thing happened. So right now my attendant is working but cannot sign in or sign out, and we will once again be on the phone with payroll trying to get things reset. In the meantime his shifts from the past three days will be non-compliant. I asked payroll how can we be considered non-compliant when the app is not working and when that is the reason that attendants enter when trying to correct time entries. The answer I received from them was DMAS requires them to send those emails. ****Our worker gets flagged in the system because the app does not work. This EVV system is so broken and families/individuals are the ones who I fear are going to be flagged as non-compliant and lose attendants/services. In addition, emails being sent out about non-compliance are frustrating families/individuals even more.

Thank you ARC of Virginia for standing with those with disabilities in Virginia and stating: "We are asking House and Senate budget conferees to: (1) Keep all developmental disability waiver funding included in the Senate Finance report. (2)Include rate increases for Respite and Companion services, which are part of the eleven services covered under the Permanent Injunction. (3) Add the live-in caregiver exemption from Electronic Visit Verification (EVV). This is a focused and realistic request. We have considered the current state and federal budget cuts and know the needs can still be met, prioritizing stability for families and caregivers."

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Every 8 Seconds someone new needs a caregiver. One day that might be you. Just because you got money In your pockets now and you might never need Medicaid, someone, somewhere does. They shouldn't be subjected to this level of surveillance just to have the ability to have care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- The below song was written by someone with disabilities. This is how those with disabilities feel about EVV for live ins. They ask that, "Please help people with disabilities and our live in caregivers stop this unconstitutional invasion of our privacy. We should not be GPS tracked by the government and have our movements questioned and restricted simply because we need assistance with bathing, dressing, and other daily tasks." EVV is Comin' to Town You better clock out, You better clock in, EVV apps can see where you've been. Sandata is watching you....POO. They're checking for "fraud" and tracking your phone. Gonna find out if you left your home. Time4Care is watching you...PEE. They see you when you're sleeping. They spy when you're awake. They store your fingerprints and voice for identity thieves to take. So, you better stay home. No more vacation. Leaving your house is an "exception". EVV is comin' to town. They track disabled people who've committed no crime. Taking our Fourth Amendment rights, Freedom, privacy, and time. So, you better clock out. You better clock in. And let Big Brother track where you've been. Medicaid is watching you....POO!

evv for live ins is going to hurt us. Why did you have to do this to the most vulnerable people in your state? Please continue to exempt live ins so we don’t have to be placed in facilities

Remove under Item # 291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------- I visit so much I get mail here. Live-ins do not "visit", but they do a very important job. It is also the most affordable caregiving option available to the state. This keeps people out of nursing homes and saves DMAS a lot of money. Continue the live in caregiver exemption from electronic visit verification (evv) as the federal government has done or watch live ins disappear.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- What are you doing? Changing the rules and regulations constantly and, often times, not for the better. When it ain't broke, don't fix it. I have been disabled for over 25 years. One thing that has never changed is the changes that DMAS spits out. My accountant and attorney are reluctant to give me advice when it comes to Medicaid, DMAS regs, etc.... They both said the rules are "moving targets"! Now, EVV for live ins is it's OWN moving target on a grand scale! DMAS, where is the listening to the disabled? Why does no one care how these moving targets affect us?

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------- I'd rather fall down a flight of stairs in a dress (and I am a guy) than deal with EVV for live ins, and all the problems an EOR will have with it.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------Even our service facilitator says most of her clients will be leaving if evv is enacted for live ins, because they don't use computers, etc... Many of live in attendants don't use smart phones. At least 1/3 of live in attendants I have hired don't drive a car. This is a low paying no benefits job. Even with all that, we are able to hire better people and treat our loved ones better than they would be treated in a group home or nursing home (the alternative placement to having them home.) . What is the plan here? For DMAS to pretend it supports community living, but then take away all the options? Many of the actual clients and family members see and understand what a hardship EVV is on the disabled. Not to even mention the tracking aspect of it.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- You closed institutions, so there is no place to go. Now, there are much less live in attendants who are willing to work for low pay, no benefits, and deal with EVV. This is not about what is best for the disabled or listening to us. This is about how you stereotype and distrust people on Medicaid Waivers who are disabled!

I respectfully request that you: Keep the EXEMPTION from Electronic Visit Verification (EVV) for live-in caregivers, in line with CMS recommendations! Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. Keep all developmental disability waiver funding included in the Senate Finance report. Include rate increases for Respite and Companion services,

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------Not everyone has digital access or landlines that is required for live ins to use EVV. Rural live ins' internet access is limited. With self-directed waiver programs there’s a concern that if a state dictates EVV for live ins, this will make the state a joint provider for purposes of the Fair Labor Standards Act, and could trigger overtime requirements. The expense to live ins of purchasing EVV equipment could create an incentive for them to look elsewhere and they wouldn't have far to look, since attendant care is entry level pay and experience.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------- Requiring the attendant to clock in daily is invasive, a time vampire, and unsafe to the attendant and consumer. EVV puts an unnecessary burden on underpaid live in attendants whose first obligation is taking care of the disabled. The app crashes, gps is all over the place, and it can take up to 30 mins to log in or out. The live in attendant then has to go unpaid trying to log in or risk manual entry and fraud accusations. If it isn't working on the final day of the pay period, again, they go unpaid for who knows how long. If the consumer is having an emergency need, the live in attendant has to decide if logging in/out or taking care of the consumer is more important. It's not a fair choice and one that never had to be made with the website portal method. Not to mention it is ***dangerous to force that choice*****.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- Is EVV fiscally responsible? What are the actual monetary costs of EVV? I want to see the actual numbers. I suspect that the technology is more costly than whatever minor "fraud" is being reduced. EVV is quite frankly just a gift--a payout--to the companies that are tracking our disabled family members.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------DMAS seems to operate under the assumption that people with disabilities have a very limited existence. There's no respect for our privacy. There is no awareness that we do the same things as people without disabilities, such as work, shop, travel and have families. EVV for live ins steals the autonomy of people with disabilities and our right to live freely. *****It treats us like children who can't manage our own lives.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ EVV was frustrating. Every day while I was cooking breakfast, I had to stop and clock in. No telling how many eggs I've ruined bc I couldn't get clocked in quick enough. Repeat this scenario every night when I wascooking dinner. Sometimes, I had to pull over on the side of the road to clock in or out. Once, I had to let my child stay on the floor after a fall , because I had to clock in. Please continue to exempt live-ins.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- What am I, a felon? Put an ankle bracelet on me

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." ---------------------------- We are supposed to buy our own devices, so the state can violate our rights because the state wants to save money so it can pay a bunch of money to the makers of EVV?? Wow.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------- March is Developmental Disabilities (DD) Awareness Month, an annual campaign in the U.S. designed to raise awareness about the inclusion of people with developmental disabilities in all facets of community life, as well as to ***ADDRESS BARRIERS (like electronic visit verification - EVV)*** they face. Established in 1987 by President Reagan, the month celebrates the contributions, and rights of people with disabilities

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- Loss of freedom Life was pretty good on cdpa before evv for live ins was suggested. I can hire attendants without too much trouble. Now if evv for live ins is forced, my sibling will go without care. I either have to quit work or place them in a nursing home. This isn’t right. I thought the move was to keep them out of institutions. Now, evv for live ins will make it impossible for them to stay home.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------We will probably be sending my child away if evv is forced on live in caregivers. We won't be able to staff out someone for our child if evv for live ins is forced. No one wants to load an intrusive app on their phone. It doesn’t even work on I phones people say. I had to quit my 80k a year job. I can’t take care of my child 24/7 though. I don’t know what I am going to do. Life has been going well since we have had access to live in attendant care. Evv will take that away. I guess my only option when evv is enacted for live ins, is a nursing home.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ The big thing about EVV for live in caregivers that's causing alarm is the use of GPS tracking and in some cases, cameras and microphones. GPS tracking tells the government where services are delivered...but it also tells the government where disabled people are going. EVV data can show where disabled people go to church, school, or shop, and this compromise of privacy extends to family too.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- Electronic Visit Verification for live ins will force disabled people back into institutional settings. Many are opposed to what feels like a profound privacy violation and/or are worried about being unable to find live in providers who are willing to work with EVV. If they don't have private funds to pay for care, an option not available to many disabled people, they will be stuck in nursing homes."

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- How is paying EVV lobbyists to track live in caregivers in the best interest of the disabled? I live in my own home and am employed. To enable me to continue living independently in my own home and working, I have a live in caregiver who assists me with getting out of bed, bathing, dressing, toileting, cooking, house cleaning, shopping, driving, etc. My live in attendant care is the lowest cost service available to the state. I am in a self-directed Medicaid waiver program, in which I control my own care. I hire my own attendants, set the days and times they work, where they work, and how they assist me. I am extremely concerned about the potential impact of EVV for live in caregivers on my life and the lives of millions with disabilities. EVV lobbyists tacked on EVV to the 21st Century Cures Act. Now, they stand to profit by invading my private life and home and my live in attendant's private life and home. How is paying EVV lobbyists in the best interest of the disabled?

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------When we tried electronic visit verification (EVV), it did some strange things, so we gave up and used the portal. Please don't force the stress of EVV on live in caregivers. To determine where I needed to be in order for the app to get my location right, I discovered that if I was in my bathroom, the app showed my correct address (anywhere else in the house and it would list at least three different towns, none of which I was ever in). When I went to my bathroom to clock in or out and my correct address showed up, the app told me that I was .7 (or some other random number) miles from my location. :/

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Please do not force electronic visit verification on live in caregivers. Costs are being overstated by DMAS as purely oppositional. The federal Center for Medicaid Services (CMS) allows Live Ins to be exempted and Virginia has already done so as well. This requirement for Live Ins to use EVV creates an excessive burden for people who live the individual - ARE NOT VISITING- and have the primary burden of care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- CD services are the best because you get to stay in your home. EVV is the worst because it erodes CD services. EVV is like the missing ramp to the best facility for the disabled ever built.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- EVV for live ins will pass the burden of Id theft and Medicaid Fraud to shoulders of poor and disabled. Electronic Visit Verification (EVV) for live ins will create a more anxious home space for the consumer and PCA, and it's a violation of privacy. Is it secure? No, it isn't. CMS and DMAS both recently had breaches. EVV will cause layers of dependency on cyber for poor reasons, and this is a junk app. with little security(that is very costly to the taxpayer). This insecurity leaves consumers/participants much more open to identity theft and possibly Medicaid fraud. A large part of the bipartisan support the original legislation was passed on was "stamping out Medicaid fraud". So, the government has done nothing more than put the fraud and identity theft threat onto the shoulders of the poor and disabled that can't afford it.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- Dmas in their education sessions said as long as you had a smart device that could connect to the internet at least when timesheets are due there was no need to actually have WiFi services at your home . Again numerous people getting waiver cdpa are very poor and don’t have WiFi . Dmas told them to go to public areas where WiFi is available like the library or Walmart to upload the times captured on the smart devices via the apps . If this isn’t an option is Dmas purchasing WiFi services for everyone? Or punishing us for being poor?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------The electronic visit verification app was such a pain. No telling how many adult diaperings delayed and pairs of gloves wasted, because I had to stop in the middle of clean ups to clock in or out (not to mention the device getting soiled and having to clean it). Then, got distracted by waiting on app updates, having to turn phone on and off to get app to work, etc.. Twice, I've had to dry hands and step away from my child in the tub to clock out. When we took our adult child out of state, I could not log on to the app the entire time we were gone. They say too many manual adjustments to hours could cause the consumer to lose services. This infuriates me!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- If it ain't broke, don't fix it. The evv app keeps you glued to your phone and stuck. Most folks don't like being glued to an app. or a phone. They like getting out and getting fresh air and accessing the community not being stuck dealing with all the problems of the app. and the resulting payroll issues. The portal enables one to be free and more independent, the app. keeps one glued to a phone.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------This could happen to you. my knees are shot due to a car accident. this can happen to anyone. EVV is extremely tiresome. having attendant log in for 5 hours machine malfunction, log out, machine malfunction. then log in again for 2hours. log out. then they got to chose which waiver service. then click on the start time then end time. I have to help attendant every time. it is hard enough to FIND an attendant.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- It is true EVV for live ins will capture GPS location in real time. It is true DMAS and DBHDS has shown to have a poor track record of keeping our information confidential. But that is ok because DMAS doesn't think people with disability are worthy people, it is ok if they are tracked like dogs

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------Another way to deter people from being attendants. EVV will deter people from becoming home care aides

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- Tried EVV. Didn't like it. Perfect example: I clocked out at 4:30 and an attendant clocked in at 4:32. It had me out at 4:30 and attendant start at 4:30, which they called overlapping. So the next attendant had to sit and wait all the time to round up. It was nuts.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------- Live-in care-giving services are often delivered by family members or those closest to the patient. These care givers already get visited 2-3 times a month by community services board and the agency overseeing service facilitation and harassment from the mcos and billing through the fiscal agent. These providers don’t visit but usually have given up well paying careers so they don’t see their loved one abused and neglected in a state facility. Now dmas wants to harass them even more.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------- My live in attendant is refusing to put the electronic visit verification (evv) app on their phone and I dont blame them. The apps take up a lot of space and use up data. It also can access all the information stored on the phone. We are supposed to trust a for profit evv vendor to not access our data or use it other than for it's intended purpose? We have all seen enough bad actors in the tech industry. No thanks.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- My live in attendant submits their timesheets electronically every 2 weeks. This is works and is good, because it allows for tech issues (which are never ending especially for us because we are not tech savvy) on my end, cable co's end and payroll's end. The attendant cannot submit more than allotted hours. It is already monitored electronically. With evv for live ins, the attendant will be required to remember to clock in and out every day, instead of submitting twice a month (this doesn't allow for tech issues which is nerve wracking to think about). The attendant doesn't have a smart phone, so she'll have to use a landline. These waivers were created to keep individuals/consumers in the community and to save the Commonwealth of Virginia money by reducing the number of individuals going into state care due to lack of supports. With evv for live ins, they will be confined to home oftentimes to ensure their live in attendant can clock in or out.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ So, out of fear of being flagged, will individuals with live in caregivers be discouraged from thinking for themselves? From changing their minds on the restaurant they're going to or the park visit that was scheduled? "Heck no, we can't go to the next town to sightsee--it's not on your plan of activities and the government might flag it!" That is what evv for live in caregivers will do. It is stripping disabled individuals of their human and civil rights. Why stop at their right to privacy & liberty? Let's remove their pursuit of happiness, too--the life part will eventually follow. And why must it be told when an individual goes to the doctor? How does that not violate the HIPAA law? No one knows to whom this information goes or how it is used--there has been zero transparency regarding this.

The Autism Community requests that you: Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. Keep the Electronic Visit Verification (EVV) EXEMPTION for live-in caregivers. Keep all developmental disability waiver funding included in the Senate Finance report, and Include rate increases for Respite and Companion services.  Thank you.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…” EVV (electronice visit verification) was never meant for the live in model of care. The fed gov't pretty much confirms this with their live in exemption in place. what if an individual is in the middle of a seizure? Or is needing a trach cleaned? Or has vomited and is needing cleaned up? Or is choking? Or is needing to be transported to the restroom? Or has needed an unexpected bath because of an accidental spill or sickness or bowel movement? Is the live in attendant expected to drop everything they're doing in caring for the individual so they can go to clock in or out at the expense of the individual receiving care? There is so much potential liability here and it’s terrifying to think about.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------Finding attendant care is difficult enough. $13 an hour and zero benefits. And now, they have the potential pleasure of being tracked and monitored (by forced use of EVV for live ins) all under the guise of cutting down on fraud and ensuring the individual is receiving the care they need. It is clear—in reading the fine print—that ensuring quality care is not a factor.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------- Fraud won't be decreased by forcing evv on live ins. As a matter of fact, there will be an increase in cost for states due to loss of live in attendant care--families that had been helped prior will no longer have assistance and will be faced with difficult decisions on placement. EVV for live ins explicitly removes the entire “self-directed” part of self-directed care. It is now government-directed.

Please remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------- Some of many legitimate reasons for requiring manual entries: I forgot to clock in because the consumer was having a seizure. My phone wasn't working because...well...myriad of technology issues. The app wasn't working (not the attendant’s fault). Consumer had an emergency and attendant chose to care for the consumer rather than electronically clock in at start of shift, making a choice between potentially the consumer’s life or meeting EVV's requirement. (Not a hard decision, and yet, it is “non-compliance” that could lead to the consumer losing services.) DMAS calls all these reasons “non-compliance” and may lead to disenrollment. Why would DMAS force these threats and stress on an already extended family? Why when even the federal government recognizes the need to exempt live in caregivers?

