I was Johnny’s English teacher. Johnny was 15 when the accident happened. I taught him before the accident and briefly after. Later, he was moved to a different school—one better equipped, they said. But his mother stayed in touch. She wanted me to know how he was doing because English had been his favorite class, and I was his favorite teacher. Johnny loved words. He loved Hemingway and Shakespeare. He was a gifted writer and once told me he wanted to become an English teacher. Before the accident, he loved football. I remember his parents at the games, so proud of the young man he was becoming. Those were the happy days. No one imagined a head injury during a school game would alter his life so completely. When he returned to school, the changes were immediate. His words slurred when he was tired. He struggled to find language he once reached easily. He couldn’t recall conversations, follow directions, or understand danger. This was not behavioral. This was neurological. After a dizzy spell and fall, Johnny became profoundly and permanently disabled. He needed constant supervision and care around the clock. His mother quit her job to care for him. She mentioned it briefly, almost apologetically. She learned Johnny’s routines and triggers, the signs of fear she could no longer reason away. After the injury, Johnny spent his afternoons sitting by the window, waiting for his dad to come home. Every day. Same time. Care did not happen in shifts. It happened in moments. I later learned what that care demanded on paper. Electronic Visit Verification required her to clock in and out of a home she never left. A missed overnight clock-in became “no service delivered.” A timesheet was rejected for being “too evenly spaced.” Payments were delayed for weeks over a GPS error. She once wrote to me that she was exhausted. That she set alarms through the night—for Johnny and for compliance. A social worker tried to help. A temporary approval came through. Then it expired. The rules returned unchanged. Johnny’s mother tried to keep up. Then one morning, she collapsed in her kitchen. A heart attack. She died. Johnny’s father tried next. Caregivers came and went—kind people who could not survive unreliable pay and constant penalties. Eventually, Johnny was placed in a facility. His behaviors worsened. He was restrained. He was injured. His father brought him home and quit his job to care for him himself. Then his father got cancer. Then his father died. Johnny was institutionalized again. He ran away. His confusion was mistaken for defiance. He became homeless. He was arrested and sent to a labor prison camp in Louisiana. I later learned Johnny died there—from a seizure. Alone. I am writing this now, weeping, because Johnny was not abandoned. He was outlasted. Outlasted by paperwork. By policies that assume caregivers are endless. By systems that never saw the boy who loved poetry and waited by the window. Johnny did not fall through the cracks. The cracks were built around him. If this is not what policy intends—why does it keep happening? Disclaimer: Johnny is a composite story, drawn from real experiences shared by families, caregivers, and advocates across the disability community. While anonymized, the barriers and outcomes described are real and recurring. Imposing EVV requirements on live-in caregivers harms long-term care for people with chronic disabilities.

Mary Braxton Testimony before the House Appropriations and Senate Finance Committees Of the Virginia General Assembly January 7, 2026 Good morning. My name is Mary Braxton. I am a child care specialist at the Child Care Network in Fredericksburg. I work with child care providers daily to promote high-quality and best practices. For more than 27 years, I was a family child care provider – providing childcare in my home for children birth to age 12. Now, my job is to help child care providers to become licensed and to offer technical assistance to child care providers to strengthen the quality of care. As well as to assist families with understanding what types of child care is available to them to assist with placing their children in a program that best meets their needs. Throughout Virginia, the most recent Census Bureau household pulse survey found that 133,785 parents with young children are not working because they are caring for children not in school or child care. Nearly a million Virginia families with children, 988,210, had difficulty paying for regular household expenses. As you know, child care is expensive. Statewide, the average annual price for center-based infant care is $17,264. The average annual price for an infant in a family day home is $13,728. For many families struggling to make ends meet, child care is just not affordable. This morning, I want to talk to you about two policy issues. First, a 2023 JLARC Report found that the supply of child care in Virginia falls far short of the demand for care. Twice a year, Child Care Aware of Virginia maps the supply of care across the state. In this way, there is a visual that shows available care and what are known as child care deserts – where parents have few or no choices among child care settings. Since 2019, the number of family day homes statewide has declined by nearly 1,000. Family day homes play a critical role in communities, particularly in more rural areas where the economics of operating a center are not viable. Families choose family day homes because they offer a small setting, an opportunity for siblings to be cared for together, and are much more likely to offer nontraditional hour care, which is critical for those in the service sector or parents who work shifts such as nurses and first responders. The General Assembly will consider legislation this session that offers grants to help with start up costs and health & safety compliance for family day homes. This is a targeted strategy to halt the decline in home-based care and grow the supply. We urge you to support it. Second, there are over 13,400 children on waiting lists for the child care subsidy program. About 8,100 are children under age 5 and the remaining 5,300 are elementary school children who need before school or after school care or both. Clearing the subsidy waiting list will mean that more parents can work, which has a direct impact on a family’s well-being and also the state economy. For a strong workforce in Virginia, we must understand that there must also be a stable child care system. And put things in place to assist in stabilizing and supporting the child care system. Thank you for your time today. I also ask that a copy of Child Care Aware of Virginia’s Policy Agenda be included in the hearing record for today. Mary Braxton Early Childcare Specialist

Dear Governor Youngkin and Members of Your Administration, Power reveals values. And moments like this—when a single line in a budget can quietly alter the lives of thousands—are when leadership is tested. As Theodore Roosevelt once said, “A measure of a civilization is how it treats its weakest members.” How Virginia treats its disabled children and adults—and the families who care for them—will be one of the measures by which this moment, and this administration, is remembered. The proposed 2026 budget language requiring live-in caregivers to use Electronic Visit Verification (EVV) may appear technical on paper, but its impact is deeply human. EVV was designed for shift-based care. Applied to live-in caregiving, it misunderstands how care actually happens and places unnecessary strain on families holding our most vulnerable citizens safe at home. Live-in care is not clock-in, clock-out work. It is constant presence and responsibility. It is vigilance through quiet hours and restless nights. Care happens in moments—sometimes visible, often unseen. EVV systems do not recognize on-call responsibility, require repeated overnight clock-ins, and penalize natural rhythms of care, turning devotion into data and humanity into compliance. Virginia is a remarkable Commonwealth within the greatest nation on Earth. Many of us raising children with severe disabilities have spent our lives contributing—working, building, and paying hundreds of thousands of dollars in taxes. We did not choose this path. But when this life was entrusted to us, we chose responsibility, resilience, and love. We chose to keep our children at home, where dignity, stability, and humanity are possible. While individuals with severe disabilities may represent a smaller population numerically, their families do not. Parents, siblings, grandparents, caregivers, educators, and advocates together form a large, engaged, and passionate community. We are voters. We care deeply about disability rights, and we will advocate fiercely for policies that protect our loved ones. We ask you to show us—through your actions—that you care about us as well. Our disabled children and adults deserve to be cared for by people who love them, understand them, and will remain when care becomes difficult. Preserving the EVV exemption for live-in caregivers makes that possible. Eliminating it risks caregiver burnout, fractured families, and unnecessary institutionalization—outcomes that are more costly and far less humane. Governor Youngkin, your administration will leave a legacy. Not only in policies passed, but in the lives protected—or made harder—because of them. You have spoken about valuing families and safeguarding the vulnerable. Actions speak louder than words. This is a defining opportunity to show that Virginia stands with its disabled children and adults, and with the families fighting every day to care for them at home. We respectfully ask you to preserve the EVV exemption for live-in caregivers in the 2026 budget. Use your power for good. For those without a voice. For families who have done everything right and now ask only for dignity and compassion. Respectfully, A Virginia Parent and Taxpayer On behalf of the disability community

As an agency lead that initiates visits to the home, I can speak from experience. the evv apps are terrible and definitely not for live in caregivers. i feel horrible for the independent contractors who have no one on their side and get denied pay frequently in an already over regulated and under paid field. I can at least go through and adjust visits for my staff as I know when they are there and when everything should be signed in for. it's really bad and it's not like it's quick either. It takes forever to load. I sometimes wait 5 minutes for the app to actually open and let me start a shift. Their response? Well just plan ahead and make sure you're ready to log in 5 to 10 minutes before your shift.

Thank you for the opportunity to submit written comments on the introduced 2026–2028 biennium budget (HB30/SB30). On behalf of Didlake, a 60-year-old rehabilitation services organization creating and promoting opportunities that enrich the lives of people with disabilities across the Commonwealth, we submit these comments to inform consideration of disability-related budget items that directly affect service access, workforce capacity, and system outcomes as the General Assembly reviews and amends the budget. We respectfully offer the following priorities: • Support Developmental Disability (DD) waiver rate increases (DMAS Item 291). Maintain the introduced Developmental Disability (DD) waiver rate funding to stabilize the direct support workforce in a high-cost labor market and ensure provider capacity for Community Living (CL) and Family & Individual Supports (FIS) waiver services. • Support and implement acute-care support staff authority (DMAS Item 288). Retain and fully implement language authorizing DMAS to amend the CL and FIS 1915(c) waivers to allow payment, in limited circumstances, for a designated support staff person in an acute care hospital when necessary supports are identified in the individual’s service plan and not otherwise available. • Maintain employment and independent living supports (DARS Item 318). Protect funding for Vocational Rehabilitation, Long-Term Employment Supports, Centers for Independent Living, and brain injury services for individuals with disabilities. • Continue funding for sensory disability services (DBVI Item 329; Department for the Deaf and Hard-of-Hearing Item 330). Maintain operating support for blind/vision rehabilitation services and deaf and hard-of-hearing access services that promote independence, employment, and community integration. • Protect Community Services Boards (CSB) community and ID/DD crisis service funding (DBHDS Item 301). Maintain funding for Community Developmental Disability Services and targeted ID/DD crisis response investments to reduce avoidable emergency department utilization and institutional placement. Thank you for considering these priorities as the budget advances. Dr. Rachel Payne, VP of Advocacy and Public Policy - Didlake

Pushing EVV on live in caregivers shows the state isn't supporting home services anymore; they are not supporting community placements... what are we supposed to do? how can we safely manage those with disabilities at home who need 24/7 supervision? if you know please let me know.....

