Someone I love is one of the over 40,000 Virginians using Consumer-Directed Services with a Virginia Medicaid Waiver! To make these services sustainable and build the provider network available to those who want it, including the many people who will get those DD waiver slots in the coming years, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. 2) The degree requirement for Consumer Directed Service Providers needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually.

Consumer-Directed Services with a Virginia Medicaid Waiver To make these services sustainable and build the provider network available to those who want it, including the many people who will get those DD waiver slots in the coming years, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. 2) The degree requirement for Consumer Directed Service Providers needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually. Without these adjustments, it is impossible to secure employees who can work and live in the area. In the last two years, our daughter has had 3-4 SFs which makes continuity impossible. Thank you for your consideration.

My son is one of the over 40,000 Virginians using Consumer-Directed Services with a Virginia Medicaid Waiver! To make these services sustainable and build the provider network available to those who need it, including the many people who will get those DD waiver slots in the coming years, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. 2) The degree requirement for Consumer Directed Service Providers needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually.

Someone I love is one of the over 40,000 Virginians using Consumer-Directed Services with a Virginia Medicaid Waiver! To make these services sustainable and build the provider network available to those who want it, including the many people who will get those DD waiver slots in the coming years, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. 2) The degree requirement for Consumer Directed Service Providers needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually.

1) Consumer Directed Service Providers are in dire need of a significant rate reimbursement increase. It is extremely hard to hire and retain staff at current reimbursement rates and will all the DD waivers that are opening up lots of families may be granted a slot but not be able to access a service provide due to staffing shortages. 2) The degree requirement for Service Facilitators should be removed. A degree is not required for most government careers. Service facilitators preformed in the field professionally for years without a degree before this was implemented. Requiring a degree makes it hard for providers to staff. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually. The vast majority of waiver holders are at immunocompromised, battling an illness (some terminal) or at a significantly higher rate of risk than those not on a waiver. It’s only fair that we protect those that we serve within the community by offering some Telehealth / Virtual visits.

Someone I love is one of the over 40,000 Virginians that uses Medicaid Waiver Services! I have 2 children who have benefited from waiver services for the past 10 years. Without the supports they have received via the waiver program they would not be as functional as they are today. I am disappointed in the recent changes and the lack of financial compensation for a group of people that have supported us to the ends of the earth after leaving the doctors office with a diagnosis and no solution, next steps, or guidance. Our CD services provider has provided us with guidance and resources and support over the years when it felt like nobody else was in our corner! I am proud to say that I attribute the passion and supports provided by our provider to my kids ability to be functional members of society in the future. Without these supports I feared what the future may have looked like. To make these services sustainable and build the provider network available to those who want it, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. Nobody works for free and the high turnover of CD services providers staff due to pay has a negative impact on the people using these services and all of the other providers involved in service delivery. The increases in past years don’t even make for an appropriate cost of living raise for these people who are providing this much needed service in the ever changing waiver program with constant guidelines changes. It seems the CD services providers are being ask to do more and more work but there is not additional compensation being provided for that additional workload which leads to more burnout and in turn high turnover that is already vastly experienced in the human services fields of work to begin with. 2) The degree requirement for CD services providers needs to be removed. There are many people who have more passion for the clients that are excluded by this ludicrous degree requirement and ultimately it makes staffing impossible and in turn penalizes the individuals using services with high turnover of providers that they desperately need to maintain and navigate the waiver program. In past years before the change in requirements we had some of the most dedicated CD services providers who understood the strife and struggles we face as a population that no degree could have ever provided them the experience to understand. Education should not be the only factor considered when hiring staff to work with a disabled population that is receiving services. Education does not dictate intelligence or ability and certainly doesn’t begin to touch passion for working with the disabled population. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually. Times are changing and so are modern technologies and conveniences. It is absurd to think that the waiver program cannot adapt to modern ways in some capacity. In person 100% of the time leads to a breakdown in communication of information. Sometimes a missed visit or a scheduling complication because of the in person requirement means a breakdown in the ability to gain knowledge needed solely based on a lack of convenience and in an ever changing waiver program with constant new guidelines and requirements when information is not shared it can cause huge detriment and disruption of those services.

Tax cuts are a missed opportunity to act on climate. Doing nothing is damaging - it is a decision to spend on cleaning up damaged communities after climate impacts hit, instead of investing in mitigation and community resilience. Budget and planning fail.

Comments Document

Childcare supports all parts of the economy and entire workforce in Virginia. However, due to the high cost of childcare, there are many parents, especially women, who are not able to work due to needing care for their non school age children. The average wage for someone working in childcare is just over $13.00 per hour. And there is a childcare staffing crisis occuring due partially to very low pay and also due to the background check process for childcare not allowing for a substitute pool, which is what is done for schools K-12. Our asks 1. Wage supplement stategy to increase the pay for those working in childcare. Similar to refundable tax credits (Louisiana) or a monthly grant supplement (Maine). 2. Legislation to support a substitute pool for the childcare field, allowing for flexibity related to the background check process. 3. Support the children who are our future in every way by supporting a child care system that families can afford and that those in the profession can afford to earn a living in. 4. Childcare set the foundation for development, future learning, and school readiness. 5. For the economy to be strong and stable, we need the childcare system to be strong and stable enough to support working families. If additional information or statistics are needed, they can be provided. Mary Braxton maryb@thechildcarenetwork.org

Thank you for your support of the Developmental Disabilities Waiver Program. My daughter is one of the 40,000 residents of Virginia utilizes Medicaid Waiver Services, currently the CCC Waiver. It is a wonderful program that provides vital assistance, however if Consumer Directed and Agency providers are not reimbursed at higher rates it will be unsustainable. Every year these companies are asked to more and more with no real increase in reimbursement rates. The rates leave very little room for overhead - sick leave, benefits, software, training, etc. Our fear is that when my daughter is finally granted a DD slot (waitlisted now for 12 years), there will not be any agencies left for facilitation, rendering it useless. Please fund these agencies and direct care professionals appropriately so that our loved ones are given the critical services needed. Thank you.

