EVV for live ins is all by design. The EVV "glitches" are intentional to drive people, the vulnerable, off the tax payer dole. Couldn't be more evident. It's a joke, and it's deliberate. IF this was truly intended for good, why doesn't the government keep the reliable system they already have for live ins? The portal is not only user friendly but accommodating to those with disabilities, intellectual disabilities, learning disabled, etc.. It's all intended to drive everyone off. It's a cruel game they're playing. I have an idea of what they're up to and it's never in the people's better interest, certainly not those deemed vulnerable, lower income and dependent. VOTE NO TO EVV FOR LIVE INS.

Why add EVV to an already difficult situation for live ins? They already go without pay and have to be covered for income from someone else. They must rely on 4 separate agencies to do their job just to be paid and that does not always happen. Folks in the community services program are home, where they want to be, alive and healthy. State licensed agencies visit at least twice a month and see these people thriving. Where is the fraud ? EVV for live ins is allowing the state to take away the ability to help support these people in family homes! Say no to EVV for live in caregivers.

Im my sons live in caregiver and we live in the same home. I tried to use the app for EVV to clock in and out. If i took my son camping which he really likes that put us outside the geo fence. So dont get paid. So the only way to be paid is stay home 24/7. Thats not even fair to my Son. So, I had to stop using EVV. Don't cause the disabled to be fenced in with EVV!

Good afternoon Chair Torian, Chair Lucas, and members of the House Appropriations and Senate Finance & Appropriations Committees. My name is Auraliz C. Quintana, and I am a parent, community doula, parent educator and advocate. I am writing to express my support for protecting funding for perinatal health hubs, formally recognizing care coordination as a defining function of these hubs, and preserving funding for the FAMIS MOMS program. Care coordination is the foundation of effective maternal and infant health care. Families do not experience health care, behavioral health, social services, and community support in separate systems—they experience them all at once. Without care coordination, families are left to navigate complex systems alone, which increases the risk of missed care, delayed treatment, and preventable complications. Virginia’s Maternal Mortality Review findings make clear that care coordination is not optional. It is a priority need if we are serious about continuing to reduce maternal and infant deaths across the Commonwealth. Funding for perinatal health hubs must also be protected. This funding does not support an experimental pilot program. It builds upon a proven hub model that has been operating in Virginia for more than 35 years, supporting mothers and babies through coordinated, community-rooted care. Perinatal health hubs strengthen prevention, improve continuity of care, and support providers by reducing fragmentation across systems. Please restore the $2.5 million in funding that has been cut from the budget. I am also urging you to preserve funding for the FAMIS MOMS prenatal care program. As more families face coverage gaps, providers will see an increase in uninsured patients with limited options for care. FAMIS MOMS ensures that pregnant individuals can access timely prenatal services while allowing providers to be reimbursed. Eliminating this program will increase reliance on Emergency Medicaid, which is more costly and less effective for both families and the state. Protecting perinatal health hubs, recognizing care coordination as a core function, and maintaining FAMIS MOMS are essential steps toward improving maternal and infant health outcomes in Virginia. I respectfully urge you to support these priorities in the final budget. Thank you for your time and consideration. Auraliz C. Quintana, Parent Educator/Doula Roanoke, VA

The GPS / biometrics that live in care takers would face if EVV were enacted for them would have a chilling effect. It would further shrink the chronically inadequate pool of available employees. Often working at minimum wage, PCAs are reluctant to be geo-located during their work day, to be biometrically identified, or to take a job requiring technology skills without increased compensation and at the risk of providing quality care. Some live in caregivers are cautioning consumers they will leave once subjected to EVV. Potential workers will be going elsewhere when they learn that GPS or biometrics are required for the job. Individuals with disabilities across the country are facing increased provider shortages. People with disabilities have a right to transparency and access to any private data that is collected from our lived experiences. The burgeoning EVV industry is not forthcoming about the type of data it collects and stores.