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------- The individuals receiving the care are the true victims here. They will be the ones feeling the brunt of this atrocity, and I, for one, am not okay with that. This EVV for live ins will turnthe individuals’ homes into institutions. The only times the individuals can go out into their community are when the live in attendant is with them. Now, in many instances, they will be confined to their homes.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Informational material put out by DMAS states that individuals may receive services out in the community, but how does that translate when the live in attendant is required to clock in and out from the individual’s home telephone due to lack of mobile data/cell service? They are tethered to the house. Not everyone has mobile data, and those who don’t are required to use a landline. So, DMAS’ proclamation that individuals will still be able to receive services in the community is utterly misleading!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- As a tax-paying citizen of the great Commonwealth of Virginia and the United States of America, I ask you—I implore you—to recognize and take action against the oppressive nature of electronic visit verification (evv) for live-ins and the blatant breaching of human and civil rights that accompanies it. Our most vulnerable population is worth it.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- I am writing with an urgent request pertaining to Electronic Visit Verification and live in caregivers. There are many who have questions and concerns about this new policy. The 21st Century Cures Act doesn’t mandate GPS tracking. Why has Virginia put this in the policy? Our loved ones are not required to receive services in one location. They have the freedom to receive services at home as well as the community. Many feel that this is a huge invasion of privacy and really doesn’t prevent someone fraudulently logging in or out of a shift. Virginia wants live in caregivers to log in and out on their own devices with no reimbursement of use (many have limited data plans and they pay for their own phones, data, and battery) and many have no device. What is the GPS data going to be used for? Is the GPS location a violation of HIPPA? Won’t the GPS show when the consumer is receiving medical care? Another great concern of mine is that if my caregivers fail to sign in repeatedly or have to edit their entries, that DMAS could remove my child’s waiver. A loss of services that the waiver provides could create a detrimental domino effect to the families of Virginia. Parents or guardians could lose their jobs, because they will have to stay with their loved ones or they will be faced with the choice of institutionalizing their family member.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- GPS constitutes a search under 4th Amendment. In United States v. Jones, the Supreme Court ruled that GPS tracking constitutes a search under the Fourth Amendment of the United States Constitution. That means for Virginia to track someone, they must either obtain consent or obtain a warrant, for which they must have probable cause to believe a crime is being committed. Unless there is evidence that people with disabilities and their live in attendants are committing crimes, Virginia has no grounds to use EVV to track us or our live ins in our own homes. Further, any consent given could be interpreted as illegally coerced since the consequence of refusing tracking could be the loss of life sustaining health care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------- I have employer authority. I need help with my daily activities, but I still work a full time job and I am productive. I am also the consumer and EOR. Self-directed PCA programs specifically state I, as EOR, have "employer authority", therefore, Virginia should have no right to force me to use invasive tracking on my live in attendant and myself. I have lost attendants who have indicated they are not willing to be tracked by GPS. There is no way I would hand that kind of data over to a for-profit EVV vendor. Judging by the recent security breaches at DMAS and CMS, my concerns are already well founded.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- Folks don't get paid with evv due app. errors. Most live in caregivers cannot afford to do this and will leave. Is Virginia forcing care workers to quit, causing the consumer directed model of service to fail?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------- DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- I'm his only worker now. Everyone else has given up thanks to evv for visiting attendants. I've lived with him for 30 years. He lives with his parents and me. Great boss and friend. I am going to have to stop helping them. EVV for live ins will make it impossible to get paid.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ You're putting in a tech solution that they're not asking for, for a problem that doesn't exist. Why?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ You want low tech workers to do what? These live in caregivers are hands on persons: the complete opposite of a techie. They are paid the lowest of wages. The majority don't know tech and don't want to know tech. They specialize in people as in not just conversation, as in DOING. Thank God for them! When my father needed care, they were there. I will never forget the care he received! They do the hands on work many do not want to do. They are good with anything people to include the most private and basic of human assistance needs. Why in the world would you ask them to use an application and make their tough, low paying, very important jobs more burdensome? Why?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------- Could evv for live ins be a way to get care workers to quit, causing the consumer directed model of service to fail??? Wasn't the app designed or funded by agencies??? Wasn't the evv legislation lobbied for by agencies and large corporate nursing homes? Could this be the real purpose of evv??? At first I thought the purpose of evv was to make sure handicapped persons could not give a care worker an extra hour of pay for being willing to come over for an emergency etc. Evv steals your power as a boss to make these kind of trade offs. Of course officials don't know how the real world works.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- As the EOR, I am responsible for ensuring there is no fraud. Twice a month, my attendants submit online time sheets to the fiscal intermediary payment system. I review each of them, affirm the time sheets are correct, and approve the payment, just like any other employer. For people with intellectual disabilities or dementia, a family member can be designated and trained to handle these duties. A location tracking system is unnecessary and a massive violation of civil rights.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- I absolutely hate this EVV for live ins stuff. The app we have to use for putting in our hours always seems to lock up or won’t let you add hours. This is too much stress on families whom are already stressed with every day life. I don’t see how it will help deter fraud. As it is attendants are paid poorly and then you throw more crap for them to worry about but don’t want to pay them diddley.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- please dont send me to a group home. I have been in numerous government placements in my life. This began when I was 7 and entered foster care. I have been drugged, beaten, and raped in those places. I would rather be dead then live in those placements. Would you want to live where staff yells at you all the time. Where you are placed on high levels of psy meds so you don't bother staff? I think it is more humane to do what Hitler did and just put us out of our misery instead of leaving us in group care to be drugged beaten, and raped. Would you want to live a life where you are drugged beaten and raped on a regular basis? You, DMAS, are taking away my option to live in the community and not be raped, beaten, and drugged. This isn't improving care, this is causing my life to suck. This is just so some technology companies can make some money off of the disabled. It is already difficult to find staff for a low paid no benefit job. EVV for live ins it impossible. Maybe DMAS really just wanted to kill us off quicker and help their tech companies make money while they did this to us. :(

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ EVV is not for live in’s. Using the EVV app is very difficult for a live in. If the participant is involved in an activity we are going to be unable to check out on time. I won’t do check ins over the safety, or well being of the participant who is unable to care for themselves. I will end up with a lot of corrections and I am willing to make them, but it will cause undo stress or fear of reprimand for what will appear to be my errors. Unlike the non live in attendants, when I am in the middle of caring for the participant, I have no one to relieve me to simply grab a device and conveniently walk away.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------- Please don't take away community living....... https://www.youtube.com/watch?v=LfPNBnIpsjU This is a news video of a Virginia nursing home where a woman developed necrotic wounds which lead to sepsis and death from not being moved for days. This is one of many many horrific reports of group care in Virginia. Imagine that DMAS... living in a setting some social worker placed you in, while they pretended you have human rights and you selected the place... then loosing your life cause the place the CSB social worker stuck you had sorry staff. Why do these higher cost placements make DMAS happy? This is just one of many stories that made the news... what about the ones that didn't? these people can't speak for themselves... Please save the lives of people with disabilities and do not allow EVV for live in caregivers...

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- It’s not ok to track my disabled child (who is also a minor!) and his live in attendant. We are not criminals and do not deserve to be treated as such. Do not force EVV on live in caregivers. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- Why is dmas trying to force evv on live in caregivers? It is understandable if there is just cause, because I have done something wrong or have a record, but I don't. I even get a lengthy background check before I can care for my ward. How much vetting will satisfy the state? Each extra oversight ends up costing the consumer in quality of care, because the funds intended to help THEM go to satisfy an unjustified ego or fear rather than a statistically true need for surveillance. Maintain the current live in exemption from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------- There is a great deal of concern over privacy regarding everyone's location information and data breaches with EVV for live ins especially when it comes to our most vulnerable: the disabled. There were data breaches with Medicare/CMS and DBHDS in 2019, 2021, 2023, 2024, and 2025. No one being forced to comply with EVV has been given sound information regarding how their GPS location records are stored and protected. There are already at least four DMAS appointed agencies and at least four third parties hired by these agencies accessing this information daily which greatly increases vulnerability. GPS location data is valuable information to marketers, hackers, thieves, home-invaders, etc. Please continue to exempt live-in from EVV, so that they are not living in fear of home invasions, etc....

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- EVV has caused many issues for myself as an EOR and for my child's attendant. There are constant issues with the CDCN app that cause missed hours. It is not a user friendly process. I have to fight for everything my child has. EVV is just another thing added to our plates to manage. My child is terminally ill. He needs the hours he has, and his aide workS them. EVV is an intrusion on the disabled. It is not anyone's business where my child is (home, community, vacation) when with the aide except me. We have lost aides to previous pay issues due to EVV. They dont get paid enough as is, then have to go without for weeks and months at a time. Do the right thing. Do not force evv on live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ Virginia is attempting to cut the most affordable form of care available to the Virginia taxpayer by forcing Live-in caregivers to do something that it knows Live-In caregivers cannot do (EVV- electronic visit verification)? Even the federal government acknowledges they can't do EVV and makes an live-in exception for it. Forcing EVV on live ins will fill up institutions with currently home cared individuals and have taxpayers paying a much greater amount for the care of it's most needy population. How is this helping anyone?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------why do we have to be tracked like criminals? My brother is now going to be tracked like a criminal? it is sad.. how does this help anything? it is hard enough to hire people to watch my brother... now we have this? please Virginia continue to exempt live in providers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ Sense we tried evv, my patient felt she didn't have the free will to go out and do things the new system locked me out where I had to wait 20 mins to try and clock in and they said 20 mins later that I'm not even getting paid for making 13.00 an hour this required me to have my personal smartphone for work how can evv force me to use my personal phone for work makes no sense period I'm paying my bill and my company offers phones that they charge for this is ridicules we ended up having to use the portal to get a break from the evv nonsense

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------Who is profiting from filling up institutions such as group homes and nursing homes (that will cost the Virginia taxpayer substantially more than community based care which will be completely eroded by EVV)? Who is receiving kickbacks from EVV vendors and the like to force EVV on live in caregivers? LOOK THERE...THAT IS THE FRAUD. The fraud is not in community based care.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Why are there no names of those who proposed this? Isn’t it odd that a bureaucracy creates a legally binding regulation, with penalties imposed, and no named persons can be held accountable? Something that will affect Va taxpayers (with higher institution costs versus community based services) and the most vulnerable population. Wow. Just. Wow

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ I am writing this with tears dripping down on my face! No one know how hard it is to take care of non verbal, austistic and elipesy child unless you have one on your own! Imagine when you are have to clock in or out during the time your son is having seizure, you are so shaking and worrying that he may not come back to life! How can you think of clock in or out ! This is one of the reason DMAS - VA should not be considering pushing EVV on live in caregivers. We have a hard life as it is, please help support us to have energy in our mentally to take care of our childrens! Thank you in advance for your consideration in continuing to exempt parents from EVV!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- CMS does not force evv on live ins; why is VA trying to? Va is ignoring the disabled and their families and forcing upon live ins a program which makes their lives with a disability much more difficult. VA didn't have to do this for the live ins and chose to after saying they wouldn't force anything at the state level the fed gov't did not require.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------the app. doesn't always work and it causes more work. Once, attendant tried to clock in several times. after several tries for over an hour, the thing said it is now submitted twice; so now the pay will be held up for the attendant and phone calls will have to be made. who gets paid for all the work to deal with the app?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- EVV is a burden to families and caregivers who are already maxed out. Adding a clock in responsibility is unhelpful. My child requires a demanding level of care and it makes no sense for our live in attending to be working on admin duties while expected to perform personal care. Many times, taking the time to click in would pose a safety issue, and we will not be able to take the time to do it. We should not be penalized for this. The system is too slow; not like a time clock where you could swipe in and begin work. I need my employee to attend to my medically fragile child not to have to worry about clocking her time. please consider what a burden this might be to families. Thank you!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------Live ins should continue to be exempt from EVV log ins. EVV just makes it more difficult for everyone involved, and it’s not a job that can be time quantified as clearly as EVV is set up for. This is all hard enough, help make this easier for all the dedicated live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- Are our loved ones confined to a bed? Are they not free to enjoy and experience their communities? Why are we even being asked to input a location for beginning and end of service hours? It’s absurd. We have jumped through hoops constantly to prove that our loved ones are disabled (many since birth) and are going to be disabled for life. They are constantly creating barriers to civil liberties and the intent of these waivers was to give them access to community increasing quality of life.. I have chosen to try to give my son experiences to give him joy, those experiences come with community living, educational opportunities, which give him the least restrictive life possible. He is not a prisoner of this state, but often this is how we feel. He deserves to have the same freedoms as people who do not have disabilities. He deserves to be a part of his community and to experience a quality life regardless of disability. He still requires my constant care and supervision, and that should follow him, regardless of where he is at any point in the day. His disability is not going to improve, but his quality of life should never be an expected or mandated sacrifice.

Remove under Item #291; REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- The participant's level of needs are barrier enough to services. The EVV app is full of glitches and doesn't always clock in or out as it should. We had to resort to computer portal to enter time. The attendant waited to be paid for an 10 hour shift, because the EVV tacked on an extra 15 minutes to the shift which caused the whole shift to be rejected. Then, the EOR had to make phone calls to get it fixed. Not many live in attendants can afford to go without pay and will choose to quit over these errors especially if they get blamed for the errors. The state of VA should be ashamed of making decisions that make it harder to hire and keep a live in attendant. The participant's level of needs is already barrier enough. Piling on more barriers is a violation of the consumer's rights to access services and live in the community.

I respectfully request that you remove the following language from Item #291 in the budget:------->>>>> “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”-----------------------EOR's are free help. They volunteer to deal with so much. There is always some complication with EVV which will make things worse for EOR's. It was difficult enough for EOR's to deal with the fiscal agent, state, service facilitator, and the portal, but if EVV for live ins is inacted , EOR's will have to deal with EVV and everything else. Being overwhelmed with a disability is bad enough, but add to that already having a full time job with overtime, volunteering time as EOR, and EVV for live ins and you have the perfect storm for EOR's. How can one expect them to stay and do this for free? We will lose EOR's over EVV for live ins.

I respectfully request that you remove the following language from Item #291 in the budget......: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…” Live ins are family caregivers and those who have provided their homes to persons with disabilities are making one of the ultimate sacrifices. There are no paid holidays. Their job is NOT 9 to 5. It is 24 hours availability 7 days a week. There is no salary: $13 an hour (out of that $13 an hour comes all transportation for the person with disabilities as well). They are not paid anywhere near the hours they work. There are no sick days. They work while sick. There is no job security. There is no pay security. The many different agencies tied into their pay (Community Services board, Service facilitators, employer of record, dept. of social services, dept. of medical assistance services, DBHDS, or the fiscal agent) can neglect a simple step and they lose pay and spend hours correcting other's errors. There is no healthcare. There are no bonuses. There are no benefits. With evv for live ins they would need to post times at least twice daily at arbitrary times (although they work 24 hours) to a very difficult system that will GPS'ing them like criminals. This is after they go through extensive background checks. Why would the state force evv on live-ins when the federal government recognizes live-ins as the exception and exempts live-ins because they do not "visit" and provide 24 hours care? *******Because the six figured, salaried state staff with "abled" families making the rules could care less what a live in goes through in one day.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…” EVV is a horrid App, it drained my battery, despite settings with its constant pinging. For Live-ins, we work 24/7 and not the small amt. of hours we are paid. My adult child seized once late at night while i was trying to use EVV. Did I clock in? No. Did I clock in the two hours I stayed awake making sure he didn’t cluster? No. Am I ripping off Medicaide? No. You are going after the wrong people. We can’t even make a decent living wage on $13/hr with the limited hours we are assigned. Medicaid fraud is perpetrated by Companies, not Live-In Attendants. Why are WE being treated as criminals out on parole with ankle bracelets disguised as EVV and causing wear and tear on our own devices? The App was time consuming, invasive and should be dismissed.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------- Ratios are the most valuable asset when it comes to people caring for me. I currently get one on one care with consumer directed care, but EVV for live ins will take that away. There should be a premium put on ratios. I have been in many institutions; they are bulk care. The persons working there are there for a paycheck and not because they have an interest in my well being. There were little protections from the people in the homes that I stayed in. Once, I had an elderly man in a nursing home corner me in a room and offer anything I wanted if I came to his room. No staff were around to help me. Once a man showed up naked in my room, and it appeared to be an accident until it happened one too many times. Every place I have been in smelled like urine and feces. The cushions in shared rooms had stains on them and staff sprayed them with fabreeze which didn't help. Once a violent resident backed up their wheelchair to mine and started punching me from behind. Staff laughed and did not come to my aid. Staff had a smoking area right outside the building, so I couldn't open my window and get fresh air. My neighbor next door smoked marijuana in his room, and the staff knew it, because I told them the smoke got in my room and they never did anything to stop it. I don't want to go back. I love my home. Don't make me leave it. My friend cares for me now, and I live with them in their home (they make me feel like it is my home too). **I cost the state the least by being in consumer directed care. i don't want to be in assisted living because of EVV for live ins. I understand that noncompliance with evv will result in the "offering of other services". I know that means institutions because there are no other options. Please keep my ratio low and help me stay in my home by not forcing evv on live in caregivers.