Public Comment for Public Hearing on Governor's Proposed State Budget Topic: Increase All Categories of Developmental Disability Waiver Reimbursement Rates

Evv for live in caregivers IS the Fraud!!! It's designed to eliminate caregiver availability. Very easy to see!

My name is Chelsey Ewers I am the Director of Government and Community Relations with Chimes International and representing our local affiliate Chimes Virginia. I ask that you focus on increasing the reimbursement rates for the disability community), as well as expanding access to housing and employment for individuals intellectual and/or physical disabilities. Chimes is a nonprofit, with headquarters in Baltimore that assists individuals throughout the mid-Atlantic region with intellectual and developmental disabilities (I/DD) as well as behavioral health and substance use disorder challenges to achieve their fullest potential. Chimes Virginia supports 100 individuals with I/DD through 10 community living residences and 2 day-program facilities in northern Virginia. We also hold 2 federal employment contracts for individuals disabled for the work and operate vocational rehabilitation services in the state. Chimes Virginia has just over 100 staff with the majority of those serving in a DSP role. The work these individuals do is pivotal to the success and well being of each individual with IDD in our care, however DSPs face low wages and a high turnover rate within their field. Far too many DSPs are reliant on other social programs like SNAP to make ends meet or look for work across state lines where reimbursement rates may be higher. Low reimbursement rates and wages are limiting the ability of providers to grow the workforce, programs, and services necessary to meet the needs of the I/DD population in the state as is evident by the growing waitlist for services. The current reimbursement rates in Virginia are vastly inconsistent and underfunded. We ask that you and your colleagues within the legislature recognize that wages for DSPs must reflect an accurate cost of living adjustment and that the state cannot pick and choose which rates to focus on for increases, there must be consistency and transparency in the process. In Virginia, similar to many states there is a growing list of individuals with disabilities waiting to receive housing services. Many individuals have been approved but have been unable to obtain services due to a lack of capacity and affordability. This problem will only continue to grow as the general population ages and caregivers who typically took care of their loved one independently at home are now looking to utilize residential services. Virginia must address the lack of access to affordable housing for individuals with disabilities before it becomes emergent. We have the opportunity to provide long term stability for individuals with disabilities and their caregivers and now is the time to make that investment. By creating stability through housing and employment we allow providers and those we support to reinvest in the communities where we work and live. Each individual with intellectual and/or physical disabilities should have access to employment. Yet many face significant barriers—from finding a workplace that can accommodate their needs to navigating the fear of losing Medicaid benefits once they become employed. We must look at the disability community as an asset to the workforce and Chimes is proof of that. We have individuals disabled for the work that hold security clearances to some of the most high-profile buildings and military facilities in the country including right here in Virginia. We can and should invest in employment for the disability community.

Dear Committee Members, Imagine life as you know it and WHO you believe yourself to be ends. The way you think, express yourself, and physically function are forever altered. Imagine losing your job, your home, your friends, and struggling to understand the new person who has taken over your body and brain. For many people in Virginia who have experienced an acquired brain injury through a myriad of ways including stroke, concussions, motor vehicle accidents, etc., this is their reality. My name is Stacy Stone and I work as an occupational therapist for Brain Injury Services in Northern Virginia. I am writing as an occupational therapist who works directly with individuals and families living with traumatic brain injury (TBI), to express strong support for increased funding to strengthen Virginia’s brain injury safety-net system. In my day-to-day work, I see how brain injury affects far more than physical function. Survivors often experience challenges with memory, attention, initiation, emotional regulation, fatigue, and judgment—difficulties that can disrupt employment, housing stability, relationships, and overall safety. These functional challenges are frequently accompanied by grief, anxiety, and frustration as individuals and families adjust to life after injury. Recovery is rarely linear, and meaningful progress requires consistent, skilled, and specialized support. These services are not a luxury, but a necessity and with rising costs, they are being squeezed to the limits. I have witnessed how effective services can lead to real success and most importantly, how services can provide individuals with new strategies, tools, and social supports to move forward in their lives despite the changes their mind and bodies have endured. With appropriate supports, individuals regain routines, reconnect with their communities, learn compensatory strategies, and rebuild a sense of purpose. Brain Injury Services plays a critical role in making these outcomes possible. Through community-based programs, individualized supports, and coordination with families and providers, Brain Injury Services helps survivors remain safely housed, learn technology skills, stay engaged, and sustain a growth mindset. Without adequate funding, many survivors face waitlists or loss of services, placing them at risk for isolation, missed medical care, medication mismanagement, unemployment, or housing instability. Families are often left to manage complex needs without guidance or relief, increasing stress and the likelihood of crisis. Access to recovery and stability becomes significantly limited when these essential services are under-resourced. The following budget priorities are essential to strengthening Virginia’s brain injury system: Workforce Retention – $1.5 million to address high turnover and retain skilled professionals. Strengthening Community-Based Safety Net Services – $1.3 million to reduce waitlists and meet growing demand. Modernizing Data Collection Systems – $420,000 to improve coordination, efficiency, and outcomes. Investing in these areas supports not only individuals with brain injury, but families, providers, and communities across the Commonwealth. Thank you again for your time, consideration, and continued commitment to the brain injury community in Virginia. Sincerely, Stacy Stone Occupational Therapist

Included is a written statement of my testimony given virtually on January 7, 2026, before the Senate and House Finance Committee Meeting advocating for increasing ALL Developmental Disability (DD) Medicaid Waiver Rates, including the rates inadvertently excluded by the Guidehouse study. I am also advocating for increasing the number of day programs in Arlington, Va, for DD individuals with complex medical and behavioral needs, who are currently being excluded from their local programs because there is not enough qualified staff to care for them. They are instead only being offered to attend day programs hours away from their homes, which is unfeasible.

Attached is my letter to the Senate Finance Committee, submitted as a member of the Chimes Advisory Committee, requesting action to address funding of DSP services and faster clearing of waiting lists for disability services.

EVV (electronic visit verification) for live in care takers threatens decades of advocacy work that created a true Independent Living Model for people with disabilities who wish to live and work in our own communities. EVV for live ins has no place in Personal Care Services or Consumer-Directed Services, or in waiver programs that offer CDS-like options. CDS programs provide the consumer with: choice of service provider; location of service (home or community); scheduling responsibilities; and consumer control. EVV for live ins erodes these rights and eliminates consumers’ ability to direct care at their own volition. Stakeholder groups must include and empower people with disabilities, independent of providers, to be drivers and experts in the development of policies that uphold the freedoms, rights, dignity, privacy, and independence of people with disabilities. EVV a massive financial giveaway to technology vendors of EVV systems. Global Positioning Systems (GPS) and biometrics are a direct and excessive violation of the privacy and potential safety of individuals living with disabilities. Given the growing frequency and size of private data breaches, consumers are or will be required to tolerate additional intrusions and burdens under EVV, just to receive the life-sustaining care on which we rely to live independently and avoid institutionalization. Americans are guaranteed Constitutional protection from these types of privacy intrusions, and disabled Americans demand equal protection under the law.

Good morning. My name is Laura Kim, and I am the Policy and Advocacy Coordinator at the Endependence Center of Northern Virginia, a Center for Independent Living that supports people with disabilities to live and participate fully in their communities. I’m speaking on behalf of ECNV. First, we urge support for SB 33, SB 21, and SB 35, which strengthen mental-health supports for students and justice-involved youth. These bills ensure that young people with complex needs are met with services, not deeper criminalization. Second, please support SB 34, clarifying that guardianship does not automatically remove the right to vote. This must be paired with a broader review of Virginia’s guardianship system to ensure individuals and families have full, informed consent and are not unnecessarily stripped of essential civil and personal rights. Third, we ask you to prioritize affordable, accessible housing, especially for disabled Virginians on fixed incomes who rely on stable housing to live independently. Fourth, we urge investment in police diversion and crisis-response options so disability-related crises are met with appropriate supports rather than enforcement. Finally, please ensure disabled immigrants — including undocumented residents — have access to community-based services and mental-health supports. Thank you for your commitment to these issues as you enter the 2026 session. ECNV looks forward to continued partnership to advance the rights and wellbeing of people with disabilities in Northern Virginia and across the Commonwealth.

Request adequate and equitable increases in developmental disability (DD) Medicaid waiver rates.

Dear Virginia Legislators, I am writing to express my support for Brain Injury Services in Northern Virginia, as well as for all other state-funded non-profit providers throughout Virginia (7 additional providers). Brain injuries impact numerous residents of our state, and our service system requires additional funding to effectively address the demands and unique needs of individuals living in the community. We are requesting enhancements to the Virginia budget to strengthen the brain injury safety-net system in several key areas: Workforce Retention – $1.5 million State-contracted brain injury providers continue to face high turnover and challenges filling vacancies due to non-competitive salaries and benefits. Strengthen Safety Net Community-Based Services – $1.3 million Programs across the state are maintaining waitlists and struggling to meet current demand from a population with highly specialized needs. Modernize Brain Injury Data Collection Systems – $420,000 Updated technology and business processes are crucial for enhancing client care, fostering coordination among providers, and achieving improved outcomes and system efficiencies. Thank you for your time and for your past and continued support of the brain injury community.

The elimination of this exemption adds undue administrative burden to the State and to care-giver attendants with no measurable gain. This is type of administrative excess is a waste of resources for all involved and has no place in a system already strapped for resources. Live-in caregivers fill a critical gap in care for disabled love ones the market has been unable to address. This is due to the unique services provided by live-in caregivers. EVV does not reflect this unique type of service, which is may be delivered overnight and in intermittent and on call increments that do not align to ‘shifts’. Applying EVV to this care is yet another UNNECESSARY administrative burden on caregivers and the Medicaid system without measurable impact and likely NEGATIVE cost impacts for DMAS with yet another process and system to MANAGE and MAINTAIN. The unique care provided by live-in caregivers keeps disabled children and loved ones out of state run institutions, hospitals, and improves health outcomes REDUCING Medicaid medical costs. Do we really need to add additional complexity and waste to the Medicaid system and additional hurdles for disabled people and their families being contributing members of the community?