Jim Best Meadows of Dan VA In 1961 Eisenhower warned “beware the military industrial complex.” I was 14 years old. I remember. Ike had led our nation against Fascism and Nazism in the war to end all wars. But I was wrong to think that the war against fascism and Nazi racism was over. Published in the New York Times December 2, 1948: Albert Einstein and others documented from personal experience and irrefutable historical evidence the formation of a new state “closely akin in its organization, methods, political philosophy and social appeal to Nazi and Fascist parties.” “This is the unmistakable stamp of a Fascist party for whom terrorism and misrepresentation are means.” Einstein urged “all concerned NOT to support this latest manifestation of fascism.” Virginia taxpayers contribute millions of dollars a year to supply the arms to decimate an entire indigenous population as “grass to be mowed.” The arms and technology to accomplish that carnage profits FOREIGN industry in Virginia facilitated in Virginia government through the Virginia Israel Advisory Board. The Prime Minister, a convicted war criminal, declared that “America is a thing easily moved.” THE EXECUTIVE DIRECTOR OF VIAB RECENTLY STATED “FOUR OF THE FIVE LEADING DEFENSE COMPANIES ARE HEADQUARTERED IN VIRGINIA. WE ARE VERY HAPPY THAT THE STATE IS TRYING TO ESTABLISH A ‘DEFENSE ECOSYSTEM’ IN VIRGINIA.” HE CITED ISRAELI AEROSPACE INDUSTRIES AS AN EXAMPLE OF A MUTUALLY BENEFICIAL PRODUCT OF VIAB ACCOMPLISHMENT. Defense Ecosystem? Beneficial to ISRAEL while Virginia has a greater than $162 million trade deficit with Israel!! These foreign national companies manufacture the drones that have “mowed the grass,” thus making Virginia government an accomplice in ongoing genocide. I stand with Einstein‘s assessment proven accurate all of my 80 years that fascist and Nazi policies have not changed since 1948. We now have a voter mandate to throw out those who “easily move us“ with bribes and handlers. Our Democratic Trifecta must now excise that malignancy, the Trojan Horse, the misnomer of an advisory board, “VIAB,” that cons Virginia taxpayers to cover the crimes of a foreign fascist state.

Parent Testimony on Virginia DD Provider Rates 1/7/26 Members, My son is one of 50,000 Virginians with disabilities who rely on the Commonwealth to fund the residential, community, and employment supports that he needs across his lifespan to be a contributing member of society. After 13 years of DOJ oversight for failure to ensure adequate capacity in home- and community-based services, Virginia still has not defined what “adequate” is, how far below it we are, or a multi-year plan to reach it. Fear of the true cost is not a reason to avoid a valid, transparent rate-study methodology—just as fear of utilization spikes is not a reason to exclude services from a DOJ-mandated rate increase that also covers people with disabilities who are eligible for services under the CCC+ waiver. CMS guidance identifies three essential rate-design elements that Virginia still lacks: First: a target DSP hourly wage. Using federally validated data, I found that 100% of Virginia DSPs are eligible for SNAP, compared to about 50% in other states. Until rates stabilize for providers—the employers of DSPs—another 50,000 Virginians will remain reliant on public assistance, in a system already facing federal noncompliance and potential $270 million in penalties. Second: a provider rate build-up factor. CMS recommends roughly 1.8 times the DSP wage to cover non-wage costs of being a Virginia employer and maintaining Medicaid and waiver licensure. Without it, providers cut services and turn people away—reducing access and pushing Virginia further out of compliance. Third: staffing ratios by service that support both needs and choice. DOJ findings and DBHDS quality review data already show what adequate staffing requires to meet physical needs and ensure community inclusion. Yet despite years of studies, adjustments, and administrative changes, Virginia has not identified, validated, or routinely updated any of these three elements. Other states do this with transparent methods—and they are not under DOJ scrutiny for violating the civil rights of 50,000 people with disabilities. This system is in critical distress, and the current approach is unsustainable and inconsistent with the Commonwealth’s obligations. I ask for a two-part remedy: (1) include all waiver services in this budget’s rate increases, and (2) require DMAS to immediately begin a rate initiative that sets target DSP wages by locale, applies a justifiable build-up factor, and establishes staffing ratios by service to ensure adequate support for both needs and choice. Families like mine cannot wait another year for the Commonwealth to start measuring what it is already obligated to fix. Thank you. Maria McWhirt, PhD 703-851-5966 Maria@MPM.care

The notion that EVV for live ins will affect fraud in personal care services (PCS) is very flawed. It can often take more than one year to establish Medicaid eligibility. Personal care and Consumer Direct Services consumers are extensively vetted to establish the presence of severe disability and financial need. Comprehensive medical history, documentation, testing and semi-annual renewals are required to verify the presence of serious and multiple disabilities which will likely last for life, and which are serious enough to put those individuals in jeopardy of unnecessary institutionalization. Where identified, fraud appears in agency or industry providers. ***It is extremely rare in Consumer-Directed Services. Negative stereotypes that individuals with disabilities who rely on benefits programs are malingerers is still prevalent in our society, when NOTHING IS FURTHER FROM THE TRUTH. The assertion by some that there is “massive fraud” in personal care services is false and demeaning to both those who rely on and provide these services.