Please retain the EVV exemption for live-in caregivers in the proposed budget. Why is this happening? Federal evv requirements do not apply to caregivers providing service in the shared home of the consumer and caregiver. Personal care services rendered by an individual living in the residence does not constitute an in-home visit. You are asking live-in caregivers to essentially make up hours when in all actuality they are available 24 hours per day, but only get paid for a set of hours. Many caregivers are parents and siblings of adults with special needs. When other people are enjoying an "empty nest," we are meeting the needs of our adult children in their own homes and giving them a life they deserve. EVV just adds an additional requirement to what we are already doing for our children that we love so much. Patricia Alf 8810 Dianne Place Springfield VA 22152

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”--------------------------- Please help the government to do the right thing and LISTEN to the disabled. That doesn't mean listening to agencies representing the disabled that are out of touch. That means listening to the persons that actually have to do the work and those actually receiving the care. Possibly a lot of money can be saved if PERSON CENTERED PRINCIPALS are used to communicate with the disabled and care givers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------It costs SIGNIFICANTLY more in healthcare dollars and taxpayer money to have individuals with disabilities housed in institutions (i.e. hospitals or nursing homes) vs. living in the community. This is what the end result of EVV for live ins will be in Virginia. Numerous people who were living for years in the community will be placed in higher cost settings with far less freedom and poor quality lives. EVV for live ins makes hiring and keeping attendants impossible. EVV for live ins will cause attendants to not get paid. Everyone is being threatened to have their consumer directed services taken away, but it is impossible to use EVV because of all the issues with the applications. PLEASE CONTINUE TO MAINTAIN THE EXEMPTION FOR LIVE IN CAREGIVERS FROM EVV.

The Autism Community requests that you: - Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. - Keep the Electronic Visit Verification (EVV) EXEMPTION for live-in caregivers. - Keep all developmental disability waiver funding included in the Senate Finance report. - Include rate increases for Respite and Companion services. Thank you, Shannon Grymes Parent to Henrico County autistic adult, Jack Grymes Board Vice-Chair, Autism Society of Central Virginia

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ If CMS is exempting live ins and VA currently exempts live ins, why is dmas doing the most to hurt it’s most vulnerable residences by requiring EVV for live ins? I have yet to see an answer why, so only the worse can be assumed. We are framed for failure.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- As guardian of an adult with special needs, life is very exhausting. EVV is an unnecessary, added trauma.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ We fee like animals dropped off at the pound with evv for live ins. You see, a person making a quick, and easy decision for them, can ruin the poor animal's life by dropping them off at the pound on a whim. That is what is going on here with DMAS trying to remove the exemption for live in caregivers. They are making an easy, quick decision for them with no real substantiation for what they are doing and it is going to wreck havoc on the disabled around Virginia FOR LIFE. Please, be considerate and maintain the exemption for live in caregivers from EVV.

I respectfully request that you: Keep the EXEMPTION from Electronic Visit Verification (EVV) for live-in caregivers, in line with CMS recommendations! Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. Keep all developmental disability waiver funding included in the Senate Finance report. Include rate increases for Respite and Companion services,

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------There has got to be a better way for live ins than EVV. Dealing with a disabled family member makes life very stressful. As attendant, my job is caring for them 24/7. Because my family member will be living with us for the rest of their life, EVV is an unnecessary burden. When we tried EVV, during Christmas and New Year's vacation with extended family, I had to interrupt special outings and activities to deal with the clock. A few times, the app didn't work right and I had to stress during holidays trying to get it to work and wondering if I would be paid or investigated or both. That is not a way to live a life especially during the holidays. My family member goes with me wherever I go. EVV is a burden in our situation.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- From Charlie Carr's Blog A BRIEF REVIEW OF THE ORIGIN AND POTENTIAL TRAGEDY OF ELECTRONIC VISIT VERIFICATION (EVV) 02/18/20 "During a congressional oversight committee hearing the Congressional Budget Office (CBO) was asked about the $125 million pay for and how it was determined. CBO had no credible evidence to support the allegation that there was a high level of fraud, waste and abuse in the personal care service program. Based on that, the panel declared the projected "savings" as flawed and unacceptable. Since that time no substantive/credible finding of fraud in the consumer directed personal care services program has been made available by CBO yet states continue to interpret location as using GPS and biometrics in the name of program integrity. Program integrity is code for fraud, waste and abuse." Charliecarr.com

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------I am a care recipient and EOR. I will find it very hard to hire workers if EVV is forced on live in caregivers. *****Why is it that I pay for a large portion of my care every month with MY OWN FUNDS through patient pay and I have no say about the forced use of EVV on live ins? My personal funds are spent down to COLA levels to pay for a large part of my care and I have no say. ****I am really not sure that is legal!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------- Why is DMAS trying to force live ins from exemption from evv? Federal evv requirements do not apply to caregivers providing service in the shared home of the consumer and caregiver. Personal care services rendered by an individual living in the residence does not constitute an in home visit. You are asking live in caregivers to essentially make up hours when in all actuality they are available 24 hours per day, but only get paid for a irrational set of hours. You are also asking for them to neglect the consumer and their needs to spend countless hours messing with a system that doesn't work.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- When I used electronic visit verification (EVV), it messed up my hours all the time. I wouln't get paid for God knows how long; my hours were messed up due to the app. I had bills to pay. I had to switch to using the portal. The app not only invades the privacy of the disabled, but it also puts the disabled at risk of losing their caregivers. Participants will lose their attendants because many attendants live from pay check to pay check and will be forced to quit. They will have to work where they will get paid in a timely manner.

The Autism Community requests that you: -Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. - Keep the Electronic Visit Verification (EVV) for live-in caregivers. -Keep all developmental disability waiver funding included in the Senate Finance report. -Include rate increases for Respite and Companion services

The Autism Community requests that you: Include $250,000 one time capital funding for the Autism Community Hub planned by the Autism Society of Central Virginia. Funds are in the House Budget and need to be added to the Senate budget. This Hub will be a model for other communities to establish a centralized, inclusive space to offer programs. Keep the Electronic Visit Verification (EVV) for live-in caregivers. Keep all developmental disability waiver funding included in the Senate Finance report. Include rate increases for Respite and Companion services,

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------Requiring participants, employers of record, and their live caregivers to all have smart phones or tablets is not well thought out at all. These are Medicaid recipients and persons making $13 an hour with no benefits. These folks must purchase certain phones/tablets only, since the app is only available in certain app stores and the device must have GPS capability. They must have a data plan or, at minimum, a landline phone. Who is footing this bill? The attendant on $13 an hour? What happens when the consumer or EOR can't afford a landline phone bill? What happens when the phone breaks? What happens when the phone or app or both malfunction? Who should be responsible for the expense of these items, ensuring that there are no technical matters and repairing/replacing said items immediately? Maintain the EVV exemption for live in caregivers. Don't fix what isn't broke.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------------- There are times in the world where everyone turns away from a certain population. The sacrifice for standing up for them is too great for most. There was HItler, Mao Zedong, Idi Amin, etc...Once again, with EVV for live ins, the stakes are becoming too high for our disabled population. People's very lives are at stake on both ends. Disabled lives for risk of institutionalization, and the caregivers for threats/accusations of Medicaid fraud, court, lawyers, and jail. Open your institutions, Virginia. You have left many no choice. Only the very brave and offenders will be left to stand up for the disabled.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------A perfect storm is brewing. An additional consequence of electronic visit verification (EVV) for live ins is that it adds yet another layer of bureaucracy to programs and recipients and includes privacy rights infringement for workers to each state’s already overburdened Medicaid agencies. EVV for live ins is time consuming, invasive and pushing away qualified workers and further exacerbates the existing crisis in recruiting and keeping good personal care services workers nationally. Most states that administer the consumer directed personal care services program either through HCBS, MCO or some other method are already experiencing a serious worker shortage that negatively impacts disabled clients and elders who rely on these workers to live in the community outside of institutions like nursing homes. In several states, disabled and elder personal care services consumers have defaulted to emergency rooms and short term nursing home stays because they can’t find adequate and appropriate workers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------The apparent justification for GPS tracking is to prevent fraud and abuse in Medicaid personal care services. However, anyone who would advocate for such a system clearly lacks awareness of who receives Consumer Directed services and why. The majority of us have severe physical disabilities. We need and will always use the hours we receive. Even though, it would be my dream to do anything with legs (even a janitorial job at a beer fest or college dorm is a beautiful dream for me), I'm not going to suddenly get up and walk or suddenly not need help using the bathroom. EVV for live ins is an additional burden we do not need.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------- The state is mandated to consult with stakeholders including consumers, their reps, and caregivers regarding EVV for live ins especially when EVV for live ins is currently exempt with Virginia and CMS. By federal law, the state is mandated to consult with stakeholders, which includes consumers, designated representatives, and employees completing the work in addition to EVV vendors.

Remove under Item #291: REMOVE - “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…” EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks. I don't "visit". I'm on call 24/7 everyday and night. I do not need to be tracked. There is NO FRAUD.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- EVV can be traced back to a money grab by technology companies looking to make a profit off the disabled (it is always the disabled first; YOU are next). This has nothing to do with fraud (except that of EVV companies) and helping people with disabilities. Evv for live ins is attempting to track people with disabilities in their own homes every. single. move, each. and every. day. If I didn't have live in CDPA, I couldn't have attended a family wedding. I have live in CDPA, because I qualify for nursing home care level services. CDPA allows me to live in the community and saves taxpayers money compared to nursing home costs. Without it, I would be waiting to die in a nursing home (and spending a lot more of the taxpayer's $). But, it isn't right that my every move is monitored, so EVV tech companies can turn a profit. CDPA has very low fraud. EVV for live ins will make sure most of the people getting CDPA in Virginia WILL NOT continue to get the care they need.

Remove under Item #291; REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------Many people will leave the field over invasion of privacy in the home, gps tracking in the home, and app unreliability for live in caregivers. This needs to be considered when states have stakeholder meetings. We must work to keep the privacy of all citizens including people with disabilities, their families and their caregivers. We have a crisis with the shortage of healthcare workers as it is. This technology and use of geo tracking can create a catastrophe within the home care community. The loss of providers could cause people to end up in institutions or nursing facilities. This alone could be detrimental as there are not enough nursing facilities to house the thousands of clients in each state the rely on HCBS waivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- We can't keep an aide. EVV is a deterrent for visiting aides. No one wants to have trackers on their phone. Low pay already has us down to family members for live in aides. We need another aide, but can't find someone to fill the gap that lives out, and now, we will have no hope of even trying to find someone who will live in if evv is forced on live in caregivers. Thank you for listening.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- What I am angry as heck about is being forced to be GPS'd and spied in my own home with a unrelieable/faulty system to care for another person. I give up so much of my life to help someone else. So many unpaid hours already just to keep them out of a facility (that doesn't even exist because there are not enough facilities to take people). Now, they want to force me to give up more of myself for this? It is so frustrating. It feels like rape, because it is not necessary (not required by the fed gov't and CMAS), and so forceful on people who only want to care for others

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------I had to get a live in attendant because of problems I had with EVV when I had two live out attendants. Often they would deny the original submission, because attendant 1 clocked out at 12:45 and attendant 2 clocked in at 12:45. They adjusted attendant 1's shift but shorted their hours. So, I would have to spend the rest of the day on the phone to sort it out and sometimes it was never sorted out. One attendant just got paid less. Please maintain the established regulation for live in attendants exemption from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------------- ADD: Inhumane cruelty. So cruel . Dmas attempting to take away a service that worked by implementing ridiculous requirements. Don't let EVV happen to live in caregivers!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- ADD: Skimming pay. Is this the "fraud" everyone is looking for (that DMAS is committing)? There are plenty who will not put up with not being paid and the skimming of people's pay that EVV for live ins will cause. How much "fraud savings" by cutting time with a minute here and a minute there, before we have no one to care for our loved ones? People will quit over it. No one would ever tolerate the missed wages, app glitches, repeated phone calls and emails, online corrections, threats for online corrections, service facilitation agency errors, DMAS errors, case manager errors, last min. mtg. cancellations, late arrivals to mtgs, payroll agency errors, all four agencies playing "hot potato" with the service plan causing delays, no one caring about the delays and loss of pay due to the agencies not processing the plan in a timely manner, privacy breaches of all your info., prior authorization hang ups, threats of losing services, etc... that so many live in caregivers endure. Don't make CD services worse by adding a faulty program called EVV.