Someone I love is one of the over 40,000 Virginians that utilize Medicaid Waiver Services! To make these services sustainable and build the provider network available to those who want it, including the many people who will get those DD waiver slots in the coming years, the following things MUST happen: 1) Consumer Directed Service Providers must get a significant rate reimbursement increase. 2) The degree requirement for Service Facilitators needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services, allowing for some visits to be conducted virtually.

I strongly support the Creation of the Rural Charging Infrastructure Program and Fund. A key part of tackling the US largest economic sector for GHG emissions is transportation 28%. For Virginia, Transportation is also largest at 42%. If we compare US VS CHINA – Looking just at Fast Charging stations China has 750,000 stations and the US has 28,000. We are WAY behind and Virginia’s share of Federal funding for charging infrastructure is woefully inadequate since it will only cover a few interstate charging stations. Investing in EV charging stations near tourist destinations in low-income rural localities will ensure that people continue to visit the region maintaining contributions to the tax base and supporting local businesses. As the number of EVs grows – which is a well-established trend – these rural communities will fall behind where they currently are economically. Case in point. I have an EV – a Chevy Bolt. I have RANGE ANXIETY as do all of my friends who have EVs. Meaning we think long and hard about long trips. In my case I’m a hike and I like to drink wine. There are plenty of places in rural Virginia I have or would like to visit, but I won’t take my EV. I looked at an area out I66 and Southwest that is roughly bounded by Gainesville (out I66) to Lake of the Woods to the South to the Western edge of Sperryville. 1000 sq miles, lots of nice hikes and wineries. There only two fast charging stations in that 1000 square miles of rural Virginia. So for all of the above reasons, I would greatly appreciate your support for funding this initiative.

Hello my name is Anna Thomas and I work as the Outreach Manager for Moms In Motion and At Home Your Way. I also am the aunt of a nephew who has severe autism and am advocating for his rights as a CCC+ Medicaid waiver recipient, and someone who is on the DD Waiver waitlist. It is wonderful that the governor plans to fund all of the priority 1 DD Waiver slots in his new budget. Unfortunately, if we do not also address provider capacity, simply awarding those slots will not solve the problem of people being able to access services. Consumer-Directed services have existed since 2005. It gives people the ability to choose how and by whom their services will be delivered. As of the end of 2023, unfortunately, these services have become unsustainable, with many providers closing their doors. The more than 40,000 people in Virginia that use these services WANT to continue to have this choice. In order to make these services sustainable and build the provider network available to those that want it, including the many people that will get those DD waiver slots in the coming years, the following things MUST happen: 1) CD Service Providers must get a significant rate reimbursement increase 2) The degree requirement needs to be removed. 3) Telehealth or video methods should be allowed for some components of CD Services. I'd like to go into more detail about the only one of those 3 pieces that needs funding: 1) The MOST important change that has to happen is that the General Assembly MUST fund a significant CD provider rate reimbursement increase. Consumer-Directed (CD) services have not had a significant increase since the inception of the services in 2005. Do you know that the minimum wage in Virginia in 2005 was $5.15/hr? Today it is $12/hr, which is a 133% increase. Two years ago, the General Assembly had temporarily given all providers a 12.5% increase. When it came time to make permanent changes, almost every other DD provider saw a much more significant increase, even more than the Burns & Associates recommended 50th percentile rates. CD services, though, were left at 12.5%. This is the one and only increase we have seen since 2005. How should CD providers use a 12.5% increase to cover a 133% increase in minimum wage? Last session, we got bipartisan agreement in both the house and the senate to put our Burns & Associates recommended 50th percentile rate increase into the budget. Unfortunately, during the course of budget negotiations, once again our rate increase was stripped out of the budget. We cannot function on 2005 rates! 12.5% is not enough! It does not make CD services a sustainable choice for Virginians with disabilities! I'm here today to ask you to fund a significant CD Services Provider Rate Increase. It needs to be at least the 50th percentile of the BLS, as recommended by Burns & Associates in the most recent rate rebase study, which is based on 2019 data. That is still not enough to get us to 2024 minimum wage, but at least it would be enough to make these services sustainable and bring CD Services to the same level as all other DD Waiver providers. In addition to the rates, removing the requirement that Service Facilitators have degrees and allowing some portions of our services to be done using video conferencing methods would go a very long way toward Consumer-Directed provider capacity, which will sustain the services that so many Virginians want and need.

My name is Zeina Ashrawi Hutchison. A mother to two kids in the public school system and a longtime resident of Loudoun County. I am a member of various organizations. The Virginia-Israel Advisory Board is a state agency that operates within the Virginia legislature. Yet again, the budget proposes to give hundreds of thousands of unaccountable Virginia taxpayer dollars to this foreign government agency. Not only does VIAB get preferential treatment over other “advisory boards”, but also, as Grant Smith writes, “no state in the U.S. offers more preferential market incentives to Israel over its U.S. and state companies than Virginia.” What are some of these companies they brought to Virginia? Elbit Systems, Israel’s largest arms producer whose weapons have been used extensively over the years to kill and maim Palestinians, including in Israel’s current genocide in the Gaza Strip. Elbit also happens to be a prime contractor for the militarization of the U.S.– Mexico border. Another company is Israel Aerospace Industries (IAI), whose CEO Boaz Levy said on a Nov. 22 call with investors, that their Heron drones have “played a pivotal role” in Israel’s attacks on Gaza. Another one is Energix, a company that has been cited by the United Nations for its violations of human rights in the occupied West Bank and the occupied Golan Heights, which also happened to have received one-third of all PPP loans that were given to VA solar companies during the pandemic. Since its inception, it is reported that this board has only reached quorum once. Among the most visible and active board members are people like Executive Director Dov Hoch, who a few years ago was retained by the Israel Ministry of Economics to help Israeli companies enter the US Market and who also served with the IDF. The board’s VP Chuck Lessin who was forced to resign from the Charitable Gaming Board early in 2023 for failing to recuse himself due to conflict of interest, who also has a checkered past with other projects in VA like with the Tobacco Commission, and like board member Julie Strauss Levin, whose husband recently wrote that there are no innocent Palestinians. VIAB is not only blatantly and unfairly getting dangerously preferential treatment; ranging from political access, State resources, taxpayer money, and are outrageously embedded unaccountably in our legislature, they are making Virginia and Virginians essentially directly complicit in what experts consider war crimes. The involvement of the aforementioned companies may be used in the genocide case presented before the international court of justice against Israel. Why are we giving over a quarter of a million dollars of our tax dollar annually to advance the interest of a foreign government when we have heard many testimonies who would greatly benefit from those funds for programs for the elderly, the hearing impaired and for childcare programs? I've testified more than once in front of this committee over the years, and I again ask for a budget amendment to defund the Virginia Israel Advisory board. We should not enable this state agency to continue at the expense of Virginians and Palestinians. We all deserve better.