My mom has a long and storied legacy of service to the commonwealth under DBHDS, as one of the chief architects of the commonwealth's deinstitutionalization and substantive community integration of individuals with development disabilities and severe mental illness after the landmark settlement with the DOJ. The commonwealth has made enormous progress in the last fifteen years in supporting thousands of individuals with disabilities to exit dangerously understaffed and restrictive facilities and instead live fulfilling lives in the community. Every time we talk, however, I sense how much closer we are to unraveling all of this progress and dumping the most vulnerable Virginians on the streets. With HUD's imminent withdrawal of support for permanent supportive housing and rental subsidies earmarked for individuals with disabilities, she predicts that we have about six months until we run out of reserves and default on subsidy payments, causing a mass exodus of thousands of individuals from the supportive housing that sustains them today. I know full well we can never fill the vacuum left by the federal support. People are going to be evicted, incarcerated, left behind, and in many cases, left for dead. But I believe the commonwealth has a duty to mitigate the effects of this incoming crisis with every tool at its disposal - if there is an opportunity to put our resources towards the material needs of the most vulnerable Virginians, we have a moral obligation to do so. One glaring opportunity to redirect funds lives in the budget of the Virginia Israel Advisory Board, the only economic advisory board in the state to receive taxpayer funding. VIAB's chief purpose is to divert state, local, and federal development incentives to Israeli companies at the expense of other businesses, including those from the Commonwealth. Our taxpayer dollars essentially fund a lobbyist for Israeli industry within Richmond, a privilege afforded to no other nation, nor to companies actually run by Virginians from underrepresented communities. VIAB will receive $304k this year, and the proposed FY27-28 budget would increase that to over $316k, once again beyond the rate of inflation. In the scale of a state budget, that might be a drop in the bucket, but let's think about that number in terms of the actual material needs of Virginians. $304k could finance a year of housing subsidies for 15-20 Virginians with disabilities. That's 15-20 more individuals who would otherwise be cast out on the street in the next 6 months when their HUD subsidies expire. That's 15-20 more disabled Virginians who can live in dignity, not retraumatized through incarceration or warehousing in the facilities the Commonwealth has worked so hard to shut down. VIAB's defenders claim that they bring in far more in taxpayer dollars than they cost the commonwealth. I would argue that VEDP, which pursues investment from across the globe without a baked-in bias towards a single genocidal regime, is far more effective at generating tax revenue for the state of Virginia. VEDP can direct companies to apply for economic incentives based not on some misplaced sense of loyalty to a single foreign nation, but on their actual viability and potential contribution to the Commonwealth. A budget is a moral document, and Virginia has a moral obligation to protect its citizens facing imminent catastrophe, rather than funding lobbyists on behalf of foreign industry and supporting genocide.

Hello, My name is Michael Beer. I live in Arlington. My spouse is a public teacher. My son attends UVA. I am grateful for your service. I hope and believe you can lead Virginia (and the nation) toward curtailing corruption, support equality for all including the vulnerable among us, make our taxes much more progressive by taxing corporations and people like me more, supporting Ranked Choice Voting additional reforms, and investing powerfully in halting climate chaos. ­ Today I'm here to talk about a small but significant line item: the Virginia Israel Advisory Board. When a wealthy foreign country can influence our state government to specially subsidize its businesses—something we do for no other nation among 194 countries—that's corruption. When legislators tell me the $300,000 is "too small" to spend political capital on terminating, that's exactly how corruption persists. This isn't about the dollar amount. It's about the principle. Will Virginia's government favor harmful special interests, or will we serve all Virginians equally? This is corruption. We've mis-spent over $5 million in taxpayer funds on VIAB over 30 years. Meanwhile, Virginians of Palestinian, Lebanese, and Syrian heritage watch their tax dollars support an Israeli state engaged in vast killing, theft and occupation. Where is the $5 million each for Palestinian, Lebanese and Syrian Advisory Boards? This is so profoundly racist and corrupt. We want our tax dollars to increase pay for teachers like my spouse, and to decrease class sizes, not to subsidize a wealthy self-avowed apartheid state. Virginia knows something about the ongoing legacy of apartheid. We have a shameful history. Why are we subsidizing Israeli apartheid in 2026? This can only be explained as corruption. We want tax dollars to better fund higher education for my son at the University of Virginia. Why are we instead subsidizing corporations that are deeply engaged in the holocaust in Gaza? Virginia knows something about holocausts. We have a shameful legacy of genociding the native peoples of Virginia. Subsidizing genocide. This is corruption. Virginia shouldn't be in the business of providing tax dollars for one wealthy foreign country that is able to afford universal health care that you are unable to provide your own citizens. This is corruption. Funding VIAB does not increase Jewish safety. It feeds tropes that Jews are manipulative and controlling the country and the world. If you care about Jewish safety, if you care about ethical use of taxpayer funds, if you care about all Virginians, including Muslims and Christians—end VIAB now. And please don’t let the conference committee slip this funding in the secret room near the end of the session. Send a clear message to our grossly corrupt President and Supreme Court in Washington DC and to all Virginians that change is finally here. Virginia will not tolerate corruption or favoritism. We serve all Virginians equally. Oh, and we will save some money in the process. BTW, don’t pat yourselves on the back by just ending VIAB. It is not enough to stop subsidizing apartheid and genocide. Next year we need to bring divestment and boycotts to make sure we stop supporting these criminal endeavors. Shalom.

Dear Members of the Virginia Budget Committee, I am writing to share my perspective as a development professional who has spent the past four years working closely with our staff and individuals living with brain injury and their families. Every day, I see both the challenges and the resilience of this community. Staff work tirelessly with survivors to rebuild memory, communication, mobility, and independence—often while navigating housing instability, unemployment, social isolation, and complex medical and behavioral needs. At the same time, I witness remarkable successes: individuals returning to work, reconnecting with family, engaging in their communities, and regaining a sense of purpose and stability. At Brain Injury Services, we support survivors and families through our community-based, person-centered programs that provide long-term rehabilitation, case management, clubhouse services, mental health and assistive technology supports, and peer connection. These services are often the difference between isolation and engagement, crisis and stability. Our programs help individuals remain housed, reduce reliance on emergency services, and build skills that allow them to live more independently and with dignity. Families/caregivers also benefit from education, support, and reassurance that their loved one is not navigating recovery alone. Without access to Brain Injury Services—or without adequate funding—many individuals would face long waitlists, fragmented care, and a lack of specialized support. Recovery would stall, preventable crises would increase, and families would be left without guidance or relief. Community-based brain injury services are a critical safety net for a population whose needs do not diminish over time and often intensify without consistent support. For these reasons, I respectfully urge your support for the following budget priorities: Workforce Retention – $1.5 million, to address ongoing staff turnover and unfilled vacancies caused by non-competitive salaries and benefits. Strengthen Safety Net Community-Based Services – $1.3 million, to reduce waitlists and meet growing demand for highly specialized brain injury supports. Modernize Brain Injury Data Collection Systems – $420,000, to improve coordination, client care, outcomes, and system efficiency across the Commonwealth. Thank you for your time, leadership, and for your past and continued support of Virginians living with brain injury. Your investment makes a meaningful difference in the lives of survivors, families, and communities across the state. Sincerely, Andrew Wilinski 571-970-8546

My name is Katy Schnitger, and I serve as the Manager of Advocacy, Outreach, and Development at Brain Injury Services. I am also a brain injury survivor. In 2007, I sustained a traumatic brain injury in a catastrophic fireworks accident. While my physical injuries eventually healed, I quickly learned that recovery from a brain injury does not end when medical treatment ends. Like many Virginians with brain injuries, I faced ongoing cognitive, emotional, and functional challenges long after my doctors told me there was nothing more they could do. For several years, I struggled to navigate daily life and rebuild a sense of stability. In 2010, I connected with Brain Injury Services, and that support fundamentally changed the trajectory of my recovery. Through specialized, community-based brain injury services, I relearned essential life skills, rebuilt my confidence, and ultimately returned to work. These services did not simply help me survive—they helped me rebuild a meaningful, productive life. Today, in my professional role as Manager of Advocacy, Outreach, and Development, I work to ensure other individuals with brain injuries and their families can access the same supports that were critical to my recovery. Unfortunately, many Virginians cannot. Providers across the Commonwealth are struggling with workforce shortages, maintaining waitlists, and operating with outdated data systems that limit coordination and efficiency. These challenges directly affect access to care and outcomes for a population with highly specialized, long-term needs. For these reasons, I strongly support the following budget amendments: $1.5 million for workforce retention. State-contracted brain injury service providers continue to experience high staff turnover and difficulty filling vacancies due to non-competitive salaries and benefits. Without a stable and qualified workforce, providers cannot meet existing demand, expand services, or ensure continuity of care. $1.3 million to strengthen safety net community-based services. Programs across Virginia are maintaining waitlists and struggling to meet current demand. Strengthening this safety net is essential to preventing isolation, unemployment, and unnecessary institutionalization—outcomes that are both costly and avoidable. $420,000 to modernize brain injury data collection systems. Updated technology and business processes are critical to improving care coordination, supporting providers statewide, enhancing accountability, and achieving better outcomes and system efficiencies. Brain injury is a lifelong condition, and recovery is a long-term process. With appropriate community-based supports, individuals with brain injuries can work, contribute to their communities, and live with dignity. My own experience reflects what is possible when these services are adequately resourced. I respectfully urge approval of these budget amendments to stabilize the workforce, strengthen community-based services, and modernize system infrastructure. These investments are fiscally responsible and reflect the Commonwealth’s commitment to equitable, effective care for Virginians with brain injuries. Thank you for your consideration.