Remove the following language in HB30 regarding Item #291: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours for live-in caregivers. This is important to my family because we are the caregivers for our son with autism. Requiring live-in caregivers to use EVV creates an additional burden as we care for our son. In addition, the EVV system is not designed for a live in caregiver arrangement. EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregivers do not "visit," and the use of a "visit" monitoring system does not capture the ongoing presence and involvement of the caregiver.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------Here is a problem my live in had when trying to use the evv app.....When they clicked for time entry or payout report, it said to contact administrators? I emailed and called with no response. How can anyone allow all these issues with the app and demand us to use evv for live ins?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------------ Dmas is just trying to get us all dead quicker by taking away the only useful service they offered (which happens to be the most affordable for the Virginia taxpayer). Besides making money for technology companies, the only other purpose evv for live ins serves is to make it impossible to hire self selected live in providers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------------- I could not use the evv app. but I tried to. Not one time did my live in attendant get paid on time when using EVV app. The app will boot you out. It will make shifts disappear. It will not pay a whole 8 hour shift if the shift went over the hours by minutes. It’s hard enough having special needs kids , even harder finding live in attendants, but it would be literally impossible to keep them with EVV for live ins. An error on their end can cause lost pay . I can’t loose my live in attendant or I don’t have a job. I can’t keep my live in attendant when they can’t even get their whole paycheck they worked for . They already get paid pennies for what they do, then for their paycheck to always be messed up when they use EVV makes them late on their bills and they will have to find work elsewhere. This app clearly isn’t doing any good. Please don't let exemption from EVV for live ins be taken away. All of us will suffer greatly.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------- Why is DMAS willing to change a disabled person's life to the point where many will end up in nursing homes for no substantial gain? Or is there behind the scenes gain? Kickbacks from evv vendors? Profiting from the filling up of institutions such as group homes and nursing homes? WHAT IS THIS? ------->>>>>DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  While the savings are not significant to the Commonwealth, *****the burden for live-in caregivers is significant and this is why the exemption was granted in 2020 by the Legislature.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- The bureaucracy of living with a disability is difficulty enough not to add in electronic visit verification (EVV) for live in caregivers. Living with a disability is a never ending paperwork nightmare. We are vetted and verified a thousand different ways. Year after year. We are constantly proving a disability that is obviously never going to improve, only progress. Hiring attendants constantly. How many others will not be able to cope with this additional burden? How many of us will end up in nursing homes and for what? A program that is not required by CMS and is unnecessary? Please continue to exempt live in caregivers from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- Please, come to my home and see how live in caregivers live. Why is it our lives get more and more complicated on top of everything we already deal with?? It continues to blow my mind on how this all keeps getting more and more complicated for us to just simply care for our children. It’s hard enough trying to manage everyday life and then throw in the disabilities part. Now its EVV for live ins, then its a request for paperwork that you've done already and then its a statement or letter from yourself and others. It’s unbelievable the hoops we have to jump through to make it work. I have written a letter twice for renewals because they want to take away caregiver hours. Each time I have to explain I am a single full time working mother of twin autistic boys. I need all the help I can get. Feel free to come over for a day and see how we live! Please keep the exemption for live in caregivers from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------------- For the short period I tried the electronic visit verification app, I was bewildered at all the problems. For example: Once, I submitted a question through the "contact us" on the app about them changing my hours from 40 hours to 39 hours and 45 minutes. I filled out all the requested information. I got a reply back saying I did not give attendant Id, birthday, and ss number. They didn't ask for these items on the form. After 3 weeks, needless to say, they never answered the question. This is a bungled system. Please don't not force evv on live in caregivers. Continue to exempt them as it currently stands.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------- Please continue to exempt Live Ins from EVV. Why must a family of a consumer have to clock in with an app that most days would show our location two houses down? How is that a verification and why do I need to verify? This is where I live with my disabled daughter that I care for daily. Why must you make it harder on the families? Thank you for your time.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------------My visiting caregiver has been frustrated over and over by the app. going down. It will go down at the most inconvenient times...sometimes for every day of the week. My live in caregiver uses the portal and posting the live in's time is never a stress. Please do not add to my troubles by forcing this EVV app on my live in caregiver. Continue to exempt live in caregivers from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- We are in a caregiver crisis that EVV for live ins will make worse. According to an AARP study, in 2010 there were 7 potential caregivers for every person over 80. The study reveals that by 2030 the ratio will decline sharply to 4 to 1 and by 2050, 3 to 1. Those who qualify for the state’s Medicaid program for in-home care are already having a very difficult time finding workers to meet the demand. EVV for live ins will make it impossible for consumer directed services to keep up with the demand/needs of the disabled. Please, continue to exempt live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- When people think of caregivers, they often think of adults taking care of their elderly family members, but that is not the reality for many adolescents and young people who are forced into distressful situations when loved ones are diagnosed with cancer. There are so many situations when family must step up or no one else will. Sure, they can abandon loved ones in nursing homes or other state placements. But we know as a society, people don't get good care there. There are a number of situations where people in all stages of life step up to care for loved ones unable to care for themselves independently. In the few situation where Medicaid is able to step in and help the family from becoming homeless, consumer directed care steps in. EVV is taking away the entire consumer directed care system. Continue to exempt live in caregivers from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- EVV systems for live in caregivers erode the intent of consumer-directed services, walking us back in time 40 years where disabled people are no longer in control of their private lives. Without consumer-directed services or adequate home care employees to assist us in our homes, many disabled people will have no other option than to be placed in a nursing home. This is the antithesis of the spirit of independent living and would violate the Supreme Court Olmstead decision, which requires states to offer services in a home and community-based setting when they also provide nursing home care. Continue to exempt live in caregivers from EVV. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------------ My house is not an outpatient hospital or nursing home. There is never a reason for the government or their EVV vendor to have access to the private dealings of my life solely to prove I am disabled and in need of assistance. The very fact that I’m alive today to write this piece means my live in caregiver completed the tasks with which I needed help for the day. And I’m completely capable of continuing to verify that my employee performs the work I direct them to do. Please continue to exempt my live in caregiver from EVV.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I am a parent of a person with disabilities and maintaining the EVV exemption for live-in caregivers is important to me because Live-in caregivers do not "visit," and the use of a "visit" monitor system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually happens and forces caregivers to log artificial “shifts” that don’t reflect reality. EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks. If there is a need for oversight, care recipients and families can easily verify that care occurred. Live-ins are on call 24/7. Shift workers are not on call and clock out at the end of a shift. Live-ins cannot clock out. It’s unreasonable to expect a live-in caregiver to clock in and out for every issue addressed around the clock. The EVV system was created to track shift-worker attendant time and movement to help prevent fraud. There is no potential fraud component for live-in caregivers. EVV tracks location. The live-in caregiver will be at the location, so there is no point in the location tracking aspect. The task tracking is easily verified by other means. Live-in caregivers are working around the clock far more hours than they are being paid. Live-in caregivers provide care intermittently throughout the day and night Live-in caregivers respond to unpredictable needs such as: seizures, elopement, behavioral crises, toileting, medications, and much more. Overnight and on-call hours are hard to document. Live-in caregivers must remain available at all times and may be awakened multiple times per night for seizures, medical needs, or elopement. Live-in caregivers are tied up with all too common urgencies and emergencies around the clock, day and night. They shouldn't be forced to direct their energy to a time clock and away from the person receiving care. EVV does not add anything to the quality of care or even accountability, since care recipients and families can easily verify that care occurred without EVV. Many live-in caregivers are family members who left paid employment to provide care and save Virginia significant institutional care costs. Requiring these live-in caregivers to use EVV will push many toward institutional care instead. It shows bad faith for Virginia to now remove that exemption, and it will make caregiving feel punitive and distrustful.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- Many people are happy with online timecards, which they say are accessible and work well; and as the ones receiving services, they have no incentive to collude with providers to lie about the hours of care provided, as they’d only be defrauding themselves. Plus, with live ins, we get more hours of care out of live ins than what the live in is paid. We get care when we need it this way. EVV is fraught with problems and will eventually cause more persons to be forced into institutions. Please don't let this happen. Please save the evv exemption for live in caregivers. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- EVV for live ins doesn’t address fraud or quality of services. A ton of money will go to the EVV vendors, who continually spend a lot of money lobbying for EVV. Don't mess with the evv exemption for live in caregivers.

Please remove language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------- DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  *****Once EVV for live ins is enacted, it will erode the most affordable care program for Virginia taxpayers and force persons with disabilities back into institutions. This will greatly affect the Virginia taxpayer, because institutions cost substantially more than Consumer direct care. Any "savings" will be eclipsed by the flooding of institutions. It amazes me that the representatives of our state fail to recognize that caring for our own family members is the most cost effective solution for those who are able and every means should be taken to make it easier for these parents instead of increasingly difficult. There should be no limit as parents are on duty 24/7 and even if parents were paid 24/7, it would still be more cost effective than living in a state funded institution. And, the level of care is far superior to most institutions and the family gets to remain at home where they are comfortable and wish to remain.

remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”---------------------------- DMAS alleges a savings by removing this exemption; however, 1) These alleged savings were not supported by documentation by DMAS nor by the Department of Planning and Budget. 2) These alleged savings to the Commonwealth will be realized only when recipients do not receive necessary care. 3) Interim DMAS Director Jeff Lunardi said on February 6, 2026 that the removal of the EVV exemption is "not a significant amount of savings". VIDEO 4) The Department of Planning and Budget (DPB) stated that no records were supplied by DMAS to substantiate the alleged savings and the DPB did not produce their own records. So this number has no substantiation.  *****Once EVV for live ins is enacted, it will erode the most affordable care program for Virginia taxpayers and force persons with disabilities back into institutions. This will greatly affect the Virginia taxpayer, because institutions cost substantially more than Consumer direct care. Any "savings" will be eclipsed by the flooding of institutions.

Hello, I am the official caretaker for my adult son via his Medicaid waiver. It had come to my attention that we are at risk of losing the EVV exemption for live in caretakers like myself. When I first became his official caretaker, I tried to use the log in phone app system. Quite frankly, it was a disaster. I am with my son nearly all the time. It is extremely difficult to remember to log in and log out given I’m literally always on duty. Setting a timer to remember to log in and out is only helpful if you are not in the middle of a task when the alarm goes off. There is no pausing butt wiping or teeth brushing (among a million other daily tasks) to log on or off for the day. Please reconsider. We are already some of the most overworked, overwhelmed people imaginable. Don’t make our lives harder when the purpose of logging in via the app is to make sure we are with our client. We live in/family members are almost always with our “clients” and our worked hours greatly exceed the amount of time for which we are paid. (Honestly, I don’t understand why this is such a significant line item in the budget. I don’t see how our ability to log time online is costing so much.) Thank you in advance for your help.

I respectfully ask that you remove the language in Item 291 directing the Virginia Department of Medical Assistance Services to seek federal authority to eliminate the live-in caregiver exemption from Electronic Visit Verification (EVV). Live-in caregivers are not visiting workers coming and going from a job site. They are family members or caregivers who share the home and provide continuous support throughout the day and night. Requiring them to “clock in and out” through an EVV system in their own home does not reflect the reality of how this care is delivered. The current exemption recognizes that live-in caregiving is fundamentally different from shift-based services. Removing it would create unnecessary administrative burdens for families already providing the majority of care and support. Please remove this language and maintain the existing live-in caregiver exemption.

I respectfully request that you remove the following language from Item #291 in the budget: “The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments…to eliminate the live-in caregiver exemption from electronic visit verification requirements…”------------------------ The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours in an EVV device for live-in caregivers. Please preserve the live in exemption from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------------- Since you passed legislation granting live-in caregivers this exemption effective January 1, 2021, live-in caregivers have been able to provide round the clock care without the constant interruption of clocking in and out. They can't be expected to clock in and out based on the small amount of hours they are paid, because they do not watch a clock and provide care around the clock. EVV electronically verifies that home and community-based services are delivered to the client. This is easily verified by a live-in caregiver by other means than using EVV to clock in and out for shifts and tasks. Requiring a live-in caregiver to use this system is burdensome and takes the focus away from providing care which can be dangerous. Please continue the exemption from EVV for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------------There are a lot of problems with EVV for live in caregivers that have disabled people raising concerns. One is the rigidity of the system, which in some cases could require people to wake up in the middle of the night to sign off on hours. For others, people who perform multiple kinds of services may struggle to classify them. What happens when someone helps someone with toileting, washes some dishes, and then preps some medication? These may be classified as different services, and have to be logged independently. Problems with logging services accurately are a big concern. It’s already hard to find qualified workers and EVV for live ins will be a deterrence. Protect the disabled trying to stay in their homes and do not take away the exemption from EVV for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------GPS tracking of live in caregivers tells the government where services are delivered…BUT it also tells the government where disabled people are going. EVV data can show where disabled people go to church, school, or shop, and this compromise of privacy extends to family too. Our families don't deserve this in their homes. Don't let this happen to your family. Maintain the exemption of EVV for live in caregivers.

I am the parent of a 37 year old Autistic young man. I am asking you to please remove the EVV language from this bill. I take care of him 24/7. His needs are not time based. I cook, food shop, do laundry, take him to and from work, medical appointments, hair cuts, by-weekly pedicure appointments, clothes shopping, and anything else he needs. I take him on “play dates “ (game room) on a regular basis. When he doesn’t sleep, neither do I. I’m asking you to please not put anymore stress on me by forcing me to have to clock in and out! I’m on the clock 24/7. I get no sick leave or vacation time.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------EVV for live ins causes harm. I am particularly troubled by a provision that has not received much attention: the requirement that states begin effectively geo-tracking people with disabilities who use personal care services through Electronic Visitation Verification (EVV) systems. I have spent the past month gravely concerned for my future. With massive cuts to Medicaid, my ability to receive the necessary supports to live and work in my community is at great risk. EVV for live ins will place me further at harm.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------How would you feel like if you needed to verify your identity and physical location with your state government via a GPS-enabled biometric device every time you exercised a civil right? And if you didn’t properly check in, you ran the risk of losing that right — or of losing your health, or even a family member’s life? Maintain the live in caregiver exemption from electronic visit verification.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- What would it feel like if the government outsourced the responsibility for managing a forced check-in process to a third-party contractor that had a backend database prone to leaking protected personal health data to other people? What if the recipient of the contract to build those devices and maintain those databases was a major lobbyist behind the law establishing this obligation? Would you be angry? Please stop taking advantage of the disabled and continue to maintain EVV exemption for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------The core purpose of in-home live in care assistants is to ensure that differently-abled persons and their families are can live the fullest life possible in their own community and not in an institution. EVV for live ins will hinder this in many ways. Please continue to keep the exemption for evv for live in caregivers. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- Where does Virginia think live in caregivers are? They LIVE in the home. They do not "visit". They have a very serious job of which, if they weren't doing it 24/7, someone would be neglected, or worse, expired. Virginia sends professionals to visit the home at least twice a month and insists on the disabled sitting through countless meetings yearly regarding a their needs, appearance, health, supports, etc....Are these people in the program neglected when you see them? Are they dead? Oh no? They are healthy, alive and thriving in their home environment which is being threatened by EVV for live ins. Live ins are vetted on location/habitat by several means. EVV and the small amount of hours assigned to a live in do not fit a busy live ins' round the clock job and will, by the live in's inability to stick a very small amount of paid hours and a strict schedule, cause the live to not be paid and the disabled to lose their care. Please let exemption from evv for live ins stand as is. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------- At first glance, EVV seems like a simple distributed time clock, but it also represents a deceptively intrusive tracking of the lives of Medicaid recipients. Live in caregivers for the disabled are required to work varied, sporadic, and flexible hours around the clock (even though the hours they are paid do not reflect this) and in a variety of locations. Recipients of these services are people who may need help getting to a doctors appointment one day, or getting around the mall another day, aid with prevention of elopement, getting up in the middle of the night, or myriad of emergencies and extreme situations/needs. EVV does not fit the schedule a live in or the disabled care recipient live by. Keep the live in exemption for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------EVV establishes distrust as a baseline in a relationship that is fundamentally about trust. When caregivers log into a GPS-enabled EVV device, they also provide a precise and analyzable location history of the clients, and by implication, they also provide a record of private and Constitutionally-protected behavior. This is one of the tricks of data analytics, especially when enhanced by machine learning techniques: data is never just about the thing you originally think it is, it is always also about what can be mechanically inferred. EVV adds an extra layer of intrusion because it unilaterally alters the labor-management relationship between PCA and client while offloading audit responsibility to the client. Leave live in caregivers exempt from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------- According to ADA, governments aren't supposed to create programs that are beyond the competency of the participants. EVV is very difficult for even skilled tech savvy clients, eors, and attendants to use. EVV for live ins will make consumer directed services unusable to people who do not have a smart device, computer, wifi access, or a landline. DMAS doesn't seem to understand people using this service are typically poor. Many elderly parents are able to keep disabled, adult children home under this service. EVV for live ins will take that away. No amount of "education" and "training" is going to fix this issue. Please, continue the exemption from EVV for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- We want the same rights free range chickens have. Chickens get free range. They are not GPS'd or geofenced and can go anywhere. We want free range. We want to be able to be and go anywhere. No geofencing or GPS tracking! Keep the exemption from EVV for live in providers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------Please exempt live in caregivers. Location not being captured in rural areas. Even though the software has offline capability, some of our patients live in such rural areas that the location can't always be captured. And when it is, it's not always accurate. DMAS states providers will not be reimbursed unless this information is in the claim file. We can't just not provide care to patients just because they live in remote areas-many without landline phones-as that would be considered neglect. DMAS has not been clear on what to do in these scenarios and we are just trying to provide the best care possible for the patient because that's what they deserve. EVV has been very burdensome and time consuming-the patient/client is what truly matters. There needs to be some better preparation/direction on what to do if the location can't always be captured.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- Did the electronic visit verification (EVV ) vendors not make enough funds off of the true "visiting" caregivers? So, now they want to repurpose their app for people it was not intended for, that do not visit over greed? It is dangerous to ask someone who is mentally and physically busy 24 hours per day, who is available at every problem big or small, including emergencies, to drop what they are doing and prove they are visiting their own home. Actually, that is impossible to do because no one can visit their own home. EVV vendors, go and find another group to take advantage of and quit profiting off the weak and voiceless. Leave live in caregivers alone. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------- EVV is not good to push on live ins. EVV will make my life with a disability much more crappy... things were going pretty well. Now I am at risk of nursing home placement. I would rather die. I can no longer hire attendants as they don't want to work these days and now under these problems with EVV for live ins, it will be next to impossible to hire someone. Please continue to exempt live ins from electronic visit verification.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------Please maintain the exemption for live in providers. there is no reason live in providers cannot continue to be exempt.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- EVV hurts the disabled. EVV for live ins will limit the lives of the disabled and track them in their own homes. It isn't helping anyone except EVV vending companies' bottom line. Keep the exemption from EVV for live in caregivers. Thank you.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------DMAS is telling people if they just educate the eors and attendants more then all these problems will be solved. That the people can be indoctrinated into understanding the necessity of EVV. But the thing is EVV isn't needed for live ins. It is a burden to the disabled and especially for their 24/7 caregivers. Many people were using consumer directed services without a problem. Now they can't because hiring staff is impossible. No one wants to work and get time cut over EVV problems. Address the real issues DMAS. People can't get the free phones. People will have to purchase a dedicated smart device and a wifi service now just to stay out of a nursing home. Stop acting like all these people with disabilities are just stupid. We fully understand what you are doing to us. Continue the exemption for live in providers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------- EVV is bad. DMAS should at least continue to exempt live in providers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-----------------------------Live ins should continue to be exempt from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- CMS says Virginia doesn't have to have live in providers do EVV. Virginia said they wouldn't do anything more then the federal law requires. Virginia has exempted live ins since 2020. How could continuing to exempt live ins from EVV cost anything? There are several costs/losses for taking advantage of the disabled and forcing EVV on live ins.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ 23 years ago, my child was strangled by the umbilical cord during birth, leaving her brain-damaged and paralyzed. "She will be a vegetable the rest of her life," said doctors. "Put her in an institution". When my child was 10, we asked a top University if there was anything to help her communicate. "No way. There's nothing going on in her brain." But, we noticed she laughed at funny stuff. Turns out a lot was going on in her brain. With a computer that allowed her to control the cursor by touching a switch with the side of her head, our child was finally able to communicate. DMAS is attempting to take away our freedom and autonomy with EVV for live ins. Please, continue to Exempt Live in Providers .