Comments Document

Thanks to the governor for funding all of the priority 1 DD Waiver slots in his new budget. Unfortunately, if we do not also address provider capacity, simply awarding those slots will not solve the problem of people being able to access services. Consumer-Directed (CD) services give people the ability to choose how and by whom their services will be delivered. As of the end of 2023, unfortunately, these services have become unsustainable, with many providers closing their doors in recent years. In order to make these services sustainable and build the provider network available to those that want it, the following things MUST happen: 1) A significant CD Provider rate reimbursement increase MUST happen (see attachment for details). Last session we had agreement in both the House and Senate for an amendment to address this, but these were stripped out in final budget negotiations and CD service rates we re once again left out of the budget. Please do not leave us out again this session! 2) Please remove the degree requirement for CD Providers, much the same way you did for state employees last session. This will enable providers to pull from a wider pool of candidates to be able to fully staff our teams. 3) Please allow for some portions of CD Provider services to be conducted via virtual/video method in order to make our visits less invasive for families, less expensive for employers, and more desirable for workers, thereby attracting more people to do this work. In the PDF attached, please find details for each bullet referenced above. Thank you for all of the hard work that you do! We appreciate you listening to our concerns and needs!

I would have provided oral testimony, (see below (but my computer closed and I could not get back to the meeting itself. Good morning. Thank you for this opportunity to speak and for holding this meeting online. My name is Terri Lynch, and I am speaking for NVAN, the Northern Virginia Aging Network, about the need for paid sick leave for workers who provide hands-on direct care for older adults and adults with disabilities. The Virginia Commonwealth Council on Aging also supports this request. A recent front-page story in the Washington Post made it clear that the wages of direct care workers are exceptionally low, and the job functions can be grueling. It was reported that many would rather work for Uber or Amazon. Unfortunately, Virginia’s annual direct care workers salary is ranked 42nd out of 50 States. Paid sick leave is not only an important workforce benefit, but a public health issue -- and these workers need not only higher wages, but BENEFITS like PAID SICK LEAVE. Direct care workers may work while sick to sustain income. Most direct care workers are middle aged and older women of color. In addition to low direct care wages, Virginia does not extend paid sick leave to direct care workers to allow financial stability while they are sick, which can result in working while sick.  Some daily job responsibilities include bathing, dressing and assisting with eating. These tasks require the worker to be in close proximity to the adults they serve and thus can be contributors to the spread of infectious disease to the older adults they assist. When direct care workers have more than one job, there is risk of transmitting contagion from one job setting to another. In 2021, the General Assembly took a first step in requiring up to 5 days of paid sick leave through MEDICAID for consumer-directed home care workers. It’s time to extend this benefit to OTHER home care workers – those who work for agencies – as well as those in nursing homes and assisted living? NVAN urges the General Assembly to: Require employers to provide at least ten days of paid sick leave for all workers, including direct care workers in nursing homes, assisted living, and home care. Thank you so much for this opportunity to speak. Terri Lynch

Good morning, my name is Erika Rogers. I’m a participant in the Partners in Policymaking Program with VBPD. My State Delegate is Buddy Fowler and my State Senator is John McGuire. I am here today to talk to you about the issue of accessible changing tables. I am a single mom of 10 kids, 7 who still live at home, 4 of whom have Down syndrome. I would love to tell you about my 20 year old son, Caleb. I adopted Caleb from Ukraine when he was 9 1⁄2 years old and he weighed just 26 lbs. He was extremely malnourished and had only been given 1 bottle a day and 1 diaper change a day for 9 1⁄2 years. Now, 11 years later, he is 20 and weighs 125 lbs. Unfortunately, due to the early neglect and abuse, he never learned to chew, is incontinent and wears a diaper and is non verbal. Imagine with me, if you will, that you are watching Caleb for me and decided to go out to do some shopping. You realize he needs a diaper change. You walk into the public bathroom and into the handicapped stall. What then? The only changing station is for infants. It’s a public bathroom and you have to lay him on the floor and kneel down next to him to change him. Can you picture that? Pretty disgusting and dehumanizing, isn’t it. I am asking that all businesses and buildings that receive Federal or State funding have an adult changing table available. They are accessible for infants, children AND adults who deserve the dignity of not having to lay on the floor in a public building to have their needs met. This would be a great start! Thank you for the opportunity to bring this important issue to your attention.

Subsidies must be issued if middle-class folks will make the jump to EVs. I have three kids, five cars, and make over $100K (jointly). Yet, EVs are still too expensive. All of my cars are gasoline-powered. I just bought a car this year, and an EV would’ve been $10-15K more (for the same type of vehicle). If there’s no subsidy, then folks like will ALWAYS choose cheaper, which means no EV. Thanks for considering this important issue.