As a professional who has worked closely with individuals living with brain injury, I see every day how invisible yet life-altering these injuries can be. Survivors often face challenges with memory, emotional regulation, executive functioning, employment, and community integration. Tasks that once felt automatic—managing appointments, maintaining relationships, or returning to work—can become overwhelming. At the same time, I also witness remarkable resilience. With the right supports, individuals rebuild routines, regain independence, reconnect with their communities, and restore a sense of dignity and purpose. Brain Injury Services plays a critical role in making these successes possible. Through community-based case management, vocational supports, skills training, and family education, BIS meets survivors where they are and walks alongside them through recovery and long-term adjustment. These services do more than address symptoms; they create stability, reduce isolation, prevent crises, and support families who often become informal caregivers without preparation or resources. Without Brain Injury Services—or without adequate funding—many survivors would face long waitlists, fragmented care, or no support at all. This often results in increased emergency room visits, housing instability, unemployment, caregiver burnout, and involvement with more costly systems such as hospitals, corrections, or long-term institutional care. Access to recovery and stability would become a privilege rather than a lifeline. To strengthen Virginia’s brain injury safety-net system, targeted investments are urgently needed. Funding for workforce retention ($1.5 million) would help address high turnover and staffing shortages that disrupt continuity of care. Additional support to strengthen community-based services ($1.3 million) would reduce waitlists and ensure individuals with complex needs receive timely assistance. Modernizing brain injury data collection systems ($420,000) would improve care coordination, outcomes tracking, and overall system efficiency—benefiting both providers and the Commonwealth. Thank you to our legislators for your time and for your past and continued support of the brain injury community. Your investment directly impacts the lives of survivors and families across Virginia, helping them move from survival toward stability, independence, and hope.

I am Scott Cameron, President of the Virginia Association of Soil and Water Conservation Districts (VASWCD). The Virginia Association of Soil and Water Conservation Districts is a private nonprofit association of the 47 soil and water conservation districts in Virginia. The VASWCD’s members are all elected and appointed directors of those 47 districts. Virginia’s soil and water conservation districts were established in the 1930’s as political subdivisions of the state in response to the pressing need for the conservation of our natural resources in the Commonwealth. Each local district is directed by a board of elected and appointed directors who are elected in general elections and serve four-year terms. In addition to my role in the VASWCD, I am also Chairman of the Northern Virginia Soil and Water Conservation District, which serves Fairfax County’s 1.2 million resident. The VASWCD is very concerned that the outgoing governor’s budget inexplicably zeroed out the Virginia Conservation Assistance Program (VCAP), which has proven to be an extremely popular and environmentally beneficial conservation program across the Commonwealth, particularly in the urban and suburban areas of Virginia. There is a significant backlog of unmet need for VCAP. Urban/suburban programs complement the Agricultural Cost Share Program. SWCDs currently have qualified, trained, and experienced staff and are well-positioned and capable of implementing a wide range of voluntary urban best management practice (BMP) cost share practices for private commercial and residential landowners. Virginia’s Phase III Watershed Implementation Plan recognizes a need for urban/residential BMPs in its “Local Implementation Strategies for Urban/Suburban Source Sector,” including a cost-share program strategy. Please restore full funding for VCAP. In fact, we would like the General Assembly to enhance support for VCAP to help Virginia more effectively achieve the Chesapeake Bay Agreement, by funding VCAP at $8 million over the biennium. Thank you for your consideration and support.

Hello, my name is Kerensa Sumers. I live in Manassas, Virginia, and I’m a proud member of SEIU Virginia 512. I have worked as a care coordinator for individuals with disabilities since 2013, and before that, I was a Direct Support Professional. I have seen this system from every angle, and I am here to urge you to tell you that investing in our state’s home care workers must be a priority in 2026. The Problem Right now, we are creating a deficit of care. In high-cost-of-living areas, it is nearly impossible to find and keep workers. We are driving people out of the profession with poverty wages, a lack of benefits, and limited training. To fix this, we must give home care workers the right to collectively bargain and pay them a living wage, with good benefits. The Solution The numbers are clear. If we fail to invest in home care, the alternative is even more expensive. When home care workers aren’t available, working families are forced to place their loved ones in costly, long-term care facilities,nursing homes, or group homes We don't have enough of these facilities to meet the need and have historically cost the Commonwealth billions in meeting regulations, maintenance, staffing, and lawsuits. Investing in home care is cheaper and safer, and allows the most vulnerable members of our community to live and age with dignity. Making home care jobs a sustainable mode of employment also produces an additional revenue stream for the state. Providing 28,000 workers a living wage and health insurance will reduce reliance on Medicaid, reduce strain on public health providers, and allow for more people to participate more fully in our economy. This will only benefit Virginia and Virginians. Rather than increasing costs, investing in good, unionized, home care jobs will save the state billions and boost our economy. Closing We have a choice: We can continue down a path where home care workers continue leaving the profession, forcing working families to either lose their employment or turn to expensive care facilities, Or, we treat home care like a viable, respected profession; it is, and workers can earn a living wage and fully participate in our economy. Thank you.

EVV for live ins costs the Medicaid recipient - the poorest Americans. To be eligible for Medicaid and personal care services, consumers must meet severe income and resource limits. This income is typically around $1,000 per month total. Consumer resources or assets generally cannot exceed a cumulative value of $2,000. Nonetheless, all proposed EVV electronic visit verification for live ins requires the consumer to spend part of their meager resources to regularly access, maintain and pay for secondary services. These may include regular tech assistance, smart phone purchase, cellular data plan, internet connection, landline telephone connection, electric utilities for charging devices, etc. These EVV mandated costs may seem inconsequential to many, but for Medicaid recipients, usually on a fixed income, these requirements mean the difference between having enough to eat or going hungry at the end of each month. Strike down EVV for live in caregivers.

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In 1990 Douglas Wilder- then acting governor- released a state-wide resolution on divestment from business with apartheid South Africa. In 2026 Virginia must cut funding to Israel from its budget. The Virginia-Israel Advisory Board was founded in 1990 and is the only taxpayer-funded advisory board in the state. Virginia taxes should go to improving Virginia, not to a foreign country that is being investigated by the world’s largest court for war crimes and genocide. VIAB has continuously operated in a ‘grey-area’ manner with most Virginians not even being aware of its existence. It’s time Virginia removes funding for VIAB and focuses its resources on our schools, infrastructure, and local businesses.

As the Executive Director of a private non-Profit organization which provides specialized housing and residential supports to individuals with developmental disabilities and complex medical support needs through the operation of 17 group homes, I want to reiterate to the honorable General Assembly members that significant DSP workforce issues persist within our industry. Rate increases are needed for all DD support services in order to attract and retain quality staff. At minimum a 3% increase for all services non included in the Guidehouse study along with an additional 4.7% increase on top of that to deal with the DD service provider business sustainability implications of the increase in the state minimum wage is needed. Further, funding for companion staff, from our group homes and respite programs, while our residents are in acute care facilities (hospitals and rehab centers) is essential. Having a familiar face who understands the needs of the individual while he/she is ailing and in an unfamiliar setting helps to facilitate the individual's cooperation with treatment and yields better clinical outcomes.

Under the Virginia Medicaid Waiver, increased funding is needed to raise personal care attendant rates to ensure adequate staffing and quality services for individuals with disabilities. Current rates make it difficult to recruit and retain caregivers. Additionally, expanded access to respite care is essential to support family caregivers, prevent burnout, and maintain safe, sustainable care in the community.”

Hello, I am Angela Comiskey and my family lives in Prince William County. I am writing today on behalf of my son, who has severe developmental disabilities. Our family relies on Medicaid Waiver Services for his care—specifically, nursing, personal assistance, and respite care. My son is almost 22 years old. At six months, he developed infantile spasms, a type of seizure, which halted his development. Because of his weight and physical limitations, it takes two people to move him, even with a Hoyer lift. Tasks like showering, changing clothes, and changing his diaper always require two people. To keep him at home, we need reliable, quality help. With the support of nursing, respite, and personal assistance, my son has been able to live at home. This is where he belongs, and I wouldn’t want it any other way. But we can only do this if the right supports are in place. That is why I am asking you today to increase the funding provided to nursing staff, personal assistants, and respite care workers. Individuals like my son depend on these services. Increasing reimbursement rates will help agencies attract and retain skilled nurses and assistants for families like mine. I also want to address the budget for developmental disability waivers. This year, my son’s allocation for personal care and respite services was reduced, even though his medical condition has not changed. I urge you to ensure that individuals like my son receive the services they need to live in the least restrictive environment—their family home. Without these supports, my son and others like him risk unnecessary hospitalizations or placement in institutional care or nursing homes. This would not only cost the state more, but more importantly—would cause these individuals to suffer. Studies show that loss of waiver services can lead to unnecessary hospitalizations, caregiver burnout, and forced institutionalization—not because it’s better, but because it’s the only option left. Waivers are not luxuries; they are lifelines that keep families together and individuals thriving in their communities. I ask you to remember that behind every budget line is a real family, and a real person who deserves dignity and the chance to thrive at home. By investing in Medicaid Waiver Services, you are not only saving the state money, but you are also choosing compassion and supporting the right of every Virginian to live in the least restrictive, most fulfilling environment possible. Please protect and strengthen these essential supports for our most vulnerable citizens. Thank you for your time and your commitment to making a difference.

Greetings, Chair and members of the committee. Thank you for your time and for your ongoing support of Virginia’s brain injury community. My name is Jess Linquist, and I serve as an Intake Case Manager for Brain Injury Services in the Northern Virginia region. Every day, I work with people whose lives changed in an instant after an accident or medical event--including teachers, parents, first responders, lawyers, even toddlers. These survivors face challenges most of us never imagine: relearning basic skills, managing memory loss and mental health concerns, and navigating an incredibly complex healthcare system --All while trying to stay financially afloat. Without help, many do end up isolated, unemployed, and even homeless. As the first face that most of our clients meet, I often think of something I learned in my previous work in domestic violence intervention: Sometimes, you will meet someone on the worst day of their life. In this role, I meet people in the worst year—or even decade—of their life. Brain Injury Services provides a lifeline to help them move forward. Whether it’s through case management, day programs, employment and volunteer services, skill-building, counseling, social programs, or support groups… We take a holistic, team-oriented approach to connect clients with the resources they need. We also help families understand what recovery looks like and give them hope. To quote a current client of ours: “To have you mirror back to me what I've been screaming into the universe is so powerful.” We heard her when no one else did, and that is the power of these services. But demand far exceeds capacity. Programs across Virginia have waitlists. Staff turnover is high because salaries can’t compete. And without modern technology, we struggle to track outcomes and coordinate care efficiently. If funding doesn’t keep pace, survivors will wait months—or even fall through the cracks, costing the state far more in emergency care and disability benefits. That is why we’re asking for your support for three critical investments: (1) To support workforce retention (2) To strengthen community-based services and reduce waitlists, and (3) To modernize data systems so we can improve care and measure impact statewide. These are modest but essential steps to ensure every Virginian with a brain injury has a chance at recovery and stability. Thank you for your time and for your continued commitment to the communities we all serve together. Your support truly changes lives.