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- This hurts my son. just trying to stay out of a nursing home. we are even more humiliated by the attempt to track us 24/7 now. EVV harms the disabled.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------- Olmstead was supposed to help us stay out of facilities. EVV for live ins will make the lowest cost stay at home option impossible to use. Was Olmstead even informed? Did the Olmstead people think this would help? It does not help. Save the status quo: keep live ins exemption from electronic visit verification.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------------- We have live out attendants right now. We want a live in. We have desperately been trying to find one. There are so many things about the job we must warn them of that make the job difficult (like not being paid for errors of several agencies involved in the consumer direct process - something out of our control). Often times, that is when they decide not the take the job is when we warn them; however, if we don't tell them, then they end up leaving after they do discover the problems. I am sure we aren't the only ones struggling like this. EVV will make it impossible to hire and keep live in attendants, so we will never get one. Please don't remove the evv exemption for live in caregivers. Thanks.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- No to EVV for live ins! Electronic Visit Verification is Incompatible with Independent Living! Currently live ins are exempt from EVV in virginia. Let's keep it that way! Thank you!

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------Ed Roberts had severe disabilities and founded the Independent Living Movement. Ed was assisted by personal care attendants for most of his life and neither he nor his attendants were subjected to technical surveillance and prohibitive policies that monitored their every move. Consumer directed used to be an utterly simple and deeply humane program that fostered living and letting live. In fact, it was precisely because he enjoyed the unhindered freedom to move and function that he accomplished all that he aimed for himself and us, his brethren, in the Independent Living Movement. His revolutionary Independent Living way of life was based on the notion that we may not be able to do many physical things for ourselves due to our disabilities but that we are still able to accomplish them with the use of assistive technology and the unhindered help of personal care assistants who respect our wishes and preferences in how to do things our way, when and how in the secure privacy of our home. The original consumer directed was a very delicate and symbiotic relationship of respect and trust between us as personal care recipients and our personal care providers. The secure and private set up of that relationship is another form of the God-given right to life, liberty and the pursuit of happiness enshrined in the US Constitution. Please don't take away our independence by forcing EVV on live ins. Keep the current exemption from EVV for live in caregivers as it is.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- The Consumer Direct Program is only funded with Medicaid dollars to make sure that disabled people don’t die, starve or suffer neglect because there is no one to feed, bathe and take care of them. The use of government funds to provide the personal assistance services should not force the loss of civil liberties the way this intrusive EVV system would be if forced on live ins who have no choice but to rely on personal care services. I’m sure that Taxpayers who fund the most affordable care program for the state - consumer direct program - would strongly oppose the use of invasive technologies that stifle the very basic freedoms that threaten their future when perhaps they themselves have to use the program. Don't let EVV happen you and your family.

Consumer directed care was not designed as a business arrangement between animal handlers and a herd of cattle who have to be taken care of, an arrangement that businesses can manipulate with as much technology and control as they want. Yes, providing essential personal care services to human beings calls for funding the way we answer with food the problem of human hunger. But It does not give the government the right to violate our humanity and control and herd us like captive cattle. The outrageous insistence of government to force EVV on us or else is just truly sinister. Will this be another cottage industry to the home care and IT industries?-----------------------------------------No one cares or is fighting for those of us with disabilities. ACLU, DREDF, NDRN need to see more blood spilled before they'll consider it a privacy rights or Olmstead violation, respectively. EVV for live ins harms us. Maintain the exemption for live ins from the harmful EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------------------------- Consumer directed care was not designed as a business arrangement between animal handlers and a herd of cattle or an arrangement that businesses can manipulate with as much technology and control as they want. Yes, providing essential personal care services to human beings calls for funding. But, It does not give the government the right to violate our humanity and control and herd us like captive cattle. The outrageous insistence of government to force EVV on live ins is just truly sinister. Will EVV vendors be another cottage industry to the home care and IT industries (in other words: another of many vampire agencies profiting from the disabled's misery)?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- There is a ton of controversy that surrounds that fact that your phone comes GPS track enabled. Wherever the phone is, it can be tracked by someone that has the software to do so. While this is helpful in instances of missing kids, criminals, or a lost cell phone, many others feel as though their privacy is being violated with tracking capabilities. Tracking a cell phone without a person’s knowledge is against the law. If you have the ability to track a phone with GPS, you may be tempted to break that law and violate the phone owner’s rights. Perhaps the biggest problem or complaint with phone tracking capabilities is the invasion of privacy. Hackers, thieves, and other dishonest people may use your phone GPS tracking software against you. If they want to break into your home or cause you harm in another way, they can easily track where you are at any given moment. So, while you are out at the mall, they are at your house taking everything you own. DMAS wants live in caregivers to give up their rights against illegal search and seizure to use EVV (electronic VISIT verification) to prove that they "visit" their own home??? Unbelievable. Maintain the exemption from EVV for live in caregivers.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------- From CMS Centers for Medicare and Medicaid Services (federal government) Informational Bulletin, August 8, 2019: EVV requirements do not apply when the caregiver providing the service and the beneficiary live together. PCS or HHCS rendered by an individual living in the residence does not constitute an "in-home visit". Maintain the exemption of live in caregivers from electronic visit verification (evv).

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- Live in caregivers and EOR's put up with so much. This is one of many scenarios: They receive two scheduled visits (scheduled at the convenience of the service facilitator and the case managers) twice a month where the Service Facilitators and the Case Managers are often no shows, are late sometimes by an hour, or cancel at last minute. So, the planned meetings are rescheduled at the convenience of the service facilitators and the case managers. The live ins and EOR's may as well of had four meetings, because the live ins and the EOR's planned and got ready four times. Another fun one is when the service facilitator or case manager never schedules, shows up out of the blue and expects you to be there. When you are not there, they write you down as a "no show". Both service facilitators and case managers will LIE about a EOR or live in just to get themselves off the hook as in the above scenario where they wrote the live in and EOR down as "no shows". Then, they have the live in and EOR sign on a tablet at the meetings they finally arrive at for God knows what because you don't get a copy and they don't tell you what you are signing, so you are probably signing that you were a "no show" and don't even know it. Then, your case managers and service facilitators are constantly (6 months or less) having turnover, so the fun learning curve begins all over again and some of the people they hire (by their unprofessional ways) make you wonder how they passed the background check. Please don't add more of a burden to EOR's and live in caregivers by forcing them to say they visited THEIR OWN HOME....just try getting the SF and CM to respect the live in caregivers and EOR's at little more...that will go much further than EVV for a live in caregiver.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------------ Many folks do not put apps on their phones at all because of how invasive they tend to be (not matter what data mgmt. "claim" they do or do not do). All of these systems bring into question data security during transmission and storage of information. Who has access to the data regarding our whereabouts? What are they doing with that data? Have there been breaches in the past (the Centers for Medicare & Medicaid Services - CMS - reported that a single hack compromised the personal information of 3.1 million individuals)? Protect persons with disabilities privacy and maintain EVV exemption.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------------- Several times and with several people I know of, a caseworker or service facilitator doesn’t put in the plan for services in a timely manner and services lapse. They usually get back dated (sometimes for upwards of 2 months waiting on a pay check). With evv, how will this work? You can’t send the time through the payee system until DMAS approves the hours cause they will just be permanently rejected. This program is difficult enough for live in caregivers not getting paid for months at a time not to have to burden them with EVV too. Please continue to exempt live in caregivers from EVV.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------- Tried EVV. Hated it. One annoying app. issue among many was when assisting attendant with logging out on app. Went through whole process, hit ok, end, etc.. like we always did. The next day? Still logged in. Made no sense because we know how to log out. So we had to continually adjust. Just a sample of many annoying app issues.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------------- CMS/fed govt does not require EVV for live ins, because they know it would be a burden to live ins. In their impact statements, Virginia said they would not require more then the federal guidelines stated. By attempting to force Live Ins to do EVV, DMAS is not following this statement. Please maintain live in caregivers exemption from Electronic Visit Verification (EVV).

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------------- Many folks receiving community based care,where dmas is attempting to force EVV on live in caregivers, pay a good portion of their own funds towards their care. It is called "patient pay". These folks deserve a say in how the program affects them. If you are a care recipient in this program, you know that EVV will cause a shortage in live in caregivers, and for many that means going back into institutions. That is a deadly quandary for a care recipient. Why would dmas, knowing this, force something unnecessary on the disabled that would erode the community based program? It is without any reason, so there must be other intentions that ignore the costs to the care recipient, ignore the care recipients' financial contributions, ignore the care recipients' input, and ignore the cost to the taxpayer (community based care is least expensive care option for the state). Kickbacks, bribes, EVV vendors push for more clientele, profiting off filling up institutions, etc?? One wonders.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------- The federal Center for Medicaid Services (CMS) allows Live Ins to be exempted from EVV and other states have done so. Mainly because they know the burden EVV puts on a live in provider. LIve ins ARE NOT VISITING.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change.------------------------ We were flagged by EVV and had to resort to the portal to gain sanity. We were told the app would work anywhere, because attendants all have their own passwords to log in. However, we discovered this was disinformation. When in another state, the attendant was not able to log in to the app. The attendant had to manually enter all hours upon returning home. All of these manually entered hours were flagged. The EVV requirements appear to be restricting community integration. This is unfair to the waiver recipient as Dmas has stated that too many flags could result in a a loss of services. This does not seem to be in compliance with the Olmstead Act. Why was this misinformation put out there in the first place?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Forcing a live in caregiver to use EVV is like asking a policeman or fireman on the job 24 hours a day to punch the clock at arbitrary times. Wait a minute, policemen and firemen are salaried, well paid, get overtime, get vacations, and get breaks! Well, let's just say for hypothetical sake they were working 24 hours a day and we asked them to punch a clock at certain times. Due to their unscheduled, impromptu, erratic emergencies, it would be impossible. Welcome to the world of a family caregiver just trying to survive and you want them to do what?

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Family caregivers receive abuse and neglect every day. They are neglected in that the majority receive no benefits (NONE). They are abused in that on any given day, they can be spit at, defacated on, or hit repeatedly by those receiving their care. It is a thankless job. Even so, they know caring matters most in life. EVV for live ins will add mental abuse to the abuse/neglect family caregivers already receive. EVV tells live in caregivers they are worthless, and deserve to be tracked like criminals. EVV will end up making the national caregiver crisis worse by turning a thankless job into a loathsome job.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------- EVV in all waiver families' homes is a big pay day for evv lobbyists and those being paid by EVV lobbyists. No Thanks.

Remove under Item #291 harming the disabled: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------- The Electronic Verification system was not easy to use. The portal proved to be much easier. My live in attendant devotes her life in to caring for my daughter, and with the attendant being so committed, I have been able to further my education and work a full time job. My attendant is 65 years old, and has a very basic cell phone which made it hard loading the app. With her constantly here, already exceeding the allotted hours, and working “off of the clock”, she often forgot to clock in and out. She also had a hard time with the system being down, and the app was so time consuming taking away from the care she provides that she gives up trying to clock in and out. That in turn would mess up the hours, and cause us to spend more time in fixing the problem. I feel that the portal is sufficient for live ins to keep track of time. I am so thankful that my daughters attendant does care for her, because most people would not tolerate all of the hassle that comes with a job that doesn’t pay well at all. We need to show these caregivers how much they are appreciated, not show them that they need to be tracked and treated like criminals.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------- It appears that family caregivers have been stereotyped as common criminals needing GPS tracking through EVV. The low wages, lack of benefits, sick leave, retirement, workmen's comp., etc...are throw backs to slavery. Workers are expected to drive a client around for no additional reimbursement, and now be tracked like a criminal via evv. Not only are the attendants now tracked, but the clients are tracked as well. Virginia needs to continue to exempt live-in providers and help ease this burden. This isn't stopping fraud; this is making it impossible for the state and consumers to utilize the lowest cost service and treating the family caregiver like slaves and criminals.

Remove language forcing disabled into institutions and costing taxpayers more under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------------- If EVV for live in caregivers is enacted, we will be tied to a GPS tracker in order to claim hours we provide care. the hours are not accurate as we provide 24 hour care (but paid for much less). Medicaid is working to decrease money spent on caregiving by forcing a faulty device like evv on live in caregivers. They think they are saving money because of this, and that is the ultimate goal. Sadly, this is the cheapest care program available, so in the long run, when this program is gone, the state will spend more tax dollars to pay institutions for all care-giving. It is also nearly impossible to find a new caregiver that wants to adhere to this ridiculous program.

Please remove the below under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ If EVV is forced on live ins, my client is likely to end up either with a higher cost service plan or in a high cost group home (more expense for the taxpayer), because evv is very time consuming and screws up everyone's time and pay...it is sad Virginia does not want to maintain the exemption for live ins. I don't know why Virginia wants to shut down the lowest cost services.

Remove detrimental language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----------------------------- We have had difficulty with the evv app and switched to the portal. Half the time my attendant couldn't punch out or stop the clock, the other half the time, he couldn't get it to start. It never picked up the location correctly, inside the house it read service location unknown, but if you walked to the neighbors driveway, it will pick up. This caused a lot of stress when we were trying to clock him out in time, or was 30 minutes of wasted time trying to get it to work. I am not sure I understand how this is an improvement over the portal which has always worked well. Thank you.

Please remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------- EVV for live ins is going against ADA law by not providing unfettered access to the community! It also infringes on the rights of consumers and attendants. It's also a HIPPA violation. Please, do not force that cumbersome tech on live in individuals - they have it hard enough.

Remove language under Item #291 (harms persons with disabilities) REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------- I can understand clocking in and out of a normal job with a regular time clock (not evv which is faulty), but caretaking of people with special needs is especially taxing, and adding the burden of entering time worked in to EVV for live ins is a stress that live in attendants really do not need. In addition, the amount of time spent trying to adjudicate everyone's problems with the EVV app must be incredibly expensive to the State. The question is, why are we doing this? Does EVV really cut down on fraud for live ins (they live there which has to be proven any time upon request)? It just makes the lives of the people with disabilities and their caretakers that much harder.

Remove hindering language for the disabled under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."-------------------------- CMS (fed govt) exempts live in caregivers from EVV, and since 2020, Virginia has exempted live ins and said they would never go above CMS guidelines. However, now, after many attempts to stymie LRI's, Virginia is suddenly attempting not to exempt live ins . This is a drag net of which not just LRI's are affected; many persons that have made this program a success for over 20 years are being attacked too with forcing EVV on live in caregivers. VIRGINIA, PLEASE, DON'T THROW THE BABY OUT WITH THE BATH WATER. THIS IS NOT THE WAY AND WILL END UP COSTING THE TAXPAYERS MORE IN INSTITUTION COSTS WHEN EVV erodes further what was a great and most affordable form of care for the state.

Remove crippling language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------- DMAS says, "Person centered planning requires really listening to the person" DMAS is not practicing what they preach. No one wants their daily lives and their habits tracked with EVV. No one. To have live-ins do evv, is essentially having their lives tracked. It is an invasion of privacy. Live-ins do not visit. Their job is 24 hours a day and yet they are given a set of hours to clock in and out. It is nearly impossible to clock in and out at set times when a person is providing 24 hours care. The clock becomes more important than the person cared for. The state is making a live-ins's job so difficult, that they may be forced to quit. Institutionalization will be the ONLY option at that point. With the majority of live-ins receiving two in-home visits per month and countless ongoing evaluations, how much oversight and expense is enough (yes, EVV costs the taxpayer)? EVV has created unnecessary burdens and additional bureaucracy just to clock in and out. This is not a simple clock in and out procedure. There is always some difficulty with EVV which can be attested to simply by using a search engine and reading complaints readily available. State officials have been contacted was well concerning this cumbersome, burdensome process.The waiver program was put into place to allow independence and community access to persons with disabilities. EVV is a hindrance to partaking and enjoying community access. Do not say they can go anywhere with the app and clock in and out! When folks are stuck at home, because they dealing with the app., the bureaucracy, and fallout EVV causes, they are NOT in the community! Crippling the disabled by making it more difficult to maneuver their daily lives is not an option.