We urge the General Assembly to fulfill its constitutional duty and adequately fund Virginia's public schools by lifting the arbitrary cap on funding support staff, and implementing the critical near-term recommendations made by JLARC. There is no research basis for the 24:1,000 cap on support staff funding. However, the decade long experiment in restricting support staff funding has had a clear impact on our schools. Virginia has some of the largest drops in reading performance in 30 years; achievement declines in math, science, and history; and a rising teacher vacancy rate. Virginia schools receive 14% less state funding than the 50-state average, equal to roughly $1,900 less per student. We urge the General Assembly to correct the outdated At-Risk Add-On calculation which underestimates low-income students; set the Standards of Quality based on actual staffing & compensation practices; and create Special Education and English Learner Add-On funding to reflect the differences in enrollment of high-need students across school divisions and the supplemental services needed for academic success. To combat the rising fentanyl substance abuse crisis, increasing rate of school violence, and mental health challenges faced by our youth, we urge the General Assembly to make significant investments in youth mental health services including staffing mental health professionals at nationally recommended ratios, and creating a permanent mental health grant program that enables school divisions to partner with community-based and telemental health providers. We support continued robust investments in improving the accessibility, affordability and quality of early childhood care and education, and improving staffing levels for K-8 reading and math specialists. Investments in the physical and technological infrastructure of our schools are critical to fostering academic success. We urge the General Assembly to dedicate funding for school building renovation and construction to enable aging schools to meet modern health, safety, and technology standards. We also support investing in Virginia’s statewide student information system in order to increase transparency and access to high-quality, real-time data on enrollment, staffing and student performance patterns. Please place our students, and their future contribution to Virginia's economic prosperity, at the center of your budget discussions this year.

As a Board member for 4 Public Education, I am disappointed with the Governor’s proposed budget. It seems that the Youngkin administration has dismissed the report by the Joint Legislative Audit and Review Commission (JLARC) and their recommendations regarding the serious underfunding of public schools in Virginia. Also, the administration has dismissed the results of an expansive study recently published in Forbes magazine that concluded “efforts to close the learning gap should look at the more fundamental reasons for the disparity in achievement between affluent and disadvantaged children”, with the ‘quality and funding of schools’ among the factors with the greatest impact on closing achievement gaps.” The JLARC report concluded that Virginia school divisions need 66 to 93 percent more funding, depending on the model used to estimate the degree of underfunding. Adjusting the funding formula to reflect the actual expenditures of school divisions would require an increase in state funding by 45 percent, or $2,700 per student. Of course, local funding obligations would also increase, but according to the JLARC report, “all localities are already contributing more than what is required; three-quarters are already contributing 45 percent or more above what is required.“ Instead of planning ahead for when the funding formula is corrected and a bigger budget is needed for public education, Governor Youngkin’s proposed budget significantly reduces funding for public education in Virginia. Instead of paving the way to improve public education, his budget reveals his lack of commitment to a quality public education in Virginia. He has the mistaken notion that his proposed reduction in state taxes, which would mostly benefit the wealthy, would encourage people to move into the state. According to the Center for Policy and Budget Priorities, low state tax levels are ineffective at attracting people to a state, and it is the quality of public education that is the major factor motivating people to move to a state. I encourage Virginia’s legislators to pass bills and budget amendments that will revise the out-of-date funding formula that Virginia uses, and increase rather than decrease K-12 funding to public education in Virginia. There is an urgent need to correct the way school divisions are funded as Virginia’s current formula still uses funding reductions that were put in place during the Great Recession of 2008, resulting in the serious underfunding of public education in Virginia.

Removing Income Penalties for Recipients of a Medicaid Waiver Our system of social service support is based on the long-held belief that people with disabilities (“PWD”) would not be able to work. Limits on income in these federal and state programs continue to assume this to be true. With technology and medical advances, PWD can have meaningful work experiences but our policies place antiquated income restrictions that put these individuals at risk of losing their life-saving Waiver benefits. A child or an adult who is disabled may apply for a Waiver. Virginia has three (3) Developmental Disability (DD) Waivers under the federal Home and Community-Based Services (“HCBS”) program. The person who receives a Waiver (“Recipient”) may have daily support like attendant care and transportation. They may live in a group home or other housing that allows them to live as independently as possible. The Recipient receives services under a Waiver. They do not receive income or money from that Waiver. Income to the Recipient can be “earned” from employment or “unearned” from benefits through the Social Security Administration (“SSA”). These individuals need both services and income to live independently. Once they reach a certain income level through either earned or unearned income, the Recipient pays the state a “Personal Maintenance Allowance” or a Patient Pay Amount (“PPA”) to the state based on their income as a contribution to the cost of their Waiver Services. The Penalty Issue: An unearned income issue arises when a parent retires or dies. The Recipient who may have been receiving Social Security Income (“SSI”) is moved to Social Security Disability Income (“SSDI”). This benefit is based on the past work record of the parent. An earned income issue arises when the individual is able to work at a full or part-time job. Because it is based on the work record of the parent, SSDI benefits are substantially greater, sometimes up to three times SSI. The total cost of care for the individual is more than this larger amount. This increased SSDI amount can push the Recipient up to and over and over the Waiver Services income level limit, thus terminating their Waiver Services. These SSDI benefits become a substantial penalty for them because these lost Medicaid Waiver service costs are much greater than SSDI income could provide. The Centers for Medicare and Medicaid Services (CMS) has addressed this problem with updated policies and have instructed state Medicaid Directors about these policy changes. DMAS has thus far refused to adopt the CMS changes but Delegate Shin has introduced a bill that would disregard the SSDI income penalty above the maximum monthly SSI amount. Please be aware that a better fix for this issue may be a budget amendment.