Regarding the Governor’s language on Electronic Visit Verification (EVV): We strongly oppose the Governor’s language which would remove the exemption for the live-in caregiver requirement to use EVV to login. The most obvious reason we oppose this is in the name itself, Electronic VISIT Verification. A live-in caregiver is not a visitor and as in our case, many of the live-in caregivers are family members. My adult son is a medically fragile individual with a severe seizure disorder. He requires constant around the clock care. We want to keep our son at home where he belongs. He has agency directed nurses and my husband is his consumer directed live-in caregiver. Requiring a live-in caregiver to clock in and out, often multiple times per day, is ludacris. The care my son needs is around the clock, yet with many cuts in hours by the state - against doctors orders may I emphasize- we are providing more care than the hours provided. So it’s silly, and actually inaccurate, to request that we clock in and out for any given “shift”. During a call with the state for a routine renewal meeting, the representative from the state actually suggested that my husband clock in and out multiple times per day, when my son needed trach care or needed to be fed via his G-tube and that I should provide that since those are not qualified duties for an attendant. I was teleworking at the time and she suggested that I schedule his trach care and feeds around my meetings so I could do those duties. I asked her if I should also ask my son to not have seizures or quit breathing while I was in meetings either. As you can see, it’s ridiculous. Please oppose the Governor’s language regarding removing the exemption for live-in caregivers to have to use EVV.

At the risk of sounding emotional, I must tell you that it is hard to not despair. If the Virginia budget does not increase DD Waiver rates to market appropriate levels, our state population of waiver recipients and their families/caretakers will continue to slide into even more dismal daily situations. I write to you as the 74 year old mother of a 41 year old adult with disabilities. I know this terrain and what it does to people – both the disabled and the people who love them and the people who work with them. My family has lived in this world for 39 years. If you have been lucky or blessed enough to just be an onlooker and not a participant in this disability world, I would encourage you to take a closer look. Over this lifetime I have visited many group homes and independent living situations and seen the disheartening conditions in which many of your disabled constituents live. Trying to find day support to provide more than warehousing is a constant challenge for most families. Dealing with disinterested or unqualified staff that come and go or retaining good staff are constant HR nightmares. Having reliable safe transportation to get to work, to doctors appointments or day programs can consume an unbelievable amount of time and mental stress. While my husband and I are alive we do everything we can for our daughter with multiple disabilities to have a decent life. It has been a full time job. It’s the time after we are gone that terrifies us and other parents. If we cannot rely on our leaders, like you, to ensure that our state adequately will care for our most vulnerable citizens, then we do have reason to despair. We need our electors to work with us not against us by just ignoring the reality. We all know that the costs of living are rising at shocking rates. Our DD Waiver population feels this even more intensely than the general population. I sincerely ask you to increase the DD Waiver rates for all services to realistic and appropriate market levels. Paula DeRoy (paula.deroy@gmail.com) 703-764-1043 4728 Eddystone St Annandale, VA 22003

Vote NO to EVV for live in care providers. The punitive proposition that Americans with disabilities and the caring live in providers who work with us must be surveilled by EVV is ethically untenable and socially archaic. It reverses gains of the Independent Living Movement, turning back to the default of unnecessary institutionalization, and strips Americans of their Constitutional rights to personal privacy.

I am the parent of a 15-year-old son with Level 3 autism and high support needs, and I am his paid live-in caregiver under Virginia’s CCC+ waiver. My son requires continuous supervision and care throughout the day and night, including support for unpredictable medical, behavioral, and safety-related needs. Although my son attends school, I must remain available during the school day to respond immediately if his needs exceed what the school can safely manage. These situations are unpredictable and can require me to pick him up with little or no notice, making traditional employment impossible. Electronic Visit Verification (EVV) was designed for short, scheduled service visits and does not reflect the reality of live-in caregiving. Requiring live-in caregivers to clock in and out multiple times a day and night creates an artificial documentation burden that does not improve care and can result in delayed or denied payment for work that has already been performed. EVV places unnecessary technological and administrative strain on family caregivers and can feel punitive rather than supportive. The Centers for Medicare & Medicaid Services (CMS) allows exemptions from EVV for live-in caregivers because this model of care does not fit a visit-based system. These exemptions have enabled families like mine to safely care for our loved ones. I urge you to reconsider applying EVV requirements to live-in caregivers and to preserve existing exemptions that recognize the continuous, on-call nature of this care. Doing so will help sustain caregiving for families such as mine. Thank you, Amy Shaffer Falls Church, VA 22043

Please do not eliminate the exemption from EVV for live-in caretakers. My live-in caretaker is on duty and ready to serve my severely autistic and intellectually disabled 23 year old son, who is a grown man with limited communication abilities and severe behavioral meltdowns at random times everyday. He is currently not in a day program because he kept coming home bruised and assaulted. Despite numerous APS reports being filed, the day program was not held accountable, and now the safe place for our son is in the home until a suitable alternative program can be found. A live-in caretaker is essential to serve our son and keep him safe. He needs help with every aspect of daily life, from basic communication to safety and welfare. EVV adds another layer of difficulty and burden to an already difficult situation. Please do NOT allow EVV exemption to be eliminated for live-in caretakers. Thank you.

Request for iVV Exemption for Parent Caregivers I request that parent caregivers be exempted from iVV clock in/out requirements. This system was designed for agency shift workers and fails to capture the reality of parent caregiving for children with complex neurodevelopmental needs. Some may argue overnight monitoring and crisis response are simply "what parents do." This ignores a critical distinction: these are not typical parenting responsibilities. The average parent does not need specialized de-escalation training. The average parent does not face situations where an improper response could result in injury. The average parent can sleep through the night, hire a babysitter, and maintain a career. Parent caregivers under the CCC+ waiver are performing skilled care that outside caregivers often cannot safely provide. Why do parents become the only option? Outside caregivers lack the skills to keep our children safe. De-escalating a tantrum requires precise skill—a raised voice, unexpected touch, or misread cue can trigger dangerous escalation. We become caregivers because we are the only ones who can do it safely. These developmental years are irreplaceable. We sacrificed careers—leaving professional positions with higher salaries—because our children needed us and no one else could fill the role. We already fight to keep the hours we have. The approved hours do not reflect hours we actually provide. Even those are not guaranteed—we must repeatedly justify medical necessity to insurance companies attempting to reduce services. We spend hours preparing documentation and appealing decisions. Adding iVV requirements layers another burden onto families already stretched thin. The app cannot capture our reality. It does not track nights we wake multiple times—every night—to redirect unsafe behavior or calm anxiety. During weeks of increased anxiety, this means waking at 2 a.m., again at 3:30, again at 5. These hours are never compensated. When my child is escalating, I cannot pause to open an app. Attempting to do so during a crisis can make it worse. By regulation, parent caregivers cannot bill respite hours. Practically, there is no one we trust to leave our children with. We have no personal time. All our time is dedicated to our children, and the vast majority goes uncompensated. The iVV system asks us to clock in and out of a role we never leave. I ask the committee to grant an exemption. Alternative methods—monthly attestation or service logs—would reduce burden while providing accountability. There is a painful irony: the system demands precise documentation from caregivers it prohibits from receiving respite. We must account for our time with app-based precision while being denied any mechanism for relief. The system asks everything of us and then asks us to document it too. Full statement attached.

Vote NO to EVV for live in caregivers. Don't force a system that does not work well on live in caregivers especially when there is a system already in place for live ins that is working. Caregivers that visit in Virginia have constant issues with EVV and the agencies involved WILL NOT admit fault. One of many examples: when you can't log out, no one answers. When you call the agencies for tech help; they don't return your call for days. Then the employer gets a threatening call about your services being changed. Don't add EVV to the already burdensome care giving job. Just don't.

My name is Philip Farah, I live in Vienna, VA, and I am a member of the Palestinian Christian Alliance for Peace (PCAP.) and the VA Coalition for Human Rights. PCAP is a nationwide group that advocates for peace with equal rights for all. We are calling for cutting all funding for the Virginia Israel Advisory Board. We have relatives who were killed in Israel’s genocidal war in Gaza. My relative, 84-year old Ms. Elham Farah had sheltered in her Church of St. Porphyrius, with hundreds of church members. Israel has destroyed most of their homes and businesses. St. Porphyrios is the 3rd oldest church in the world, but that didn’t stop Israel from bombing its premises, killing 19 people. Elham survived and moved to the Church of the Holy Family, only to be shot in the leg by an Israeli sniper soon after. She bled for many hours before dying; anyone trying to pull her to safety was shot at. Other elderly relatives died because of Israel’s severe restrictions on medicine. We know other families in Virginia who have collectively lost many hundreds of their Gaza relatives. Virginia Israel Advisory Board boasts that it has helped 25 Israeli so-called defense and cyber firms to build and grow their operations in VA. At least some of these have been complicit in what most human rights organizations consider a genocide. Some of these companies advertise how their Artificial Intelligence systems identify targets for Israeli weapons—targets like my 84-year old relative, Ms. Elham Farah, sheltering in her church. Why are VA lawmakers using our tax dollars to fund an outfit that helps Israeli military and surveillance companies locate in VA, companies that have been complicit in genocide? Why are we doing this at a time when the proposed budget is calling for reductions in vital programs, like supporting dental care for adult Virginians? I urge lawmakers to do the right thing and vote to end all funding for VIAB.

EVV does not support family caregivers. Family provide the best outcome for our family. Working full time in law enforcement, I have to have someone that is dependable and reliable to watch my adult child.