Please remove wrong language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."'"" I'm a mother. I participate in community directed services , evv for live ins is a nightmare, you are subject to penalty when the app or global internet is not working, my area has poor internet service, I had to discontinue verizon and my phone service to afford cox for reliable internet ,it cost more and still the app often times isnt working appropriately, it doesn't allow for corrections or it's own errors of not being able to pick up signals via the internet, the failure to recognize that the internet global communications is not a direct landline but signals by air wave to satellite and towers is weakness. Not every locality has a tower near by and weather and global positioning also affects the GPS tracking systems, we have had to purchase a cell phone and pay for cell phone service costing yet more money for use of data, data plans are expensive I have tried diligently to comply.. The tracking device wants an explanation of why I'm in my bedroom and not living room.. Entries for hours worked are often dropped by app or not picked up. Attendants are being blamed, Attendants are paid not on time and or not at all. a trip to the little gym is a nightmare explaining why we are not home. 1 minute past allowable 8 hours, is a day without pay, Forcing the disabled and handicapped to participate in this program is penalty to this population. it doesnt prevent fraud, but causes more problems for the populations and recipients of services. it already is tough getting help with no benefits at all. the Rights of live in caregivers need to be preserved and advocated for. I say to you at what cost do we have to continue to be treated like second class citizens? And at what cost would you yourself like to be tracked and have yourself answer for your every move. anyone can but in a entry and anyone can still commit fraud , this is a possibility. For a few who did such a thing should we all be held accountable for their crime? the evv is nothing more than a good talking point and with all the troubles I have experienced, institutions are now a consideration. we are tired and beaten up and loosing the community directed objective , no one cares and shifting values and objectives have caused this population more harm than good. A,gps tracker and a app isn't a prevention program, but puts more stress on a already stressed population and its caregivers.

Remove verbage under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--------------- evv is going to contribute to the shortage of care providers. Please continue to exempt live in providers so my loved one doesn't end up in a nursing home to suffer a miserable existence.

Remove language under Item #291 making a disabled person's life and needs second to a clock: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." xxxxxxxxxx Live in aides and parents should remain exempt from EVV. This system was designed for an aide who comes and goes each day at certain times, not for an aide who lives with the person being cared for and is available 24 hours a days for any need. The disabled person has needs that do not happen on a clock and must come before the nuisance and burden of making a call and answering multiple questions to clock in/out or waiting on a cell phone to come on and an app to load and checking multiple boxes just to clock in and clock out.

Remove language putting the disableds' lives in danger under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Why put the health and safety of a disabled person in jeopardy, so a live in aide can clock in/out, so they don't get a red flag? The system is severely flawed and punishes a disabled person for being disabled and needing help. Instead of encouraging and removing barriers so the disabled can thrive, this system is trapping them at home, tracking their movements and threatening their health and safety. Why threaten a disabled person's Medicaid status, because of an arbitrary system of red flags?

Remove the language under Item #291 that will force those with disabilities back into institutions *******REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."************** I care for my friend's child with disabilities. My home is now the child's home and they are treated just like family. Evv will turn my family's life into an episode of the Twilight Zone. Imagine the Walton's having to clock in and out for one child every day many times per day. That is what is going to happen to families when EVV is forced on live in caregivers: The Walton's meet The Twilight Zone. I thought the most trouble would come from dealing with a disability or from the countless in home visits by agencies and the many evaluations and meetings! We are considering the unimaginable: of letting this child go into the system! DMAS is simply "changing the channel" when it comes to the needs of this child.

Remove the harmful language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." EVV is a burden for live in caregivers. Please do not for this on them especially when it is not required or needed. For the small amount of time where I tried EVV, here is what happens when using: The app burns the phone battery quicker. One of my child's attendants logged out at the end of the shift ,but it kept running after the attendants left. The next day, the attendant saw the shift completely screwed up and had to correct it manually. This was a system error. We went on vacation with an attendant but had no wifi and thought we were able to enter the time manually at a later date. But, we were told too many manual entries could cause my child to lose services. What else is one to do if there is no wifi? The attendant's phone broke and this person could not use evv for several days. It is harder to keep track of the hours to make sure you do not go over. It definitely is complicating things for people with disabilities.

Remove under Item #291 and continue to exempt live in caregivers from EVV just as the federal government has exempted them because they know the burden EVV will cause live in caregivers-------------------- REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."------------------------ It is sad that DMAS is trying to force EVV on live in providers. Asking them if their job started and ended in the same place?! They live at their jobs. Their job never ends. Their jobs are 24 hours availability (even though they are not reimbursed for 24 hours). Their homes are provided to someone with disabilities at the lowest cost and least responsibility to the state. Stop the nonsense and continue to exempt live in providers just as the federal government through CMS has exempted live in providers because they understand the burden EVV would be for a live in.

Remove language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change The EVV system is flawed and poorly put together. I have used 4 different browsers and had problems with them all. You login and the screen sits blank/white. This happened repeatedly. I was advised by payroll to utilize Mozilla, which I hate. It worked a couple of cycles, and then began having issues. The system did not save my brother as consumer/recipient of services, nor either of the caregivers/providers. That took multiple calls, when no one was answering the phones. Multiple complaints were filed by email, which most concerns were not addressed. If you can't provide consumers with a browser friendly program - it should not be utilized! Caregivers who are not computer saavy, nor adequately trained struggled to learn the system. When an error is made, it is not easy to fix, to which that burden usually falls back on the EOR who is unpaid. Now any other entity that pulled this would have the labor board investigating. If a caregiver has to log in to register missed time - the drop down list is extremely limited. Why can't they type in their own reason for why they were not able to log the time? So, in order to get paid, they must choose from a drop down list that may not apply. But if you want to get paid, you must pick one, all by repeatedly being reminded of "fraud"!!! My brother has a caregiver for respite. He is allotted certain hours. So if that caregiver is kind enough to take him out of town for the weekend, logging in ONLY the hours assigned - yet has him out of town, how the heck is he supposed to sign in/out from home? There is NO option on any list for that. EVV says they are not monitoring location - well then they shouldn't need access to phone locations, NOR designate them. How about when you call in - the phone system option - and the system does not recognize your number, or cuts you off - there's a whole list with that as well. Then there are the caregivers! One of my caregivers stated, "it's getting so it's not worth it anymore." With what is paid to these folks - it's no wonder good help is hard to find, Talking about policing - what about those on welfare/food stamps? What's in place to monitor them? NOTHING! But an individual who is DD, will not recover, is not a result of a choice they made, yet need to be monitored. THAT IS our government trying to find reasons to not provide services to our mentally handicapped. it is unacceptable to make the DD guinea pigs!!!

Remove paragraph under Item #291 and help save community based services: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----- Virginia should continue to exempt live in providers from electronic visit verification. People are saying that because of evv their attendants are not getting paid. Good attendants are being lost and our loved ones will end up in crowded, highest cost, state run facilities. Please stop this from happening. Please let the governor know what is going on.

Remove language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - - - - Why make the majority of good people feel underappreciated? The state is fortunate there are nice people that care and will put up with the intimidation. The evv threats for live ins are going to chase away all those that have self respect and would rather not be treated as criminals.

Remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." This is from a friend who has visiting attendants for her family. Our family uses live in and the following situation would be unbearable for a live in: "EVV is like slow and painful torture. The systems keep being tweaked, so it is hard to keep track of how it operates. We are constantly having to phone to fix things and when we do as instructed the attendant is still not paid for many weeks. With the old system, the attendant entered info once a week and the Employer of Record (EOR) approved once a week. With this EVV system the attendant must do 10 entries (as opposed to 1) and the EOR must do 5 (as opposed to 1). What good is a system that does not work? Why are we fixing something that isn’t broken? People are loosing attendants and it is already so difficult to find good people! Pretty soon there will be very few services available for the Virginia Medicaid Waiver. The Independent Auditor needs to know that even though services are listed as available, they are really not available (few providers or sponsoring agencies). EVV disables the disabled."

Remove words under Item #291, so we can keep our adult child home. REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." 1) when hiring a visiting caregiver, EVV Often malfunctions causing caregiver to not receive pay on a regular basis. Often times not being payed at all. 2) after exhausted search to locate a caregiver, the Caregiver moves on to another job because of pay issues with EVV. 3) elderly live in parents getting injured having to care for their adult disabled child 24 hours a day with no help. 4.) Add the cherry on top: EVV for live ins and it is a nursing home as the only option.

Remove language under Item #291, so that I don't lose my live in caregiver. REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I hire attendants I have visiting attendants and I also have a live in. My selection for attendants is becoming smaller and smaller due to evv. No one wants this on their phones. I may be relying completely on the live in at some point and need the relief of exempting live ins, so the participant can stay out of a nursing home. The Cures Act was supposed to help drug addicts, not harm people with disabilities. Right now, live ins are easily listed/notated with the SF and FA hired by DMAS and should continue to remain exempt. I don't know how I am going to keep the participant out of a nursing home if they force evv on the live in.

Remove language under Item #291 harming people with disabilities: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I cannot take much more of the EOR duties and evv for live ins will make it worse. It is just too much for a non paying job. Finding qualified help for $13 an hour is beyond difficult, especially if you live in a rural area. The live in attendants do not always get paid for their work. Numerous calls and emails to payroll go unanswered, take weeks to answer, or they leave you hanging by acting as if their hands are tied and referencing their IT is in a foreign country. My services facilitator acknowledged that a lot of people have often not been paid, and there are so many issues with evv that prevent it form working correctly.

Remove language under Item #291 that punishes the disabled: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." If evv is forced on live in caregivers, we will have to spend time away from those who need care in order to manage this system that doesn't work. My disabled roommate's live in caregiver isn't comfortable putting the app on their phone. I don't blame them! My nonverbal roommate "consumer/participant" doesn't use a phone, so we will have to buy one. The only time we will use it is for evv. We will have to constantly monitor it to make sure the battery is charged and we are keeping up with data requirements and updates. That might not seem like much, but in my life with a business to run and my roommate's life as a live caregiver, every second counts. i hear the app rarely works, so we will be taking time away from our roommate to try to get the live in attendant signed in or out. If it isn't correct, it will take my volunteer time on the portal or phone to correct it. Our attendant roommate won't get paid for the time they are trying to sign in. It is not like an office where you can come in and grab a cup of coffee, see what's going on with your boss, and organize your desk before starting a project. Our attendant LIVES HERE and is ALWAYS ON DUTY. Yet, they are supposed to ignore important needs/emergencies to manage this faulty evv system. i understand the system shorts time as well. Everything about this is designed to punish the disabled and the people who work and VOLUNTEER hard, for little or NO pay, to take care of them. We will lose them to an institution. Then, everyone will lose.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Already know of people places in nursing homes because she of evv... it is too complicated and costly for the low skilled low paid workers to follow through with.

Remove language under Item #291 causing live ins to be subject to impossible apps: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I am a live in mother/caregiver of a person with special needs and there is no room for electronic visit verification in our busy lives. I have tried it out, and this evv cell phone app was a nightmare. I had to mark on , mark off every day even though I watch my child 24 hours a day. I was constantly setting alarms to make sure I mark on and off. . In-home caregivers need to stay exempt as they are now. Thank goodness they are exempt and have a portal which works to mark time. I once had to pull over on the side of the road to complete the long app from Consumer Direct. I would like my son to have another visiting attendant but the mark on/mark off on the exact minute is so difficult that we have not been able to hire anyone. Thank you for your time.

Remove under Item #291 language that harms VA families: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." families don't need evv. iving with a disability means dealing with constant paperwork, never ending meetings, several government agencies, and having to sit through a litany of endless evaluations. this is on top of a disability. how many folks will not be able to manage the additional burden of evv? disabled families don't tend to live by a clock. they are just struggling to live. please exempt families from this burden. they don't visit

Remove language under Item #291 calling for tracking of disabled at a higher degree than sex offenders: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."- - - Is anyone aware that one of the apps being used for consumer directed EVV is telling people their tokens have expired? That is how messed up this is...1. federal government does not require gps location; only a note the service is taking place at home or in the community.....2. Live-ins can are exempt by the Federal Government and they are already identified by the fiscal agents … 3. Why is it ok to track people with disabilities to a higher degree than sex offenders?

Remove culling the herd language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----- Thanks for nothing DMAS. Live in Caregivers work with people, not computers. Thanks for trying to make the their job a lot harder by attempting to remove the EVV exception for live ins. Live ins do not visit and the middle name of EVV is "visit". Why? To remove the newest live ins, LRI's? To cull the herd? This is not making any sense unless there are other motives. Please, do not remove the exemption of EVV for live in caregivers that was established in 2020.

Remove language forcing needless tech on the disabled under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - - - There are enough problems with the portal. It is too hard to handle a disability along with trying to manage EVV. The app is too hard to work with. Please continue exempt live ins from this burdensome process.

Remove language causing the loss of volunteer EOR's for the disabled under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." We are losing our volunteer EOR over EVV for live ins. The EOR is already upset because the irs will only allow one EIN per sole proprietor and the EIN is connected to both the business and the care giving. They are afraid their volunteering their time and social sec. # to be EOR for the state's benefit will look like they have a domestic employee and this could increase their business liability insurance. Once the payroll agency didn't do their job and the state came after our volunteer EOR (the payroll agency and EOR share a role); it took all we had to get the EOR to stay after that incident. The EOR is doing a great volunteer service and without them, we will have to resort to an institution. *****Please stop stating that the volunteer EOR use their phones or their communication devices for this crazy EVV and app. It will be the nail in the coffin for our volunteer EOR to quit volunteering their time and the person cared for could end up in an institution. The state can only ask so much from a volunteer.

Remove language damaging to lives of the disabled under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Evv for live-ins is dreadful! When we first signed on a live-in, we used EVV, but quickly had to resort to the portal to get reprieve and clarity to record hours properly. With EVV, the live in had to clock in and out in our own home six times a day. Every day revolved around alarm clocks going off, making sure gadgets were charged and working, etc... so that the live in didn't miss certain times (it is easy to miss times, because the live in works around the clock, their tiny breaks are unpredictable, and their minds and hands are very occupied all the time - it is like asking a cop, nurse or doctor to clock in and out when they are already at their jobs working). I get nauseated thinking that my child and his live in caregiver will be put through this the rest of their life just to get disability assistance.

Remove language under Item #291 harming VA taxpayers and the disabled: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." This is important because EVV is NOT FREE. Oh, they didn't tell you about the cost to the taxpayers and the profits of the EVV vendors for forcing EVV on live in caregivers (WHO DO NOT VISIT - THEY LIVE IN THE HOME - LITTLE PROOF TO BE GAINED HERE)? How about the millions in savings that taxpayers reap every day that community based care (live-in caregivers) is utilized over agency based care such as nursing homes and group homes? How about the loss of Community based care due to EVV and how this will hurt the VA taxpayer? They didn't tell you? Check your sources, check who is profiting, ask questions, get answers and realize you are not only harming the disabled, you are harming Virginia taxpayers when you enact the above language!

Remove language treating the disabled like criminals under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Isn't there enough on people that are disabled and the live-in attendants caring for them without having extra burdens placed on them such as this restrictive, socialistic evv? It is damaging to the disabled community. What kind of law is this attacking the disabled as if they are criminals? Live in attendants must have strict background checks, so they are not criminals. This is not helping the disabled community, but it is creating more chaos. WE ARE NOT CRIMINALS.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I don't want to ever be in an institution. evv is very time consuming. it makes it difficult to hire live in attendants.

Remove language under Item #291 that will diminish community support staff for those with disabilities: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." This is important because Virginia does not have enough community services staff and they will be limiting their staffing pool with EVV for live-ins. The income is $13.88 per hour with no benefits. Many are weighing the cost/benefit and realizing the job is not worth it. Many live-in attendants don't know how to use a smart device, so they go to jobs where they don't have to use one. Some clients can't get the free Medicaid phone, because they don't have a credit history. Live-in attendants will be asked to make phone purchases just to clock in and out (with visits when they don't visit )which is lowering the staffing pool even more. Asking a live-in attendant to download an app. onto their personal phones is asking them to pay for clocking in especially if they don't currently own a smart device with GPS tracking. The live in attendant, due to not wanting to give up their own phone's privacy with a app, will have to purchase a separate smart device just to clock in. Currently, the redeeming qualities of the job do not add up, and with EVV for live-ins, the community services staff will continue to diminish. Please don't let this happen to people with disabilities.

Please remove discriminatory language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---- This is important to me because EVV for live-ins flies in the face of laws on the books to give those with disabilities rights. Not to mention, it is singling out a class of people and imposing rules and regulations that other classes of people with government jobs and those receiving government benefits do not have to adhere to. Food stamps, welfare, government employees, gov't officials, and many more - do they have to be monitored? NO!!! Community care and activities are supposed to be an option for the developmentally disabled - EVV for live-ins has more problems than anyone should have to deal with, let alone someone the is already struggling with a disability. It's time to investigate challenges to this concept, since we live in America. So to our government - we should require monitoring for all government funded programs OR not single out one group. It is the EXACT definition of DISCRIMINATION!!!! Thank you.