The flexibility provided by Appendix K needs to be preserved and permanently formalized under Consumer Directed (“CD”) Services. Instead, the Department of Medical Assistance Services (“DMAS”) and the Medicaid Provider Lobby are attempting to gut CD services in favor of paying agency providers. This is both dangerous for the disabled indivdual and a disservice to the families attempting to care for their loved ones. Paying a parent to be a caregiver: -Seeks to address issues raised by the COVID-19 pandemic including the crisis of caregiver workforce shortages, -Promotes equity and access to services in underserved communities across Virginia, -Addresses the long-standing LTSS direct care workforce shortages which have now become a crisis nationwide, -Confronts increasing demand for home-based care, -Addresses gaps in meeting the needs of communities of color and English Language learners, -Recognizes increasing interest in and preference for home-and-community-based care over institutional care through consumer directed programs, -Gives older adults and people with disabilities an alternative to institutionalization, and -Keeps vulnerable children safe with parent caregivers. It would cost Virginia more to pay for agency-directed care rather than paying family caregivers under consumer-directed services. For example, one hour of personal care provided through an agency would cost $5.34 more in Northern Virginia and $5.81 more in the rest of the state than care provided by a paid family member. The annualized cost increase per individual is more than $11,000 in Northern Virginia and over $12,000 for the rest of the state. This data is according to the hourly rates listed by Virginia Medicaid. Family caregivers are an important source of home health services nationwide, though they are often not compensated for the skilled and non-skilled care that they provide. Nationally, family caregivers provide about 1.5 billion hours of health care annually to 5.6 million to children and youth with special health care needs (CYSHCN). If these services were instead provided by an agency-employed home health aide, they would cost an estimated $11.6B to $35.7B per year, well more than double the current cost of paying family caregivers.

Comments Document

Please see the attached more extensive comments to supplement my abbreviated 3-minute public testimony on behalf of the Virginia Autism Project. thank you

As a Home Care Worker to our youngest son who is diagnosed w-muscular dystrophy & requires constant care. I’m writing to inform you’ll regarding the proposed budget to increase our wages fr $12.71 = $2,033.60 monthly before taxes & with the proposed $.63 = $13.34 an hour = $2,134.40 monthly while HCW Northern Va. are already making $16 plus an hour. These wages are poverty wages especially in this current economy because most people rent is between $1,500.00 & above and mortgage is definitely higher. After rent/mortgage there are other necessary expenses like groceries, insurance, car notes, etc. Most of us that do this profession, do it out of love and compassion to those who can’t care for themselves but rely on trustworthy people to help with their daily needs like taking them to the bathroom, feeding, prescribed medications, etc. Our current wages are teenage wages because teenagers are making more than we do at some fast food places/targets/Starbucks which shows the value that is placed on those of us who care for others on a daily basis. At this current rate it also makes it difficult to hire other quality Home Care Workers and therefore. I’m asking that you to reconsider the proposed .63 cents that will be eaten in taxes and approve a budget that will correspond with current living wages of $20.00 an hour. God bless you’ll!

Registering to speak

God Bless every single parent that is still standing after the disaster that has put parents such as myself in a fight or flight panic to not only my son, Lincoln’s future, but for every other member of our family’s future as well. Why fight based on what “the government” thinks is fair because they don’t live in the same universe as parents with neurotypical families. What if we have no family near or at all? Why would anyone want to steal a future from the most vulnerable population already? It’s sickening to think about having to hire a complete stranger to take care of my son that cannot express or understand a thing. The parents sitting in this meeting are the ones that deserve the most of it all. It tells you right then and there that we will never stop fighting and that we are and always will be the best fit to take care of our children, not to mention NOONE wants to work within certain environments or approach behavioral issues for pennies on the dollar. I’ve put ad after ad out looking for someone trustworthy, honest, patient, and willing to be a part of our world with no responses. My son needs this slot now and the rest of his life. With the lack of staff all across resources there is no way parents like us or our children have much of a chance to be their own person and live their best lives.

HB 30 Item 16 allocates $244,872 to the Virginia-Israeli Advisory Board, the only foreign based entity that receives money from the state of Virginia. Does VIAB also receive office space and easy access to legislators from the same office building that no other ethnic group receives? Either give the Korean, African, or other groups the same or remove all favored status amenities to provide an equitable distribution of funds. Are the other Advisory groups organized in the executive branch and overseen by the Virginia Economic Development Partnership? If this is the case, all Advisory Boards should have the same command and control structure. Based on the VIAB own website, it is intended to help Israelis and not Virginians. “ The Virginia Israel Advisory Board (VIAB) is a government agency that helps Israeli companies build and grow their U.S. operations in Virginia.”. According to documents released under Virginia’s Freedom of Information Act, VIAB has: - Received compensation for VIAB directors from outside state Israel advocacy groups, triggering Virginia Conflict of Interest and Ethics Advisory Council scrutiny. - Provided reports of success that the office of the Governor found to be “inflated without merit.” - Lobbied for and received a legislatively predetermined and discriminatory allotment of unelected leaders from outside state Israel advocacy groups to be appointed to VIAB’s board. - Been scrutinized by the Virginia Office of the Attorney General over the selection of its executive director. - Engineered internal lobbying for the 2018 reconstitution and transfer of VIAB funding and operations from the Office of the Governor to the state legislature in order to weaken overdue, warranted oversight of VIAB. Energix, a company promoted by VIAB, received one-third of all PPP loans that were given to VA solar companies. Was this fraudulent as a result of its connection to VIAB? The Paycheck Protection Program (PPP) provided small businesses with forgivable loans to prevent layoffs due to the economic crisis. ( https://www.cms.gov/files/document/accounting-federal-covid-expenditures-national-health-expenditure-accounts.pdf). When was the last time VIAB was audited? VIAB paid Dragas Consulting at Old Dominion University (https://www.odu.edu/business/center/ceap )to issue performance reports. What independent public-accessible source reviews these reports and how often? What were the results for the five year period 2019-2023? How much money was provided to Virginia State Senators, Delegates, and State Government officials by Israeli-based organizations - is there a conflict of interest for them to receive money and vote to promote VIAB? (https://www.opensecrets.org/orgs/american-israel-public-affairs-cmte/summary?id=D000046963) What is the cost of funding VIAB versus funding mental health, health, education, environmental, and other causes Virginians want (Missed Opportunity Costs)?