My name is Jema Bryson, and I live in Leesburg, Virginia. I am a proud member of SEIU Virginia 512 and a Supervisor with Loudoun County’s after-school childcare program. I have worked with children for over ten years and help design curriculum for our after-school enrichment programs. I am here to strongly oppose the proposed changes to the Standards for Licensed Child Day Centers, 8VAC20-781. Like many of my coworkers, I chose child care because it is my passion. I love creating environments where children feel safe, supported, and empowered to learn and explore. The proposed regulation would make this nearly impossible. Increasing the number of children assigned to one staff member while lowering qualification requirements raises safety risks and significantly lowers the quality of care. This regulation increases the staff-to-child ratio for school-age children from 1:18 to 1:20, with loopholes allowing ratios up to 1:22 in “temporary” situations. The state’s own Economic Impact Analysis admits this change allows centers to earn an additional $18,800 annually per staff member. This is not about children—it is about budgets. Children are being treated as numbers to balance costs. I know this fails because I am living it. When Loudoun County programs became unlicensed last year, ratios immediately increased. Since then, staff have been stuck in damage control instead of meaningful programming. When ratios rise, the first children to suffer are those who need us most—the child with ADHD, the child learning English, or the quiet child who needs extra support. In large groups with limited adults, those children are overlooked. This regulation also lowers staff qualifications, allowing individuals with no child care experience to lead large groups. While I do not have a college degree myself, I have over ten years of experience. Not everyone entering the field has that foundation. Managing children is skilled, dynamic work. Overloading ratios with untrained staff turns learning into crowd control. That is unsafe for children and unfair to staff. We cannot lower standards and raise ratios at the same time. Virginia’s programs should strive for excellence, not containment. We need support and funding—not dangerous shortcuts. I urge you to vote NO on 8VAC20-781. Do not lower the bar for Virginia’s children. Thank you.

ServiceSource is a non-profit organization that provides services and employment opportunities to individuals with disabilities in Virginia. With 54 years of experience, we have served as a Medicaid Waiver provider since the early 1990s and are affiliated with both vaACCSES and Virginia Network of Private providers (VNPP). We respectfully request your support for reasonable rate increases across all services provided under the Developmental Disabilities (DD) Medicaid Waiver. As service providers, we recognize the significant benefits these services offer to individuals and families. However, the current reimbursement rates established by the General Assembly constrain our financial capacity to deliver services effectively. We respectfully request your support of a 5% rate increase, applicable from July 1, 2026, through December 31, 2026, for all critical DD Waiver Services not encompassed by the DOJ review mandate. Furthermore, we seek an additional 5% rate increase on January 1, 2027, for all services provided under the DD Waiver. This requested adjustment is directly associated with the proposed minimum wage increase scheduled for implementation in 2027. Once Medicaid rates are determined, it is essential to ensure they are adjusted correspondingly with each increase in the minimum wage. This alignment enables providers to effectively recruit and retain qualified staff. Elevated staff turnover can negatively impact the quality of care provided. Individuals within the developmentally disabled community merit high-quality services and consistent support. An increase in reimbursement rates is essential for providers to collaborate effectively with DBHDS and deliver high-quality services to individuals with critical needs. At present, there is a substantial waitlist for services, particularly for those with significant health requirements. ServiceSource is among the largest providers in Virginia and is the sole provider in Northern Virginia for individuals with high-intensity needs. Without appropriate compensation, it is not feasible to maintain the necessary level of support services, including nursing, speech therapy, physical therapy and behavioral services for those who require this care. ServiceSource is dedicated to delivering exceptional care to the people we serve, and adequate compensation is vital to sustaining these efforts. We appreciate your support regarding this matter. Thank you.

Please don’t require live in paid family attendants to use evv. The portal is bad enough to document tasks like bathing and changing diapers and feeding teenagers who clearly need full care 24/7. In my case, I have two disabled children and another child, I am a single parent and cannot work due to their needs. I am here all the time and so are the kids between school days off, medical issues and behavioral issues. I only get paid a fraction of the time I’m caregiving so the whole system is silly as far as logging hours. With multiple disabled children, I’d be clocking in and out all day long. It’s much easier to just use the portal once a week. These Medicaid recipients have yearly plans and sis evaluations every few years to make sure they are still disabled incase the multiple caseworker visits every 30 days and 90 days aren’t enough to Avoid fraud. I heard about this change tonight which is what happens to us parents with sudden and poorly communicated new Medicaid requirements and changes that result in more paperwork, red tape and chaos. The last change I didn’t get paid for months. The change before that I didn’t get paid for over a year. Ive spent my last 2 months dealing with a medical issue for a child and really don’t have time to clock in 6 or 8 times a day.

I am a parent to 2 daughters with disabilities and have been working around the clock or years to make sure our daughters remain as safe and healthy as possible. This job is hard enough without additional tasks . EVV will not give any useful information on their quality of care. It makes no sense to require us to constantly clock in and out all day and night when we care for them. Our focus in on caring for our daughters. We do not work in visits- we provide ongoing support that cannot be meaningfully captured by start and end times.

EVV for live ins will eliminate so many caregivers. Is the government ready to provide full time care for a multi complex adult with non verbal autism and Pandas who wanders and doesn’t sleep? This is just one example of persons needing care from live in caregivers. Live ins are a godsend and hard to find. EVV is a slap in the face for full time family members and live in employees/caregivers who are constantly available at a moments notice and work WAY more hours than the state approves. They lose many of those hours because they get more involved with their complex people they LIVE with, and in the midst of a exhaustion or crisis, forget to clock out. On duty for a live in caregiver is on time all the time regardless of this freaking CLOCK!

The proposed budget has a requirement for live-in caregivers to use electronic visit verification software. This new requirement adds a burden to those who already have an incredibly hard job. Our adult daughter has autism and epilepsy, and she requires someone to be with her. The reality is that I am caregiving whenever she is home, so there’s no natural way to decide when I am on or off duty. Please remove this daily or even hourly requirement instead of adding a technological stressor to an already challenging responsibility. Given my 30 years of experience with live in caregivers, I can assure you that very few if any are trying to cheat the system. We already have plenty of forms, both electronic and paper, to complete on a regular basis. Please do not add to that burden.. Thank you.

Please REMOVE from the Governor’s Budget language that states: “NNNNN. The Department of Medical Assistance Services shall seek federal authority through the necessary waiver(s) and/or state plan amendments under Titles XIX and XXI of the Social Security Act to eliminate the live-in caregiver exemption from electronic visit verification requirements. The department shall promulgate emergency regulations to implement this change within 280 days or less from the enactment of this act. The department shall implement this change upon federal approval and before the completion of any regulatory process undertaken to effect such change." Currently, Live-in Caregivers for Medicaid Waiver recipients are exempted from the requirement to use Electronic Visit Verification (EVV) when logging attendant care hours. Many of these live-in caregivers are elderly parents or family members caring for a disabled loved one. --CMS recognizes that EVV is a burden for live-in caregivers and allows this exemption for live-in caregivers. It shows bad faith for Virginia to now remove that exemption and will make caregiving feel punitive and distrustful. --The EVV exemption does NOT have a large fiscal impact, and the removal of the exemption would prioitize survellience over quality of life for the recipient and quality of care by the attendant. --Live-in caregiving is not done in shifts but rather it is continuous or intermittently throughout the day and the night along with supervision when not actively performing a “task”. Sudden unexpected health events or ADL assistance is provided throughout the day and night and cannot be “clocked”. --The constant clocking in and out for “tasks” is not realistic. Before the exemption was granted after advocacy by caregivers in 2020, lives of live-in caregivers were made more stressful and difficult by the burdensome and false shift paradigm. Additional administrative costs were seen by the fiscal intermediaries who had to make frequent corrections to timesheets. SUMMARY: EVV systems are designed for short, scheduled visits — not for the reality of live-in caregiving. Requiring live-in caregivers to use EVV misrepresents how care is delivered, threatens privacy, increases unpaid labor, and risks driving family caregivers out of the system. Exemptions to using EVV are allowed for live-in caregivers by CMS and they have been working successfully, allowing families to care for their loved ones in the community. Please removed the Governor’s budget language that would remove the EVV exemption for live-in caregivers. https://budget.lis.virginia.gov/item/2026/1/HB30/Introduced/1/291/

I am writing to express my opposition to Virginia's allocation of $633,310 over two years to the Virginia-Israel Advisory Board. As a lifelong Virginian, I wholeheartedly object to the use of my tax dollars for courting business from a genocidal apartheid state, especially from companies that are directly involved in the genocide of Palestinians (e.g., Elbit Systems, Israel Aerospace Industries). This money would be better spent protecting Virginians who are hurting due to the Trump administration's sweeping cuts to education, healthcare, and infrastructure or are being targeted by ICE raids. Furthermore, even during a nominal ceasefire, Israel continues to displace and kill Palestinians in Gaza and the West Bank. There is absolutely no reason to continue using Virginians' hard-earned money to benefit Israel.

Mayday: Stop EVV for live in caretakers. Can we get the government to open up institutions again so those in care have some where to be? I as a caretaker can't do this EVV. I do not visit and am way too occupied with special and important needs to be burdened with a set of hours mandated by a budget and not the real work hours that a live in caretaker does. Thank you.

I am a parent of a 42 year old son with cerebral palsy, who needs 24 hour support. For a number of years, my wife and I used consumer-directed services. I strongly support maintaining the EVV exemption for live-in care providers. The requirement for clock-in and clock-out records is ludicrous. My son recently transitioned to apartment living and support is being provided by an agency. Due to low pay, it has been and continues to be difficult to find quality staff in both consumer-directed and agency-directed scenarios. Please understand that no one goes into this type of work to get rich. In all situations, a successful relationship between the individual with a disability and the care provider requires love and trust. Therefore, I am requesting that an increase in pay for all DD services be a top priority for the coming year. I WANT TO EXTEND AN OPEN INVITATION TO EVERY MEMBER OF THIS COMMITTEE TO SPEND A DAY WITH MY SON-TO ACTUALLY EXPERIENCE HOW HE LIVES EACH DAY AND TO WITNESS THE COMMITMENT OF HIS PROVIDERS.