Remove under Item #291 - language harmful to the disabled: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Live ins work more hours than they are paid. They are making $13.88 an hour with no benefits. Live ins are available 24 hours/day, but do not receive 24 hour payment. Live ins provide a home for those they care for. Who is being ripped off here? The live ins or the state? The state doesn't even have responsibility of being employer of record. Evv tracking of live ins is a control tactic with no substantial statistics to enact it (controlling when not the employer is also borderline illegal). What if all populations were treated in such a stereotypical manner? NCIL (National Council on Independent Living) has statistics stating the fraud level in the Consumer Directed program is very low. Why is the state stereotyping everyone in the program and not paying attention to who is REALLY being ripped off?

Remove words harmful to the disabled under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Why do the disabled need 5 agencies overseeing this program? Now, you want to add Electronic VISIT Verification for live in caregivers that DON'T visit? This is oversight overkill. Please, give us a life worth living, and make the changes necessary to give us our independence back. At least give us a choice in the matter. No one wants to live like this and no one wants to go back to institutions. Thank you.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - This is important to me because Live ins do not visit - exempt family members from EVV. Exempt family members that live together from having to watch a clock instead of caring for their loved ones. Thank you.

Remove the language under Item #291 and help those with disabilities: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." The EVV was implemented to prevent fraud, but it does not capture the extra hours that are worked to care for the disabled by live ins. If the hours are authorized as necessary, and a live in care provider can only record those hours on a timesheet and no more , the EVV does not serve a purpose. Because live in caregivers are available 24 hours a day, the time they provide care varies from one day to the next and one hour to the next. It just does not make sense to clock-in and clock-out... Some nights I get woken twice because the client can’t breathe, so needs a breathing treatment or his water spilt and there is nver pay for overnight. Because a set number of hours are authorized, the consumer should just confirm that their care has been provided they way it is now with the portal. The EVV is not appropriate for live-in care providers. Please maintain the evv exemption for live in caregivers.

Please remove language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--- I see EVV for live ins as an unnecessary step due to the facts that 1. the approved hours are never paid out over the approved hours with the fail-safes that payroll has in place 2. a person's life does not always run on a regimented schedule. At least 95% of live in caregivers already work over the approved hours without pay, so Medicaid is already "getting their money's worth" of the live in caregivers. EVV takes time and many individuals with disabilities require the attention and hands on. With the EVV app, the attendants have to type in names (even though the attendant/EOR/consumer are already identified), get signatures, sign at each shift, select start/stop, turn the app on/sign in/ then turn the location services off because the app keeps following many people wearing down batteries, etc.... EVV leaves everyone at risk for hacking and this is just one more possible door for individuals information/schedule/personal details to be invaded by others. Family/live-in caregivers should not be signing in and out when they live with the individual. This should be considered as a right for the family to live their life, their way....without having to check in and out with an app. They have been successfully entering their times in through the web-portal. Again, they don't get paid more than the time they are authorized, but they are working more than the authorized hours unpaid. Maybe we can consider EVV for live-in if we raise the hourly rate to $25.00 an hour? Then, it might be more worth the time as that is what babysitters make these days-and they don't have to use an app? (Trying to hold the frustration back is not very easy).

Remove wording under Item #291 here: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." 0 0 EVV for live ins is not "a life like yours" for families managing a disability. Do you needlessly anguish over a clock constantly all day and night in your own home? Do you have to set alarms around your house to remind you to push a button at arbitrarily set times (because you live there and don't visit)? Are you GPS tracked in your own home and community by several agencies? Do you often deal with payroll and tech support, that rarely answer, due to a faulty app necessary just to punch a clock? If you punch a clock, do you have to answer several questions each time you do clock in/out? Do you anguish over whether your family member will end up in an institution, because you couldn't live up to impossible standards, were framed due to app. issues, or couldn't accept being GPS tracked? Do you have to buy (on $13.88 an hour with no benefits) an all new separate phone/device with GPS capability and paid service just to keep your personal phone or device from losing all privacy? If you do, then you have a life like mine, but I do not have a life most Americans would want to live (this is without even considering the disability). I don't have "a life like yours".

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." ----- Caregiving has always been a field where the kindness of another is exploited by offering no benefits for a very difficult job. It is assumed, the caregiver won't speak up for better standards because they are nice, caring people. EVV has added to that exploitation by taking away any dignity left in consumer directed services jobs for family caregivers. How dignified is it to ask someone who is living in the same home as the person they care for to prove that several times a day with a GPS tracking device like a common criminal on house arrest? As if mutual location is not already proven by the many public records available. Family caregivers will eventually be forced to give up to preserve their privacy and dignity. Possibly that is the intention of the state: to have the caregivers give up, thus forcing the disabled back into institutions.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Consumer Direct Services are the most affordable services for the state - EVV for live ins will deplete CD svcs. That's right. The most affordable services for the state are consumer direct services. EVV for live ins will turn the difficult job of consumer direct services into a repulsive job. NO one will want to do the job, and everyone that is living with a disability will be right back in institutions. Virginia, work on fixing this now, maintain the exemption for live in caregivers, before there is no return.

Save families with disabilities a lot of grief and remove under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." We used the EVV app. for a short period. It was a nightmare. Many days the app didn't work. When it did work, it was difficult and cumbersome to use. The expectation that the live in caregiver, has to clock in and out multiple times per day to record "shifts" is ridiculous. They can only record a max of 8 hours per day. Do you have any idea how difficult it was to get the app to record 8 hours exactly? Impossible. If he records 8 hours and 1 minute, he is in violation of the service authorization. However, if he adjusts the time to 8 hours even using the portal, he is in violation of EVV and has to explain the "error" by choosing one of several drop down options which place blame on the caregiver. There is no option to say that the app doesn't match the service authorization or that the app is difficult to use. Also, when I fixed another "error", I received an email from payroll telling me that if there are too many corrections, we run the risk of either losing services or requiring re-education. I know how to record 8 hours/day -- had NO trouble when using the portal. The app is the problem and makes us appear to be non-complaint. AND,, if the app recorded 8.01 or 8.03 hours/day, at the end of the 2 week period that sum exceeded 112 hours (regardless of how small an overage), then an entire shift was not paid. In the last example, the sum was 112.32 hours (sum of minor overages for each day totaling 19 minutes, that is 1.9 minutes per day over) so payroll did not pay the caregiver for a full 8 hour shift. The system is not even smart enough to recognize minor overages. But payroll rounds hours on the portal but not on the app -- so guess what? More challenge in trying to figure out what hours have been recorded. Recently, caregiver recorded 3 shifts; app showed 8 hours on the phone. BUT, portal showed 8.25 because the portal rounded the hours in each individual shift causing an overrun in error. There is no need for this insanity. Let live-in providers use the portal. It takes 5 minutes to enter a days time. EVV is causing problem that never existed and I can't imagine there is any benefit to it at all.

Please remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." VA needs to exempt Live in aides from having to use EVV. GPS tracking treats individuals with disabilities as 2nd Class Citizens who don't warrant protection and privacy. The APPS that aides will be required to use are full of glitches and many times do not work correctly. Live in aides are going to have to edit times all of the time Each time there has to be a manual edit, there will be a message threatening services for the disabled. EVV threatens decades of the work to create a more independent life for individuals with disabilities. The Federal mandates in the 21st Century Cures act can be met by utilizing the system that was already in place (web portal and print time sheets) and added a space within each of those to indicate location of services. There are already several forms of oversight put into place for these services. EVV is a needless burden to families and attendants.

Remove under Item #291 the words: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." ----I retired to handle our disabled child. With mental and physical disabilities and aggression, it’s all we could do (nothing else worked). I am with him almost every moment except when he is in a special school or a man from church takes him once a month on the weekends. There is no such thing as checking in and out for me except for those two situations. Please exempt live in’s. It’s hard enough.

Remove under Item #291 language: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." EVV needs another V for vampire (time vampire). Family caregivers have very little and very unpredictable free time as it is. Between having to diplomatically handle all the issues/problems evv will cause with payroll to having us time in and time out over and over even when we live at the location and each and every time in & out, answer questions. it is just a failure on a grand scale. Thank you for your time (said the vampire)!

Respectfully, please remove wording under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." There is no place like home. Don't take home away for many. The only option if evv does not work is a nursing home. Stop evv for live ins. Keep the live in exemption the way it is. Thank you.

Remove language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." As a Virginia Support Coordinator I have heard nothing but difficulties with staffing and care since the inception of EVV. It would only get worse forcing this on live in caregivers. We have several areas of the county that does not have internet and this creates difficulty for staff to call in. Also, some families have had their care staff resign because they only can afford a trak phone and this is incompatible to the system. We have heard that this new system is creating much more burdens on the care of their loved one. Please reconsider having this requirement for live ins.

Remove under Item #291 and help my disability REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Plese don't force ebv on my care person. It is hard to use and I can't find peopel to help me as much anymore. some one is living with me but is going to leave if ebv device must be used.

Remove this language detrimental to those with disabilities under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - - - - - - - Federal Mandate says not to cause a burden to disabled- EVV causes a burden to live ins and the disabled. One does not have to go far or listen too hard to understand that EVV, especially for live-ins, is a burden and a failure. Federal mandate requires that EVV not be a burden. The system in place before was working. Live in caregivers were allowed to submit their hours when they had a minute available. A minute available is rare for a live-in especially when the care can go from monotony to emergency in the blink of an eye! They do not have time to answer questions every single time they sign on and clock in/out on a troublesome app. with an arbitrary set of hours (live-ins work much more than hours assigned).

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - - People with disabilities, cannot hire caregivers because the pay is to low. EVV makes things more difficult to get attendants, because the landline and the App doesn't always work. As a result, disabled individuals will be forced to live in nursing homes violating our ADA rights to live in the least restrictive environment.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." OUR son is severe disable. Autistic and Non verbal, he can be severe aggressive. He loves iPhones. The live in attendant can not use iPhone in front of him, otherwise he will have behaviors. EVV is a big obstacle to find new attendants, to track the specific time of services in front of him, specially if the app is not working or there are other problems with the system. I'm trying to understand why somebody would like to work for my son for 13.88, without any benefits and get bitten for using an iPhone? why anyone would work for a disabled individual AND EVV? You are failing us.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."--- "No more turning away from the weak and the weary" - listen to the disabled crying out against EVV When you do not listen to hundreds of the disabled crying out for EVV for live-ins to be struck down, you are turning away. Pink Floyd said it best: On the turning away, from the pale and downtrodden and the words they say which we won't understand. Don't accept that what's happening is just a case of others' suffering or you'll find that your're joining in the the turning away. It's a sin that somehow, light is changing to shadow and casting it's shroud over all we have known. Unaware how the ranks have grown. *****Driven on by a heard of stone. We could find that we're all alone in the dream of the proud. On the wings of the night as the daytime is stirring, where the SPEECHLESS unite in a silent accord. Using words you will find are strange and mesmerized as they light the flame. Feel the new wind of change on the wings of the night. NO MORE TURNING AWAY FROM THE WEAK AND THE WEARY NO MORE TURNING AWAY FROM THE COLDNESS INSIDE. Just a world that we all must share. It's not enough just to stand and stare. Is it only a dream that there'll be no more turning away??

(Please) Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - This is important to me because with one swipe of the pen, you can damage a lot of disabled people's lives. Don't put my son's services in jeopardy over forcing live ins to clock in and out constantly. I should not have to clock in and out, in my own home, to care for my delicate and infirm son. His services should not be held ransom in order to force this on me as well.

Remove under Item #291 (please) REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change.">>>>>>> Thank you for the opportunity to comment. I have a large, nonspeaking, non-compliant, combative person on a special diet and, with a live in attendant's help, have to eek out time for me to go to bathroom or shower, for me to eat, or tend to the rest of the my family. I cannot afford to eek out those moments in order to tend to glitches, problems, mysterious issues with the EVV my live in attendant will face if EVV is forced on them. With EVV issues, my attendant will not been paid at times, and we will have to take out a personal loan to pay them out of pocket. THIS IS NAUSEATING TO THINK ABOUT, TORTURE TO THOSE OF US WHO RELY ON LIVE IN ATTENDANT CARE.

Please help the disabled and look under Item #291 and remove this wording: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." *****This is important to me, because I am a live in a caregiver. Visiting caregivers that currently use EVV say EVV is very stressful and one example they give is how the EVV GPS tracking says they are not where they are supposed to be, but they ARE where they are supposed to be. They feel they are being framed. Sometimes they say it says they are 75 miles from the client's home AND they are in the home! It will be torture to force EVV on live ins that are already burdened.

Remove under Item #291 the below harmful phrase: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."----- This is important to me because, I want to fix the health system and not break it. I have been on the Waiver for 15 years. I am ventilator dependent. I have seen a slow decline in the quality of live in nurses that have cared for me. I fear that this EVV system for live ins will continue to scare the good live in nurses away. That is unfair because once the word gets out, care recipients will lose some of the nurses they have and they will have a hard time recruiting new nurses.

Respectfully requesting removal of this paragraph under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - The poor and disabled do not deserve less in basic privacy and protections. There are plenty of privacy concerns raised with EVV and there are many known EVV inaccuracies that could hold the end user responsible. Those who cannot afford more do not deserve less in basic privacy and protections. Just because someone happens to be lower-income, disabled, and on the waiver doesn't mean they should be the ones losing their rights to privacy by being forced to use EVV/GPS to receive care and being used as guinea pigs for the flawed software. This is abuse of the voiceless.

Please remove under Item #291------ REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."<<<< Where are the savings? EVV vendors charge dearly for their services. All agencies (DMAS, services facilitators, payroll, case managers) involved are going to have to be paid to referee all EVV flaws, down times, errors, missed clock ins, additional regulations, clock ins & outs based on real hours worked for a live in, penalization's, unreliability of thousands of personal devices, unreliability of payrolls/evv's hardware and software, etc... The worst part of all, taxpayers will end up paying more for state care when the most affordable form of care is eliminated by EVV and group homes and nursing homes are flooded.

Remove under Item #291 this language REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Live-ins don't visit. maintain exemption of live ins from evv (electronic VISIT verification). *****It is impossible to visit your own home********

Remove under Item #291 this wording: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." ....... My entire family, unfortunately, is disabled: my children, my husband, and myself. My children have live out attendants who help them daily with a variety of learning tasks and one live in attendant. The EVV app is difficult for the live outs to use, tracks their location, makes approval of hours more difficult, uses up a lot of memory on their phones, and just doesn’t work well. In addition, it is absolutely wrong to have my children’s as well as their attendants’ privacy invaded like this. I do not think this is or was ever a good idea. Please don't force this on my live in attendant; they will probably leave.

Remove under Item #291 the following language: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - - The Federal government has already exempted live-ins. Virginia exempted live ins in 2020. Live ins DO NOT VISIT and work much more than their paid hours. There really is no excuse for allowing such invasive technology to enter a live-in's life....NOT VISITS....LIVES. Please maintain live-ins' exemption from EVV!

Remove these words under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." = Four days of work that I approved for my visiting worker disappeared on the timesheet in the app. I had to go back in and answer all the questions and redo all the hours. And I get in trouble for corrections/redos. This is pure insanity; evv is not a simple clock in and out procedure. I am hoping to find a live in worker, but if EVV is forced on them, I never will.

Please, remove burdensome language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - I am a live-in caregiver and when there are emergencies such as toileting accidents or worse in the middle of the night, my job is to care for the person not the clock FIRST. THE PERSON comes FIRST. Getting this person to their specialist appointments on time comes first! Not the clock. All appointments are all out of town as we live rural. It will be a very daunting task trying to schedule around the EVV which does have many glitches. Why is it that the state, insurance, and evv glitches are overlooked and acceptable, but the provider gets the blame and is threatened with not being paid for work that has been done? ! There is a caregiver crisis: don't burden the overburdened with evv, for heaven's sake!

I am respectfully requesting the removal of damaging language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change.".......... We have lost two visiting cna's due to evv. They got paid more elsewhere without having their location tracked by GPS and having to pay an additional cell phone bill for the evv app. to keep their personal phone's privacy and clock in. Now, we are afraid of losing our live in caregiver for the same reason. My family member will likely end up in a group home. That will cost Virginia taxpayers lots more. Why are you leaving the disabled hamstrung?