I am writing to urge your support for the creation of a Wildlife Corridor and Crossing Grant Fund in the 2024-2026 Virginia State Budget, with an appropriation of $5 million to fund connectivity projects aligned with Virginia’s recently published Wildlife Corridor Action Plan. As a resident of Arlington, VA, holder of a doctorate in wildlife conservation, and a regular traveler along I-66 and I-81, I - all too frequently - encounter wildlife-vehicle conflict personally and by seeing carcasses along the road. I also worked for the Wildlife Center of Virginia and saw, first-hand, the consequences of poor connectivity. This has serious consequences for Virginia’s native wildlife. Through my own research, I have become aware that Virginia is in the top ten U.S. states for wildlife-vehicle conflict, which is staggering! This puts so many Virginian lives at risk. I also am aware that the Virginia Department of Transportation does not have an obligation to consider wildlife crossing and habitat connectivity when doing infrastructure improvements/creations. Yet, I was pleased to read the recently published Wildlife Corridor Action Plan - but where is the funding to prioritize and create these crossings and corridors to reduce this conflict? The establishment of this Fund would be vital for the implementation of infrastructure projects aimed at reducing wildlife-vehicle conflict, preserving Virginia’s rich biodiversity, and fostering climate resilience. As you deliberate on the budget, I would like to bring your attention to the following critical facts on the incredible impact of even just adding fencing to existing underpasses: A notable example of success in Virginia is the implementation of directional fencing along I-64 to guide deer to existing culverts. Following the installation of this fencing, deer-vehicle collisions in the area decreased by an impressive average of 92%. The return on investment for wildlife crossing infrastructure is evident, as demonstrated by the cost savings of $2.3 million per site within just 1.8 years of installing culverts with exclusionary fencing. Furthermore, it is crucial to emphasize that state funding plays a pivotal role in leveraging federal dollars for these initiatives. By investing in wildlife corridors and crossing projects, Virginia can take a leadership role in promoting sustainable transportation infrastructure and wildlife conservation. Let’s transform Virginia from an example of high horrible wildlife-vehicle conflict to an example of high habitat connectivity for driver safety and biodiversity maintenance! If you need more information on habitat connectivity, please visit this amazing platform created by the nonprofit Wild Virginia: https://storymaps.arcgis.com/stories/7d09dfd6b426487eb50ac75bb01d81ef?eType=EmailBlastContent&eId=3de53b93-503a-49af-8512-519070bad689

Having a state rebate on top of Federal incentives puts EVs within reach of lower and middle income families, and helps reduce tailpipe pollution. Although the cost of owning an EV is lower than that of a fossil fuel vehicle over the vehicle's lifespan, the higher upfront cost of EVs puts them out of reach for many car buyers. Because the rebate would occur at the point of sale, EV buyers would be able to lower their monthly payments and enjoy a wider selection of vehicles from which to choose.

Governor Youngkin began his anti-climate administration by nominating former coal lobbyist Andrew Wheeler to be Virginia's new Secretary of Natural Resources in 2022. Fortunately Wheeler was denied confirmation, but Youngkin kept this supremely unqualified individual on in his administration as a "senior adviser." Youngkin is continuing to demonstrate his opposition to sensible measures to combat and ameliorate the harmful effects of climate change by submitting a budget for 2024-2026 notable for its omissions: - Virginia established a fund to administer the most progressive electric vehicle rebate in the country in 2020 – including funds for used vehicles and more money for low income purchasers. But this year there is no money in the fund! - Low-income energy efficiency programs. Governor Yougnkin continues his attempt to pull Virginia out of the Regional Greenhouse Gas Initiative (RGGI) but offers no replacement funding for critical energy efficiency programs that save Virginians money, fight climate change and reduce pollution. - Rural electric vehicle charging stations. Virginia is going electric but we need to make sure our network is equitably distributed. Right now, we need to invest in charging stations for rural and low income communities. Currently this is not funded at all in the budget. - Flood resilience. Without RGGI funds, we risk falling way behind on our flood resilience goals for all of Virginia. Governor Youngkin proposes only $100 million for flood resilience for 2025 and nothing for 2026. This is an embarrassing fraction of what is required to keep Virginians safe from flooding; and much less than what yearly RGGI auctions have provided. The Virginia General Assembly must not let Youngkin's outrageous budget be adopted. Under previous administrations Virginia had become a leader among Southern states in passing progressive legislation to protect its citizens from the inevitable damage climate change is causing. Please ensure that adequate funding to address this existential challenge is restored in the 2024-2026 budget. Sincerely, Gary Usrey

Thank you for the opportunity to share my perspective with you today. My name is Kimberly Ginyard, and I reside in Woodbridge/Prince William County I stand before you not only as a concerned member of our community but as someone intimately affected by the profound impact of gun violence on mental health. Recently, my family suffered the devastating loss of my nephew to gun violence. This tragedy has not only shattered our world but has taken an immeasurable toll on his father, my brother. The mental anguish he endures each day is a stark reminder that the consequences of gun violence extend far beyond the immediate incident. It is a lifelong struggle, a silent battle that consumes not only individuals but entire communities. In the past, mental health was often disconnected from discussions on gun violence, social media, and other societal challenges. However, the current state of our nation, exacerbated by the effects of the pandemic and governmental challenges, underscores the urgent need for comprehensive mental health support. I appeal to you today, not just as a grieving family member, but as an advocate for mental health reform. Our experiences navigating the mental health system have revealed both strengths and shortcomings. We were fortunate to have a dedicated case manager who guided us through the complexities and connected us to essential services. Crisis services played a pivotal role in diffusing a mental health crisis and preventing hospitalization. However, challenges persist. During moments of crisis, we encountered lengthy waiting lists and struggled to secure timely hospital beds. These gaps in the system highlight the critical need for sustained, long-term support for Virginia's mental health care system. I appreciate the recent investments in mental health services and commend your efforts. As we discuss the Governor's proposed budget, I urge your support for the following priorities: Funding to increase the behavioral health workforce Funding for the implementation of 24/7 Crisis Receiving Centers across the Commonwealth Funding for Youth behavioral services Funding for permanent supportive housing

Clean transportation funding is essential to reducing harmful tailpipe pollution that disproportionately and negatively affects the health of lower income Virginians. Additional funding for transit needs to be designated in order to provide frequent, reliable service for all, and to reduce the number of cars on our roads, particularly for WMATA's Metro. The budget should also include funding for Virginia’s EV Rebate Program, in order to put tax dollars back into the pockets of Virginians who want clean vehicle options that are currently out of their financial reach. For low income buyers, a Virginia rebate would amount to a $125 reduction on a monthly car payment for a 3-yr loan. It has been two years since Virginia passed legislation to create the EV Rebate Program, yet it remains unfunded. Sticker price is the top barrier for people who want to buy an EV. The state rebate would complement Federal incentives to put EVs within reach of lower- and middle-income families, and help reduce tailpipe pollution. While Federal incentives limit consumers’ choices based on where an EV is manufactured, Virginia’s rebate applies to all EVs, giving residents a wider range of options.