Please maintain the EVV exception for live-in caregivers! As parents to a daughter with multiple profound disabilities and medical complexities, we have been working around the clock for years on end to make sure our daughter remains as safe and healthy as possible. While we agree that fraud is a serious concern, there are already many layers of safeguards and this job is hard enough without additional cumbersome tasks that will do nothing to reduce fraud. We take our daughter with us wherever we go and we try to allow her to access to community events as much as possible, so tracking cell phone locations through EVV will not give any useful information on her quality of care. It makes no sense to require us to constantly clock in and out all day and night when we care for her. Our focus should be on her and not on managing a wasteful and unnecessarily intrusive beaucratic process. EVV should be reserved for people who do actually work shifts, not parents who are already stretched thin with reduced personal care hours, no respite opportunities, and unqualified or completely unavailable nursing options. Please help our families by stopping this terrible policy change in its tracks!

Oh, no to EVV (electronic visit verification) for live in caregivers! I tried using the EVV app to sign in/out. *** It was a mess. I constantly forgot to sign in/out because I’d already been doing the job for many years. I had to log in to the portal to fix things constantly. Then there was the time neither the EOR nor I recognized I had forgotten to sign out the night before when he approved the hours. There was no way for him to fix it, but it was unpaid to due being over 16 hours! I was able to amend it after the pay period. After that I quit using the app. ****The reality is I’m rarely not with the consumer. It’s easier for me to note when I’m not with him than when I’m on duty.

My name is Lindsey Rasmussen. I currently live in a apartment in Virginia Beach through SRAP housing. I wish there was more funding for SRAP housing and being able to port SRAP vouchers from County to County. Because of the lack of funds for enough SRAP vouchers I can not live fulfil my dream of living in Arlington right next to DC right now! I already have a SRAP voucher in Virginia Beach but due to the lack of funding it is not transferable unlike Section 8. Living in Arlington would give me my Independence and a fulfilling life. I would be able to jump on the metro and walk to places of my choice instead of having to plan everything in advance to use Paratransit because of lack of reliable transportation options here in Virginia Beach. Living in Arlington would increase my advocacy skills as well. My dream job is to work at the Pentagon one of the top government facilities in the Country! It would be so cool and amazing for me to be able to work at the Pentagon! It would also be so cool for me to go see the bigger acts in Concert. We don't have many big acts perform here due to it being out of the way from I-95. I love going to concerts but none of the acts that come here really interest me. I am tired of having to travel with my parents a few hours away just to see a concert and my dad too is tired of having to drive me to these concerts. We need to increase funding for SRAP so I can fulfill my dreams in life and increase my quality of life as a disabled adult. Thank you for reading and I really hope you can fulfill my dreams in life!

There is no nursing services in Younkin’s budget proposal. Please add it in as there are people whose life depends upon it. Hopefully it was just an oversight. Do better.

Governor’s Budget proposes eliminating this exemption. Pertinent points — EVV systems are designed for short, scheduled visits by paid providers — not for the reality of live-in caregiving. Our 32 y/o son requires 24/7 care. His sleep schedule is completely inverted - sleeps day, awake all night. Managing his food, medications and behaviors is extremely stressful and does not accommodate anything resembling a standard schedule. Either myself (71) or my spouse (67) is always available. Classic round-hole/square peg “solution” for a non-existent problem — no evidence of fraud by live-in caregivers. Requiring live-in caregivers to use EVV is not only burdensome but punitive with no obvious purpose other than driving family caregivers out of the system, undoubtedly reducing the quality of care and increasing the cost of providing equivalent services. Exemptions to using EVV are allowed for live-in caregivers by CMS and they have been working successfully allowing families to care for their loved ones in the community. Strongly oppose any change to current EVV Exemption policy.

efend Live-In Caregiver EVV exemption and back the arc of va action plan!!!! Overview- Electronic Visit Verification (EVV) is designed to confirm that home- and community-based services actually occur, but it creates unique and serious problems for live-in caregivers, especially family caregivers. Position Statement: Live-in caregivers do not work in visits — they provide continuous, on-call care that doesn’t fit the EVV model. 1. Care provided by a live-in caregiver is continuous, not clock-based. ● They provide care intermittently throughout the day and night ● They respond to unpredictable needs (seizures, elopement, behavioral crises, toileting, medications) ● EVV requires: Clock-in/clock-out times and defined tasks during defined hours which do not match the live-in caregiver model which is not provided in shifts but rather continuously during the day. 2. Overnight and on-call hours are hard to document and can’t be forced into artificial shifts. Live-in caregivers: ● Sleep in the home but must remain available, can be awakened multiple times per night. ● Provide supervision even when not actively performing tasks ● EVV requires constant logging in and logging out of shifts, which is artificial for live-in caregivers. ● EVV leads to artificially underpaying or even nonpayment of live-in caregivers for real work performed. 3. Live-in caregiver face technology barriers and the burden of constant compliance with EVV ● Live-in caregivers may: Be older adults who are managing exhaustion and constant stress and who may have limited access to and knowledge of reliable technology. ● EVV requires the live-in caregiver to use the app constantly, troubleshoot the frequent technical errors and follow up on missed or rejected entries. ● Mistakes can result in delayed or denied payment by DMAS, even when care was provided. DMAS also penalizes caregivers who have to make corrections to their timesheets. 4. Many live-in caregivers are family members who have left higher paying jobs to provide care to their loved ones. soo Defend Live-In Caregiver EVV exemption and also make sure you back the rest of the arc of va action plan! which is right here! https://www.canva.com/design/DAG5Kos92M4/WjdTeP_Wz__QQEm2yfN1CA/view?utm_content=DAG5Kos92M4&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=h0f7ed6b567

Governor’s Proposed 2026–2028 Biennial Budget Issue: Proposed Elimination of EVV Exemption for Live-In Caregivers My name is Melody Bell, and I am a Virginia parent and employer of record under Consumer-Directed Medicaid services. My family uses both the CL and FIS waivers, and we rely on live-in family caregivers to provide daily care and supervision. I am submitting this comment to express serious concern about proposed budget language directing the Department of Medical Assistance Services (DMAS) to seek federal approval to eliminate the Electronic Visit Verification (EVV) exemption for live-in caregivers. My Family’s Situation In my household: • Under the CL Waiver, my daughter receive Consumer-Directed services, supported by live-in family caregivers. • Under the FIS Waiver, my son receives Consumer-Directed services with live-in family caregivers. • All caregivers live in the same residence as the individuals receiving services. • Care is continuous, intermittent, and on-call, including overnight supervision and response to unpredictable needs. This is not shift-based work. It is real-time caregiving that occurs throughout the day and night. Why EVV Does Not Work for Live-In Care EVV systems are designed to verify discrete, scheduled visits, not continuous caregiving. Applying EVV clock-in and clock-out requirements to live-in caregivers creates several serious problems: • Live-in caregivers do not work in “visits.” They provide ongoing support that cannot be meaningfully captured by start-and-end times. • Overnight and on-call supervision cannot be forced into artificial shifts without misrepresenting how care is actually delivered. • EVV requires frequent logging, troubleshooting, and corrections, which increases the risk of denied or delayed payments, even when care was properly provided. • These systems were never designed for families providing care in their own homes and create administrative burdens without improving quality or accountability. Impact on Families The current EVV exemption for live-in caregivers has been in place since 2021 and exists for a reason. Removing it would: • Increase compliance risk for families already meeting extensive documentation and oversight requirements • Create unnecessary stress and administrative workload • Destabilize family-based care arrangements that are both effective and cost-efficient • Push families toward more restrictive or institutional care options, contrary to the goals of community-based services Request to the Committee I respectfully ask the House Appropriations Committee to oppose or amend any budget language that removes the EVV exemption for live-in caregivers under Consumer-Directed CL and FIS waiver services. Live-in family caregivers are not avoiding oversight — they are providing continuous care in situations where EVV simply does not fit. Preserving this exemption protects families, maintains access to care, and upholds the intent of Virginia’s community-based waiver programs. Thank you for the opportunity to submit public comment and for considering the real-world impact this proposal would have on families like mine. Respectfully submitted, Melody Bell Virginia

Governor’s Proposed 2026–2028 Biennial Budget Issue: Proposed Elimination of EVV Exemption for Live-In Caregivers My name is Melody Bell, and I am a Virginia parent and employer of record under Consumer-Directed Medicaid services. My family uses both the CL and FIS waivers, and we rely on live-in family caregivers to provide daily care and supervision. I am submitting this comment to express serious concern about proposed budget language directing the Department of Medical Assistance Services (DMAS) to seek federal approval to eliminate the Electronic Visit Verification (EVV) exemption for live-in caregivers. My Family’s Situation In my household: • Under the CL Waiver, my daughter receive Consumer-Directed services, supported by live-in family caregivers. • Under the FIS Waiver, my son receives Consumer-Directed services with live-in family caregivers. • All caregivers live in the same residence as the individuals receiving services. • Care is continuous, intermittent, and on-call, including overnight supervision and response to unpredictable needs. This is not shift-based work. It is real-time caregiving that occurs throughout the day and night. Why EVV Does Not Work for Live-In Care EVV systems are designed to verify discrete, scheduled visits, not continuous caregiving. Applying EVV clock-in and clock-out requirements to live-in caregivers creates several serious problems: • Live-in caregivers do not work in “visits.” They provide ongoing support that cannot be meaningfully captured by start-and-end times. • Overnight and on-call supervision cannot be forced into artificial shifts without misrepresenting how care is actually delivered. • EVV requires frequent logging, troubleshooting, and corrections, which increases the risk of denied or delayed payments, even when care was properly provided. • These systems were never designed for families providing care in their own homes and create administrative burdens without improving quality or accountability. Impact on Families The current EVV exemption for live-in caregivers has been in place since 2021 and exists for a reason. Removing it would: • Increase compliance risk for families already meeting extensive documentation and oversight requirements • Create unnecessary stress and administrative workload • Destabilize family-based care arrangements that are both effective and cost-efficient • Push families toward more restrictive or institutional care options, contrary to the goals of community-based services Request to the Committee I respectfully ask the House Appropriations Committee to oppose or amend any budget language that removes the EVV exemption for live-in caregivers under Consumer-Directed CL and FIS waiver services. Live-in family caregivers are not avoiding oversight — they are providing continuous care in situations where EVV simply does not fit. Preserving this exemption protects families, maintains access to care, and upholds the intent of Virginia’s community-based waiver programs. Thank you for the opportunity to submit public comment and for considering the real-world impact this proposal would have on families like mine. Respectfully submitted, Melody Bell Virginia

