Comments Document

Good Afternoon, On behalf of the Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO), I have attached a letter of support for HB 278.

My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!

Comments Document

Apologies for submitting attachment which was not submitted correctly last Thursday on HB 858. Testimony Opposing Virginia “Medical Aid in Dying” Bill HB 858/SB 280 One of the most frequently repeated claims by proponents of assisted suicide laws is that there has not been “a single documented case of abuse or misuse.” To the contrary, I refer you to two resources describing problem cases. The first is from the Disability Rights Education and Defense Fund, Oregon and Washington State Abuses and Complications. The second is a journal article by two New York medical doctors, Drs. Herbert Hendin and Kathleen Foley, Physician-Assisted Suicide in Oregon: A Medical Perspective (2008). Data from states where assisted suicide is legal show that all people who request assisted suicide have disabilities, even if some don’t think of their impairments that way, and that unmet disability related needs are their reasons for wanting to die. The top five reasons Oregon doctors give for their patients’ assisted suicide requests over all reported years are not pain or fear of future pain, but psycho-social issues that pertain to disability. Three of these (losing autonomy, losing dignity, burden on family) could be addressed by consumer-directed in-home personal care services, but the law operates as though the person’s reasons don’t matter, and nothing need be done to address them. (See attachment)

I'm here today to speak on HB499, which is very specific to Consumer-Directed Medicaid Waiver Services, more specifically, Routine Visits. During the pandemic, providers were afforded the flexibility to conduct their visits using telehealth methods. Those flexibilities ended in January 2023. We see the person receiving services in person to develop their plan of care and provide training and we would be seeing them in person every 6-months. This Bill would allow CD Providers to see the person for Routine visits in between those 6-month reassessments using HIPAA compliant video methods instead of physically in-person. This would reduce some of the cost to the providers by removing the mileage component, it would be less invasive for the families, and with the rise of respiratory infections like COVID, Flu, RSV, etc., it would keep this vulnerable population more safe if we are not physically in their home as often. Since we are not asking for an increase in the quantity of visits with this Bill, there would be no cost to the state to implement this change. I would encourage you to support this Bill as written and would be happy to entertain any questions you have.

We are need in our communities

We Need Your Support! We were taught that doing small things in a great way is as important as doing great things. However, this isn't always true. Community Health Workers play an essential role in various communities across the state. They perform admirable work, whether it's addressing small, medium, or large tasks. Unfortunately, these positions are at risk of being defunded or disappearing in the next few months. This situation will impact vulnerable people in the communities that really need them (CHWs) the most. One potential solution to this problem is identifying sustainable reimbursement mechanisms that can support and expand the CHW workforce.

My name is Tameca Day and I am an active member of my city and state. It is apparent that our city needs more help in multiple areas and that these issues need immediate attention. As a member of the CHW community it is my understanding that we can greatly assist in small ways that make a huge impact. To continuosly push these efforts we will need to procure and maintain funding to protect our vision. This idea is not an individual security. This mission will continue to rest on the shoulders of those providing and those who seek assistance from trusted liasons where they reside. My hopes are that we can put aside differences and uplift RVA.

I support the organization that is doing all this so that our voice is heard since as health promoters we need a lot of support.

Health promoters need to be given greater support to take care of our community with more resources such as: medical insurance, more health supplies, support for the language barrier

I am the husband of CHW member who give their all to the community with action from going to Door to Door, having social gatherings to inform the community of change to come and how resident can improve and become more successful engaged with their own communities. I have witness with my own eyes the effort and success that CHW have provided for families in need as well as health awareness they provide for resident who may have never knew about so many resources that help in their personal lives. With being in house I am able to see the day to day action of a CHW who put there community first with early morning and late night commitment to helping individuals as well as their families during crisis times including the joyous times once a goal is completed through celebration of a job well done. Back during Covid outbreak it was very challenging time for CHW because they were the liaison between the hospital/ clinic to inform the community about vaccines and Information that was urgently needed on how to treat symptoms, as well how protect against different variants. So being just the husband of the CHW I feel happy for be part of a on growing team who love the their community and willing to go above and beyond to help the residents in it. I believe it in the blood sweat and tears of CHW who want to make there community a better place for all. Just like my great aunt Geraldine Evans in the 90s who took it apon her self to advocate to have a traffic light and crosswalk provided for children crossing the street to achieve their education in school safely. Her name is still labeled and posted on the corner of Muary st and 16th st in Blackwell community with her action she has been titled as The The Mother of Blackwell community. To me that’s the true definition of a CHW at their best . CHWs always be the one of the key pillars of a community. Thank You Dominique Jackson

Mi nombre es José Roberto Sosa soy del area de Williamsburg y soy Promotor de Salud, yo estoy a favor de esta ley, por que e notado los cambios y las diferencias cuando los promotores de salud ayudan a la comunidad.