Please contribute funds to Virginia's electric vehicle rebate fund, which is currently unfunded. Currently even with federal rebates, EVs are too expensive for many people who want them. Adding a state rebate will make them more accessible to moderate income car buyers and help speed the transition to electric cars. This will produce many benefits for Virginia, including cleaner air and healthier lungs, support for American manufacturing, using electricity produced in the US instead of oil that is dependent on world markets, more progress on decarbonization, and helping consumers save money on transportation.

Comments Document

The comments below are echoed in the attachment. Potomac Conservancy is encouraged to see Governor Youngkin’s budget offer responsible investments in several policies and agencies that advance environmental protections in Virginia and build off existing efforts to bolster a safe and vibrant Potomac River and Chesapeake Bay. Founded in 1993, Potomac Conservancy is the region’s leading clean water advocate, fighting to ensure the Potomac River boasts clean drinking water, healthy lands, and vibrant communities. Potomac Conservancy hopes to make the Potomac region a place where clean water, outdoor experiences, and thriving ecosystems are accessible to and safe for everyone. To achieve this goal, substantive investments must be made in natural resource grants and programs throughout the state of Virginia and along the Potomac River. For that reason, Potomac Conservancy supports increased investments for clean water and land conservation policies. Virginia’s natural resource investments significantly trail other southeastern and mid-Atlantic states, such as our neighbors North Carolina, Pennsylvania, West Virginia and Maryland. According to the Census Bureau, other states spend about double, as a percent of state budget, what Virginia does on natural resources. In recent years, Virginia’s leadership has allowed other state government functions to grow in spending while natural resources have fallen behind. Unfortunately, this trend continues in the governor’s newly announced budget. A variety of grant programs that accomplish natural resource conservation in alignment with Potomac Conservancy’s mission saw drastic cuts or stagnant funding. Together with our partners in the Our Virginia Outdoors coalition, Potomac Conservancy is advocating for increased funding in the final budget for these valuable grant programs: • The Virginia Land Conservation Fund, which only received level funding at $16 million per year. We urge this funding to increase to at least $30 million per year to help meet the demand for lands that can be acquired for conservation purposes. • The Get Outdoors Fund, which received no funding in the governor’s budget. We would urge at least $5 million per year for this fund to bolster equitable access to outdoor recreation. • The Virginia Black, Indigenous and People of Color Historic Preservation Fund, which only received $1 million for 1 year in the governor’s budget. We request that this grant program receive at least $5 million per year moving forward, to protect the sites that tell the full story of Virginia’s history. • The Virginia Farmland Preservation Fund, which saw a 50% reduction in the governor’s budget, receiving only $437,500 per year. We urge legislators to appropriate at least $5 million per year for this program to aid farmers in their preservation efforts. Potomac Conservancy recognizes the meaningful investment in the governor’s budget of $15.5 million for the Virginia Battlefield Preservation Fund over the biennium and urges legislators to keep this funding at its current level when finalizing the budget. Thank you for your consideration and the opportunity to offer these comments. Potomac Conservancy looks forward to working with all legislators to create a budget that bolsters investments in Virginia’s natural resources and helps create a healthy, vibrant Potomac River.

Gov. Youngkin seems to have missed that fact that we've just finished the warmest year on record. His budget offers little (if any) funding for addressing climate change in Virginia. He ignores the State's electric vehicle rebate program (which has yet to be funded), provides no funding for providing energy efficiency programs for low-income residents, and seems to think that $1 million in FY 2025 will take care of all the flood resilence work needed by communities throughout Virginia as we experience more intense storms and more flooding. We really cannot afford two years of non-action on climate issues. I and many others are looking to the General Assembly to address these and other deficiencies. Also it is appalling that the Governor wants to cut income taxes and increase sales taxes -- in other words, give to the rich and screw the poor.

My name is Pat Victorson, President of the Prince William affiliate of NAMI (National Alliance on Mental Illness), and the mother of a son living with bipolar and co-occurring disorders. My son showed signs of a possible mental health condition while in elementary school, but despite our family’s efforts and resources, he was not diagnosed until more than ten years later and could not benefit from early intervention. Since he was then older than 18, as parents we had little input into his treatment and at age 36, he still struggles with his condition. I am writing to support funding to increase the behavioral health workforce, for implementation of 24/7 Crisis Receiving Centers across the Commonwealth, for Youth behavioral services, and for permanent supportive housing. Adequately funded, these are investments that might have made a difference for our son and can benefit current residents of the Commonwealth. In addition, I would also like to address the revenue side of the Governor’s proposed budget, for without adequate long-term fiscal resources, Virginia cannot address community needs for mental health, much less for our schools, transportation, the healthcare system in general, affordable housing, an improved EITC, and other priorities. I am particularly concerned about the Governor’s tax-cut proposal, which compounds Virginia’s perverse system by which low-income families and individuals pay a much higher proportion of their income in taxes than do very wealthy persons. This discordance is exacerbated by the Governor’s proposal to increase the sales tax, which again represents a larger share of the low-income earner’s wages. Low-income earners (whether or not they—like my son—have mental health or other challenges that limit their wage potential) are doubly impacted by these unfair revenue proposals. In devising a new budget for our Commonwealth, please increase funding for mental health services and supports while addressing the need for a revenue stream that is fair and will in the long-term address future needs. This might be achieved by creating a new 10% tax bracket for high income earners, an option proposed by JLARC. Thank you for this opportunity to comment and for your service to Virginia.