At a time when families across Northern Virginia are struggling to afford healthcare, groceries, housing, childcare, transportation, and basic necessities, it is fiscally irresponsible and legally and morally indefensible for the Commonwealth to allocate taxpayer dollars to the Virginia Israel Advisory Board (VIAB). Public funds should be directed toward easing the burdens of Virginians. When scarce taxpayer resources are diverted to a singular advisory board focused on advancing the interests of a foreign country the General Assembly is severely out of step with the needs and priorities of the people of Virginia. In a period of inflation, rising rents, and widening inequality, every dollar spent on VIAB is a dollar not spent on Virginians who urgently need support. The Commonwealth should not be using taxpayer dollars to subsidize international political and economic relationships that do not provide measurable, direct benefits to the people of Virginia. Beyond fiscal concerns, Israel is maintaining an apartheid system, occupying Palestinian territory in violation of international law, and committing an ongoing genocide in Gaza. Israel is also committing ethnic cleansing in Syria, Lebanon, and occupied Palestine. Many Virginians have family in these countries and are suffering from Israel’s crimes against humanity. Israel has also been condemned for its war crimes in Yemen, Qatar, Lebanon, and Iran. It is unacceptable that Virginia tax dollars help fund an advisory board that promotes economic cooperation with a state violating international humanitarian law daily! The Commonwealth has a responsibility to prioritize its own people. Funding should support lowering healthcare costs, expanding mental health services, supporting public schools, improving transportation, and addressing the housing crisis affecting thousands of families. Redirecting resources away from VIAB—which does not serve the public interest—and toward programs that directly benefit Virginians is fiscally prudent and legally and ethically obligatory. I respectfully urge the committee to eliminate state taxpayer funding for the Virginia Israel Advisory Board and to prioritize the needs of the people of Virginia. Thank you for your time and consideration.

What kind of caregiver appreciation is this (DMAS "says" they appreciate caregivers)? Caregivers treated like criminals again? What has to be done?? Write VA representatives all over again?? Write DMAS all over again?? Speak at VA forums again?? This was a well fought battle by caregivers with good reasoning, and EVV was not implemented due to those that worked hard. When a person is 24/7 (even though paid hours do not reflect this), how do you stop the toileting accidents, the tantrum, the falls, the wandering, the bath, etc...to clock in each and every day at least twice a day at an exact moment in time? Live in's do not visit. They are there 24/7. ****THEY DO NOT HAVE THE FREE TIME YOU THINK THEY HAVE. They have a few lucky seconds here and there, but they NEVER have a long moment at the right time to clock in and out each and every day. TRACK CRIMINALS OR THE BAD APPLE CAREGIVERS; NOT ALL LIVE IN CAREGIVERS. Ask for the documentation or proof of live in status. That is all that is needed or should be required.

EVV - electronic visit verification will make my community access disappear. I like the perk of being able to offer a room to a live in caregiver to help me. The Dept. of Medicaid Assistance Services (DMAS) is trying to take away live in caregivers with EVV. I have lived in a nursing home and a group home. Here is my experience: Big machines heating up rooms that are off limits to those living in the home. The rooms were so hot, that if you put your hand on the window glass, it was hot and the paint peeled off the walls. Huge bites on my arms and legs and no one can answer what they are or will do anything for them. Seeing bugs smaller than roaches but bigger than ticks attached to my legs at night. Later, after I left, I found out they were bedbugs and the heat machines were for the bedbugs. It was next to impossible to get rid of them because those hot machines were moved from room to room over and over again. Riding in elevators beside persons pooping down their legs. The air in that confined space was overwhelming! Staff spraying the whole building with cheap aerosol air fresheners right before a government visit, potential customer visit, or any kind of visit. It was hard to breathe once that stuff was sprayed. Staff spraying certain folks with cheap cologne whom they chose not to bathe for days. The toenail clipping day not happening, so my toenails grew extra long and hurt. A strange resident lying in my bed when I come in the room and need to rest. Staff smoking close to doors and bringing in the smoke every time the door is opened. No choice in what is for dinner. Being loaded into a hot van in the middle of summer when the A/C is broken and forced to sit and ride for a minimum of a half an hour at a time. I could go on and on. What I am trying to say, is I love my own home and my live in caregiver. Don't take my independence away by forcing EVV on a live in caregiver. My caregiver does not visit, and cannot accept such a burden along with all the burdens I already put on this person in one day.

I am against the requirement for live-in attendant through VA Consumer Direct Program be required to use EVV to sign in and out through day. This is a burden on families that are already dealing with stress of taking care of special needs family member and taking time to sign in and sign out on top of the chaotic days would be impossible . If issue is fraud then leave that to CSB or Service Facilitators to weed out problems. Note ➡️Federal Law allows exemptions: Federal Medicaid law allows exemptions and alternative compliance methods for live-in caregivers. Many advocates argue that requiring full EVV for live-in care: ➡️➡️1) Conflicts with the purpose of home- and community-based services ➡️➡️2) Undermines caregiver stability ➡️➡️3) Prioritizes surveillance over care quality

I'm a live-in caregiver to my young adult son with profound autism and multiple severe medical conditions. He needs 24/7 care that has greatly impacted my earnings and financial contributions to our family since he was a young child. After he received a waiver in 2024, I'm thankful that I can be his paid caregiver for some hours now; however, the allotted hours don't reflect the hours spent providing care. Just the other night, I was up at 2 am cleaning him up after he was sick. I'm certainly glad that I didn't have to get out my phone and start the app to show that I was providing care to him, as well as doing laundry in the middle of the night. Parent caregivers have enough barriers to navigate in order to obtain needed services. Please don't add another layer of complexity to our already very complicated lives. We continue to look for non-family attendants for our son. It's a long process, and when we do find one, it's difficult to find long-term commitments. I'm his only steady caregiver, and it's exhausting even when done with love. The care I give doesn't fit in the EVV model. Please let live-in, family caregivers to continue with the current system of logging hours. It would be greatly appreciated. Thank you.

I'm a live-in caregiver to my young adult son with profound autism and multiple severe medical conditions. He needs 24/7 care that has greatly impacted my earnings and financial contributions to our family since he was a young child. After he received a waiver in 2024, I'm thankful that I can be his paid caregiver for some hours now; however, the allotted hours don't reflect the hours spent providing care. Just the other night, I was up at 2 am cleaning him up after he was sick. I'm certainly glad that I didn't have to get out my phone and start the app to show that I was providing care to him, as well as doing laundry in the middle of the night. Parent caregivers have enough barriers to navigate in order to obtain needed services. Please don't add another layer of complexity to our already very complicated lives. We continue to look for non-family attendants for our son. It's a long process, and when we do find one, it's difficult to find long-term commitments. I'm his only steady caregiver, and it's exhausting even when done with love. The care I give doesn't fit in the EVV model. Please let live-in, family caregivers to continue with the current system of logging hours. It would be greatly appreciated. Thank you.

You are there, why can't you clock in and out? Can't you schedule a time to clock in and out? Live ins' care never stops...it is round the clock. They live in the home. EVV was established for visits only. That is why it is called Electronic Visit Verification. Ask an EMT to stop working on a patient to punch a clock. That is what live in caregivers are up against. There is too much going on and they are so preoccupied with the care of special needs issues that they cannot feasibly clock in and out at arbitrary times the government forces on them for their hours they are paid. They work around the clock but are NOT paid around the clock.

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I do not want to go into a nursing home. My caregiver is quitting over EVV. This person lives with me and cares for me whenever I need them day or night. They do this knowing they are not getting paid for a lot of their time. They are making a huge sacrifice that I am so grateful for. It is very, very difficult to find someone trustworthy willing to work long hours for little pay. The caregiver says with EVV that they will have to prioritize the clock over my care and they cannot be party to such neglect, so they will be leaving when EVV is enacted for live in caregivers. I have been in nursing homes and I don't want to go back. Please, for the Love of God, help by stopping EVV for my live in caregiver.

Currently, live-in caregivers have a portal on which they can record their work times that is reliable, because it has very little barriers to access and use. The Dept. of Medical Assistance Services is seeking to eliminate the live-in caregiver exemption from electronic visit verification (EVV) requirements. EVV would replace the portal with a cumbersome clock in and out process that has an unreliable access which creates barriers to the Community Living program. Consumers, caregivers and Employers of Record have already addressed this detrimental action in the recent past. On the DMAS townhall, there were over 100 comments/concerns against this act. Many folks spoke at townhalls and addressed their representatives. EVV for live-ins was exempted as a result of these valid concerns. EVV is NOT a requirement by CMS for live-in caregivers and for good reason: EVV was purposed for visitors (home therapist visits, mental health visits, etc...) and not for those that live with the consumer receiving care. Live-in caregivers work around the clock, but are forced within budget confines to report a lesser arbitrary amount of hours daily. So, it is a hardship for a caregiver to stop in the middle of work to clock in and out at arbitrary times. Their hands AND MINDS are full and it is impossible to remember and access the clock. EVV for live ins is like asking a cook to stop cooking, clock out of work, and THEN go back to cooking burned food, it is like asking a school nurse to stop helping a sick child, clock out of work, and THEN come back and help the sick child; it is like asking a janitor to stop cleaning a dangerous, slippery spill, clock out of work, and come back and continue cleaning the spill, it is asking a mental health professional to stop attending to a mental health crisis, clock out of work, and THEN come back and attend the mental crisis, it is like asking a p.e. teacher to stop teaching p.e., leave the students, clock out of work, and THEN come back to teaching, it is like asking an orderly to stop an urgent bathing, clock out of work, and THEN come back to help the patient, it is like asking an taxi driver to stop on the side of the road, clock out of work, and THEN continue transporting their customer, ETC...