Dear Delegate Sickles, My name is Jackie Green-August, and I am a certified community health worker in Southside, Virginia (Piedmont Region). I became a CHW because I live in a rural community of 15,535 individuals who rely on three physician practices, several dentists, no specialists, one supercenter, one grocery store, and 11 dollar stores to keep my community healthy. A few years ago, when I learned our county was at the top of the list for the prevalence of Diabetes, I decided I needed to educate people about how to maintain optimal health. Today, I provide a food distribution that feeds 400 people and teach Diabetes Lifestyle Change classes. In small rural communities like mine, the community health workers provide routine check-ins between doctor visits. As a CHW, I offer blood pressure and weight checks, health screenings, food, free fitness classes, SNAP and Medicaid application assistance, and doula services. I connect patients to telehealth, transportation, free clinic visits, and legal aid. I am also a CHW mentor, ambassador, and supervisor, teaching others how to improve their communities through outreach and education. You must hear my story to understand the importance of community health workers and our vital roles in the health and well-being of our families, friends, and neighbors. As CHWs, we request recognition for our work and value. Please amend the state plan for medical assistance services to include a provision for payment for services provided by certified community health workers. Thank you for this opportunity to comment on HB594 and explain its importance.

My name is Kathleen Walsh. My family and I live in Alexandria, Virginia. My autistic twins are 15 years old, Freshmen in high school. It is our hope that they will both be able to participate in and contribute to the community with support from the DD waiver. My husband is a federal employee. I was a lawyer. I now have a rare, progressive disease. As such, I currently receive the Social Security Disability Insurance that I earned. My son writes music and plays the piano. He plays chess and loves video games. He is also writing a fantasy book with his sister. They both love Dungeons and Dragons. My daughter is an artist of a different stripe. She draws and thrives while acting. She also takes karate and enjoys exploring the natural world. My son only recently received the DD waiver. We are currently setting up “community coaching“ services through the waiver. Although my son wants to engage and collaborate with people, he has difficulty understanding social cues and how to join in what’s happening around him. Through the waiver, someone will accompany him into the Community to teach him life skillsband how to read social cues and participate in the real world. We believe this waiver service has the power to broaden his horizons and possibilities for the future. This is particularly important to my family, because we are not able to take him out into the community and focus individually on these skills, because of my disease. My daughter does not yet have the DD waiver. She shares her brother’s needs, but to different degrees and may need different services. The great thing about the waiver is that each person uses only the services that they need. Its being individualized helps both the person grow and participate in the community and the state keep its costs down. As they become adults in a few short years, and especially after we pass away, the waiver supports become critical. Services provided through the waiver that would enable them to live and work in the community are not available through any other means. Community living and job coaching, to name but two. I recently learned that in less than three years, when they turn 18, because I already draw SSDI, the small amount of SS retirement that passes to them could take away all of their support, because they will exceed Medicaid’s monthly income eligibility limit. Please support Del. Shin's bill. HB908. It would allow my children to keep services and be productive members of the community. Knowing that the waiver services will be there to support our children, both now and when we are gone, enables my husband and me not to worry about their ability to function in the future, without us. Finally, Del. Shin’s bill will also provide a revenue stream for the state because they will have to pay any excess income in copays to stay on the Waiver. Your supporting this bill will make it possible for my children to be engaged and contributing members of the community rather than isolated from it. Please contact Del. Shin or Lucy Beadnell with questions. Lucy Beadnell (she/her) Director of Advocacy The Arc of Northern Virginia P: 703-208-1119 x116 Lucy.beadnell@thearcofnova.org www.thearcofnova.org Thank you.

Comments Document

The attachment references Congressionally established Medicaid continuation provisions under sections 1634(c) and 1935 (a)(2)(D) of the Social Security Act. Currently disabled Virginians receiving a Medicaid Waiver must count their gross earnings plus any social security insurance income (SSDI or DAC) towards a Medicaid Waiver income cap. This precludes some disabled Virginians from working at all and prevents others from working the same hours and at the same rate of pay as their non-disabled co-workers.

Comments Document

Testimony for HB908

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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant

Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.

My name is Donald Benson, and my wife and I recently adopted my almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of many disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. • ‘new guardrails’ that will compel many parents of minors to become employees of agencies and demonstrates a bias in favor of agencies and institutions. This makes a mockery of consumer directed service option. • Modify the 40-hour-per-week work limit to allow legally responsible individuals (LRI) with more than one waiver-receiving child to receive reimbursement for 40 hours of work per week per child receiving a waiver; Soft Cap of 56 and this still penalizes families with multiple waiver children • Eliminate the requirement that, in order for a legally responsible individual to receive reimbursement for personal care services, no one else be available to provide services to the member; No other state agency makes the Parent the last option and to be honest if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. Even though the system does not function correctly without these parents, these guardrails seem to assume the worst of intentions on the part of these same parents. • Allow a legally responsible individual or stepparent to be the employer of record when a member under the age of 18 receives personal care through consumer direction. EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents and forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. • DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. o In recent public communications as well as Emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion” • the guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families and in the eyes of many treat these families as guilty until proven innocent.

My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.

My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.

My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.