Please remove this language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." - -> I hear that live in caregivers can be exempt from EVV under the CURES Act and through CMS/Fed gov't. However, Virginia is attempting not to exempt. Let me explain two situations out of many to help you better understand why live ins should be exempted. Live ins are given a small amount of paid hours, but work all the time day and night. First situation: meal preparation gets interrupted twice daily to clock in or out. Visiting caregivers currently using EVV complain about it taking a long time to get clocked in: stiff fingers on the keyboard, an app update needing to be installed before a log-in is even possible, trying to find a place in the house where there is internet, the app not working after several attempts, phone not working, phone battery not charged, etc..... So many meals will be ruined because of the time away from the stove just to to clock in or out (not to mention the danger). The second situation involves travel. We will have to pull off the interstate and highway to clock out at the paid times and then keep working unpaid (not to mention the danger). Ridiculous.

Remove the following communication under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."==================== Why risk losing the taxpayer's most affordable care solution they have.....Community Directed Care....by forcing EVV on non-visiting families who live in the home as live-in caregivers? Community Directed care saves VA taxpayers millions every year versus any other care solution available to the state. Live ins do not visit and are ever present, so what could EVV prove other than live in caregivers over time it every....single...day? When EVV for live ins erodes community directed care and folks end up in nursing homes, Va taxpayers and the disabled will suffer. For what? To prove they live in the home? This is already proven with multiple forms of documentation. Forcing EVV on live in caregivers is over kill and over reach at it's finest and it will backfire miserably.

REMOVE under item #291: The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change. I am a parent/full time caregiver of two adult children with permanent lifelong disabilities and maintaining the EVV exemption for live-in caregivers is important to me because 1)EVV does not add anything to the quality of care or even accountability, since care recipients and families can easily verify that care occurred without EVV. 2)Live-in caregivers must remain available at all times and may be awakened multiple times per night for seizures, medical needs, or elopement. 3)Live-in caregivers are working around the clock far more hours than they are being paid. 4)Requiring these live-in caregivers to use EVV will push many toward institutional care instead.(last resort) CMS already recognizes that EVV is a burden for live-in caregivers and allows for this exemption. Please remove this HARMFUL language from the final Budget. Thank you for supporting our efforts in our Commonwealth. Sincerely, Mari Jacobs Ashburn, VA

The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours for live-in caregivers. This is important to me because I am the live-in caregiver for my disabled daughter. Requiring live-in caregivers to use EVV will impose real harm on people with disabilities and their families and caregivers. Live-in caregivers do not "visit," and the use of a "visit" monitor system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually happens and forces caregivers to log artificial “shifts” that don’t reflect reality. EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks. If there is a need for oversight, care recipients and families can easily verify that care occurred. Live-ins are on call 24/7. Shift workers are not on call and clock out at the end of a shift. Live-ins cannot clock out. It’s unreasonable to expect a live-in caregiver to clock in and out for every issue addressed around the clock. The EVV system was created to track shift-worker attendant time and movement to help prevent fraud. There is no potential fraud component for live-in caregivers. EVV tracks location. The live-in caregiver will be at the location, so there is no point in the location tracking aspect. The task tracking is easily verified by other means. Live-in caregivers are working around the clock far more hours than they are being paid. Live-in caregivers provide care intermittently throughout the day and night Live-in caregivers respond to unpredictable needs such as: seizures, elopement, behavioral crises, toileting, medications, and much more. Overnight and on-call hours are hard to document. Live-in caregivers must remain available at all times and may be awakened multiple times per night for seizures, medical needs, or elopement. Live-in caregivers are tied up with all too common urgencies and emergencies around the clock, day and night. They shouldn't be forced to direct their energy to a time clock and away from the person receiving care. EVV does not add anything to the quality of care or even accountability, since care recipients and families can easily verify that care occurred without EVV. Many live-in caregivers are family members who left paid employment to provide care and save Virginia significant institutional care costs. Requiring these live-in caregivers to use EVV will push many toward institutional care instead. It shows bad faith for Virginia to now remove that exemption, and it will make caregiving feel punitive and distrustful. Requiring live-in caregivers to use electronic visit verification (EVV) would return Virginia to a system it dispensed with for live-in caregivers in 2020. CMS recognizes that EVV is a burden for live-in caregivers and allows this exemption. Please remove this harmful language from the final Budget

Please Remove under Item #291. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." I am a parent/caregiver/person with disabilities and maintaining the EVV exemption for live-in caregivers is important to me because Live-in Caregivers do not "visit," and the use of a "visit" monitor system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually happens and forces caregivers to log false “shifts” that don’t reflect reality and forces care givers to lie on an official government document. EVV is designed for an attendant who “visits” to provide intermittent support. Live-in caregiving is continuous and cannot be chopped up into visit tasks. If there is a need for oversight, care recipients and families can easily verify that care occurred.

Remove language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."................................. I don’t have a smart phone and at my clients home where I live, there is a landline that tends to be spotty in reliability. My client is likely to end up either with a higher cost service plan or in a high cost group home cause evv is very time consuming and messes up everyone’s time and pay especially in situations where access to EVV will only be spotty... it is sad Virginia isn’t taking a stand and supporting live in care providers and people with disabilities. I don’t know why Virginia wants to shut down the lowest cost services by forcing a flawed system like EVV on live in caregivers.

Remove the language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."XOXOXOXOXOXXOXOXOXOXOX Some people with disabilities don't have enough attendants, because $13.88/hr. and no benefits is the lowest paying healthcare job. If we don't have enough staff, the live-in is unpaid for hours worked, and you have no insurance for them. Some of us rely on live in caregivers, because we do not have any natural supports. If you erode Consumer Directed Services by enacting a difficult and flawed program such as EVV on live in caregivers, this violates our ADA rights to choose to live in the least restrictive environment possible. This could lead into disabled people being forced to live in nursing homes, which would also violate persons with disabilities ADA rights to live in the community. EVV is a nightmare scenario for live in caregivers.

The flaws of EVV that will harm live ins and those with disabilities. Please remove this language........Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change."---------------------------------------------------------------------------------------- Not a week has gone by since this EVV black box started with my visiting caregiver that they have been paid the correct amount. The app is freezing up at this very moment. This is unbelievably cruel to force on my Live in caregiver.

When all reason and financial common sense are ignored, there are ulterior motives to harm VA taxpayers and the disabled in VA. Please remove this language under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Live in caregivers save Va taxpayers millions each year over agency directed forms of care such as nursing homes. This is substantially more than any "savings" DMAS "says" it will save inflicting the disabled with EVV. Due to overhead costs, agency directed care will never match the savings live ins provide the Va taxpayer. Why introduce language to harm live ins and the disabled if they are saving taxpayer money? Even the federal government through CMS, knowing live ins specialty care, has allotted for this exception. This language forcing EVV on live ins will force more persons who receive community based care into agency directed care which costs millions more annually. It does not meet reason or financial sense! Is there an ulterior motive? Does anyone stand to profit from persons being forced into nursing homes? We don't know because the response when asked is generic and weak signaling an ulterior motive. Why subject the disabled and Va taxpayers to more cost?

Remove language very harmful to the disabled under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Our family had a WWII veteran in a nursing home. The Veteran had an active family member who traveled to visit on a weekly basis and if this can happen to a Veteran who has family coming and going I can NOT imagine what happens to those who do not. Wish we could post pictures here... both feet were very infected and had a massive ulcer. DMAS should be doing everything in its power to keep people out of these places. EVV puts people in these places. Praying for those stuck in them without anyone caring for them.

Please don't cause a live in caregiver to spend their paltry free time refereeing the myriad of issues with EVV. *****Remove under Item #291 ****REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Right now, live in caregivers follow CMS and the federal government guidelines where they are able to post their assigned hours in a portal and they have a time frame of two weeks to do this before submitting times. This time frame allows them to record time when they get a free moment (since they work around the clock, it is rare to get a free moment - even though they are only paid a portion of that time). This two week time frame also helps prevent a live in caregiver being subjected to human error, system errors, agency errors, problems with phones, down times with phones, inability to target specific times for clocking in and out due to stress of the job, etc.... If a live in has to clock in and out, then their free moments to do this will be over and above the allotted hours revealing they work more than what they are paid. This will cause them penalties and difficulties that will ensue in pay being penalized, delayed, etc.... Please don't let this happen to a valuable part of a disabled person's life. It will be chaos.

Help preserve families with disabilities ability to care in the home. ***Remember, this could be your family too: Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." We are families caring for loved ones; you never know who may be next that needs the ability to stay home and care for a loved one. Could it be your family? Please, don't let this happen to your family. ***Live in caregivers do not visit. They work 'round the clock (even though their paid hours do not reflect this). They often have minds and hands full and cannot worry over a clock. It is next to impossible for a caregiver to clock in and out at their set paid hours. When they manage to clock in and out when they get a break, they will be penalized for working overtime to the point where they are paid less than their allotted hours. Not mention, there are several inherent bugs/flaws with EVV that cause a person to have to constantly be correcting, explaining, asking for help from overworked agencies, etc... **JUST TO BE PAID.

There is language that remains in the proposed budget that will impose real harm on people with disabilities and their families without any substantiated fiscal or program integrity benefit. I respectfully request that the following language be removed from Item 291 in the budget: "The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments . . . to eliminate the live-in caregiver exemption from electronic visit verification requirements . . ." The Centers for Medicare and Medicaid Services (CMS) says that live-in caregivers are not considered visitors and allows states to grant an exemption from the EVV requirement to record hours for live-in caregivers. This is important to me because my husband and older son are live-in caregivers for my younger son, Carl. Requiring caregivers to use EVV will impose real harm on people with disabilities, their families, and caregivers. Live-in caregivers do not "visit," and the use of the "visit" monitoring system does not capture the ongoing presence and involvement of the caregiver. Care is continuous, not clock-based, and using EVV misrepresents how care actually occurs. Requiring live-in caregivers to use EVV would return Virginia to a system it dispensed with for live-in caregivers in 2020. CMS recognizes that EVV is a burden and allows this exemption. Virginia has come a long way since the Department of Justice investigation, settlement, and resolution to transform the service system for people with disabilities. Removing this damaging language from the final budget is in keeping with this forward movement. Please make removing this harmful language from the final budget a priority. Thank you. Patricia Alf 8810 Dianne Place Springfield VA 22152

Respectfully requesting bad language Removal under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Keeping EVV exemption for live in caregivers is important to me, because it will be next to impossible to find an attendant. ****Their jobs are already difficult. Don't make them impossible by adding EVV. To show you what their lives are like, PLEASE READ: Here is a sample "Want Ad" for finding a live in attendant to help keep people with disabilities living in the community (with added EVV component to show the bleak future with EVV forced on live-ins) HIRING: A JOB FEATURING: no health benefits, no vacation pay, no sick time, no disability, no workers’ compensation, no retirement or 401K plan, GPS monitored time logging that tracks you which you must download on your phone, use your own data plan and minutes to support, Plan to spend your limited spare time making corrections to EVV errors and hoping you get paid right. Supported individuals must be taken out into the community and no reimbursement for your gas or transportation expenses you spend. Additionally, you need compassion and expect to be mentally and physically exhausted. Suitable Candidate must enjoy: Working in an environment with a general sense of mistrust and being treated as guilty until EVV (a broken and unreliable system) proves you innocent? Being overseen by indifferent, abusive and over-loaded caseworkers that let services expire dropping the ball on paperwork and don’t answer the phone or email? (Seriously, you can’t get anyone on the phone.)Having service facilitators not turn in paperwork in a timely manner and cause no pay for a month and a half and praying you are back paid. Working in an environment that when there is a problem- the overlords will fix the "glitch" in their software, (we hope) within 60 days. Working hard and knowing that you can't be sure when you will be paid or even if you will be paid or that the amount will be correct. Knowing that your employer will be a stressed-out family who is overwhelmed and under threats by the government to claw back funds the overlords deem invalidly paid. Being required to follow guidelines that are contained in multiple regulations without any clear instructions on how to interpret regulations.

Please help us keep our lives intact and remove the below language under Item #291: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." It is important to me that EVV not be forced on my live in attendant. Please keep the exception for EVV for live in attendants. We tried EVV for a short period and couldn't bear all the issues. My live in attendant went over my allotted time a few seconds last pay period. The last day never changed from approved to good to pay. I emailed the fiscal agent with a screen shot asking why this was happening. Never got an answer, but they changed her time and the total two weeks was a few seconds under the authorized hours. But her paycheck was also a few cents short so I don't know if they are prorating the hour or what. I never got an answer. Not good when you are trying to keep an attendant.

Remove this paragraph under Item #291 (and help the disabled) REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Keeping the live in exemption from EVV is important because my house is part of the 46% of older adults who do not have a smart phone in our house. We do not because no matter what we tried we would always get over charges for data we never used. Because we live rural, the landline we have goes down on a regular basis as well. I imagine since the Medicaid phones come with small amounts of data this would also be a problem. It isn't justified to make people purchase a $100 service and a $1000 device to access a Medicaid service. This service saves people's lives and allows them to stay in the community. It is irreprehensible that DMAS thinks it is ok to take away services. I don't understand why ACLU etc. will stand up for child sex offenders but not for the disabled. EVV for live ins is wrong. EVV for live ins is a human rights violation. Stop EVV.

Please remove the below language detrimental to many families under ITEM #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Keeping the EVV exemption for live ins is important to me because I am a live in that works with visiting caregivers who are forced to use EVV. The visiting caregivers tell me that their pay has not been right since EVV. They say there are always problems with the system or their phones, etc... I have got too much going on with my job to worry about a clock and pay issues, etc... I don't get set breaks at set times even though I am only paid for set times. I don't want to let down a family, but would you work if you didn't get paid for the hours you were there due to glitches, phone not working, app not working, etc? Would you want to waste your time correcting payment issues for a very low paying job with no benefits? I am going to have to leave this family if EVV is enacted for live ins.

Remove under Item #291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." MAINTAINING THE EVV EXEMPTION FOR LIVE INS IS IMPORTANT BECAUSE: Forcing EVV on live ins is going to get very expensive in the long run. I can see a lot of people going into nursing homes now, because no one needs this EVV stress and attendants are just going to move on. There will be nothing left but nursing homes as an option. I can see the nursing home bills versus attendant pay being astronomical in difference. None of this is making a bit of common or business sense.

Family managing a disability asks to Please remove this detrimental language in ITEM 291 REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Removing the EVV exemption for live in caregivers is very detrimental, because the Olmstead Act requires states, with some limitations, to assist people with disabilities to live at home if they would otherwise receive services funded by the state in a nursing home or institution. It is based on the Americans with Disabilities Act. Olmstead applies to individuals with developmental disabilities, intellectual disabilities, physical disabilities, traumatic brain injury (TBI), and other disabilities if a person meets the eligibility for nursing facility or other institution. EVV violates Olmstead because it is causing people to be moved out of the community.

Remove under Item #291 the below wording: REMOVE ->"NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Maintaining the EVV exemption for live in caregivers is important to me because: Our live in aide actually works way more than they even get paid . Our child only goes to school 3 hours and not consistently. (Misses frequently for dr appts or if he’s sick or there is a lot of sickness in the classroom), We work. So unless he’s in school he needs an aide all day. Our live in aide is going to leave if EVV is inacted for live ins, because they say they can't be free to work if they are worried about a clock and they are afraid of causing harm by focusing on a clock. I do not blame them. We will likely be unable to find replacement staff for the pay level, lack of benefits, no paid time off. EVV will leave left us high and dry. EVV will be the final slap in the face. Hopefully my child will get a nursing home slot when this all goes down.

PLEASE REMOVE UNDER ITEM #291 BELOW DETRIMENTAL LANGUAGE: PLEASE REMOVE: "NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such change." Maintaining the evv exemption for live in caregivers is important to me because: Guess who suffers the most from EVV? Our kids who have no one to depend on except us. Our caregivers are such a blessing they love my son and give him opportunities outside of our home. You know as well as I do that everyone needs friends and you don’t always want to be stuck with your parents or family. EVV keeps people with disabilities isolated.

I am delighted that the "Senate budget ditches data center tax break to create more than $1B in revenue" according to the Richmond Times Dispatch. I hope that as you reconcile the two budgets you will incorporate this change. It is very unfair that taxpayers across the Commonwealth have to cover this revenue hole while only the county where a data center is sited derives financial benefit. Additionally we should not be paying to lure more data centers when the ones we already have demand so much electricity that the utilities threatened blackouts. It is past time to call a halt to this giveaway.

The Congressional Sportsmen's Foundation is in strong support of Del. Bloxom's budget amendments to provide funding for the Department of Wildlife Resources. Please see attached.