Having a state rebate on top of Federal incentives puts EVs within reach of lower and middle income families, and helps reduce tailpipe pollution. Although the cost of owning an EV is lower than that of a fossil fuel vehicle over the vehicle's lifespan, the higher upfront cost of EVs puts them out of reach for many car buyers. Because the rebate would occur at the point of sale, EV buyers would be able to lower their monthly payments and enjoy a wider selection of vehicles from which to choose.

I am writing to show my extreme support for a Wildlife Corridor Grant Fund. It is our legal and moral duty to protect nature. This means protecting our water from chemicals, protecting our wild life from human activity, and protecting our old growth forests. Without nature, we are nothing. Let’s protect this beautiful world we live in. We TAKE so much from nature. We can at least make a small attempt to GIVE back to nature, I’m an highly encouraging the support of funds and resources to protect the nature of Virginia. I demand that the Virginia Government enforces legal and moral practices that help nature, not hurt it.

Comments Document

The attached document contains comments by the Virginia Conservation Network regarding funding for water and resilience, land conservation, transportation, and energy projects. VCN’s full budgetary asks can be found in Our Common Agenda (https://vcnva.org/our-common-agenda).

It’s not often that a budget appropriation has the potential to create gains in multiple domains while also delivering cost savings to the public. Yet such a win-win opportunity exists with the proposed creation of a permanent Wildlife Corridor and Crossing Grant Fund. This fund will safeguard human life and property while generating savings through projects designed to reduce wildlife-vehicle collisions (WVCs). At the same time, it extends a desperately-needed habitat connectivity lifeline to Virginia’s wildlife. Virginia currently ranks ninth among states with the highest risk of wildlife-vehicle collisions. Some 6,100 deer-vehicle collisions were reported statewide in 2022 that resulted in $250 million in property and personal injury damage. This massive waste calls for decisive action to reduce WVC frequency and severity. The Wildlife Corridor and Crossing Grant fund is a critical part of a strategy to address this issue at scale by leveraging relevant large federal grant programs. It builds upon the previously passed Virginia legislation of SB1004 and SB1274 and aligns with Virginia’s Wildlife Corridor Action Plan (WCAP). The fund ins necessary to put the WCAP into practice. We have an ethical obligation to protect Virginia’s wildlife resources for future generations. Good stewardship requires effective and targeted solutions; research has shown that wildlife corridor and crossing infrastructure improvements generate positive outcomes for both humans and animal species. In Northern Virginia especially, explosive growth in land utilization and road construction have fragmented habitats and blocked the natural movement of native species. When roads and other man-made structures block their way, animals get desperate and the results are disastrous. Corridors and crossings incorporate specific design features that give wildlife a good chance at safe passage. For the sake of the animals as well as all of us humans who are risk, I urge you to appropriate $5M for the creation of a permanent Wildlife Corridor and Crossing Grant fund. Thank you.

hey now make sure you: a suport arc of va agenda!) b. get waivers done! c. raise rates on proivders and mentors!!!!!!

I urge you to fund the 2021 Virginia Electric Vehicle Rebate program. I finally bought an EV seven months ago and it was barely affordable thanks to the Federal rebate. We desperately need to reduce the greenhouse gas emissions from the transportation sector in Virginia, and EVs are the way to go. Funding the Virginia EV rebate will enable lower income families to afford cars that will free them from the fluctuations of gas prices and reduce their maintenance costs. No more oil changes! No clogged fuel injectors! Freedom!

Comments Document

The Prince William Commission on Aging’s Budget & Legislative Priorities For the 2024 Virginia General Assembly Session are attached.

I am the sister of a brother who has suffered severely with chronic mental illness for over 40 years. He is 65 and has been involuntarily committed to hospitals in Virginia over 20 times. Thank goodness, he has never been admitted to one of the state hospitals. But that’s not to say that his experiences in several hospitals in the greater Richmond area have been adequate or even successful. He has received services from the Richmond Behavioral Health Authority‘s Assertive Community Treatment team since January 2020; previously he was a client of Henrico County’s Mental Health & Development Services for over 30 years. We are fortunate that he has family support and has had, relatively speaking, compassionate care as a client of these two organizations because of the dedication of underpaid and overworked staff. As the youngest of 4 siblings, he may outlive us. We are very concerned about the extent and quality of care he will receive if/when that happens. For years we have observed first-hand the limitations of Virginia’s mental health system, particularly its woefully inadequate hospitalization processes, treatment, and services.. We have heard for too many years that the system needs more funding, better facilities, and additional qualified staff. JLARC and others have, endlessly it seems, studied the problems and made recommendations. There have been notable advocates in this regard from two state senators: Creigh Deeds and Emmett Hanger. While we are most grateful for their efforts, these clearly have not produced the needed funding or improvements. Our family requests that the finance committees ensure that 2024 will be the year Virginia finally acts to help the many Virginians with serious mental illness. The media has given you many stories to illustrate what’s wrong —most recently, a very informative one dated December 29, 2023, in the Richmond Times Dispatch titled “Getting out: The challenge to leave Virginia state mental hospitals” by Dave Ress. Kudos to Mr. Ress. The issues he raises and explains are complex, but there’s a lot more to the picture. We urge you to educate yourselves. Read the December 11, 2023 JLARC report. Be certain the Governor’s proposed budget puts Virginia squarely on the path to achieving the results that mentally ill Virginians need. In essence, they, like all people, need safe housing, adequate food and regular medical care. They need consistent, caring case management and psychiatric treatment from adequately-paid professionals. They need to be safe and receive humane, effective treatment when they are hospitalized. If this budget proposal falls short, then fix it so it enables these needs to be met. Listen to the experts who work with, assist, and treat the mentally ill. Two worthwhile organizations are NAMI Virginia and Virginia Organizing. We endorse their advocacy. My brother is fortunate that, for now, he has three siblings to support him. But we can’t provide him the proper medical care or adequately safeguard him. It is no exaggeration to say getting this budget right is a life and death matter for many Virginians. Joy Loving, jal_1998@yahoo.com