Hello, I know that I had some technical difficulties with my testimony this morning. I appreciate you giving me a second chance to speak, but wanted to provide written testimony to be on the safe side. Thank you for your time, Joey Warren

Good morning/afternoon. My name is Kenneth Hunter and I'm speaking on behalf of Virginia Interfaith Center for Public Policy representing people of faith and goodwill across Virginia. We urge you to support three critical budget priorities: First, paid sick leave. Support HB5 and fund its implementation through DMAS and the Department of Labor. Five paid sick days annually isn't just good policy. It's a moral imperative that allows workers to care for themselves and their children without choosing between health and a paycheck. Second, child care. We support the Virginia Promise Partnership's request for $681 million in additional funding. High-quality, affordable child care is essential infrastructure. Without it, families struggle, educators leave the field, and our economy suffers. This investment supports working families, fairly compensates early educators, and strengthens Virginia's workforce. Third, maintain critical support. Preserve the $175 million Housing Trust Fund over the biennium and restore federal cuts to homeless services. Budget for the costs of H.R.1 to Virginia, estimated at roughly 500 million over the next biennium. And critically, restore FAMIS Prenatal Coverage for pregnant individuals. Virginia is in a maternity care crisis and now is not the time to reverse course on this bipartisan win. These aren't partisan issues. They're about caring for our neighbors and building a Virginia where all can thrive. Thank you for your consideration.

My name is David Minor, and I live in Madison County, Virginia. I am blind, and I apologize that I’m not able to be with you today and have to participate this way. Without someone physically present to help me navigate the technology, I’m unable to join the virtual hearing. Tasks like clicking a link, entering a password, or turning on a camera are real barriers for someone who is visually impaired and lives alone in a rural area. This experience highlights exactly why Virginia needs statewide coverage for Centers for Independent Living, including a locally based Center serving Madison, Orange, Culpeper, and Rappahannock Counties. If there were a Center in my community, I could have gone there, received assistance, and participated fully in this important public process. There are 17 Centers for Independent Living across Virginia. While the disAbility Resource Center in Fredericksburg is able to do some limited work in my area, it is over an hour away. I do not drive, and in rural Madison County we do not have services like Uber or Lyft. Distance and transportation matter. Centers for Independent Living help people with disabilities build skills, connect to resources, and live independently in their communities. I urge you to support funding that ensures all Virginians, no matter where they live, have access to these essential services. Thank you for the opportunity to share these comments.

Please, DO NOT vote for EVV for live in care providers. The Americans with Disabilities Act (ADA) and the Supreme Court’s Olmstead ruling mandate that Americans with significant disabilities should receive services in a way that enables us to live in the community in the “most integrated setting”. EVV takes away freedoms and erodes this setting. There is long history of a critical shortage of personal care providers in the home care industry. With stagnant and, in many states, declining wages over the past decade, independent providers such as personal care assistants (PCAs) are continually expected to do more with less time, less pay and less education than their traditional agency counterparts. The additional requirements of EVV will further erode the ability of live in PCAs to do the critical work of providing personal care.

People with disabilities have the right to be integrated in society and control our own lives. EVV for live ins undermines the intent and integrity of the Independent Living Model and personal care services, including Consumer Directed Services (CDS). EVV for live ins threaten the privacy of countless Americans with disabilities who would otherwise be free of intrusive governmental monitoring. EVV for iive ins is based on false stereotypes that people with disabilities and seniors are helpless and housebound, and unable to have control over their own lives. EVV is a one-size-fits-all approach in which individuals are “patients” and which leaves little room for individual consumer choice. EVV forces care recipients into standardized procedures and routines to which they must conform in order to receive services. Forcing recipients of personal care services and consumer-directed services into the EVV “patient model” takes away our ability to live autonomous lives and experience constitutionally guaranteed freedoms that non-disabled individuals take for granted. EVV forces us and our care workers to have our movements, whereabouts, and very personal activities monitored.

There is no evidence of “fraud, waste and abuse” among Medicaid beneficiaries (end users). So why the rush to push EVV electronic visit verification on live in caregivers, consumers, and families? Every year, the Department of Justice and the Department of Health and Human Services Office of the Inspector General publishes a report on their efforts to hold to account bad actors in Medicare, Medicaid and other Federal health care programs. The December 2024 report lists examples of the different kinds of fraud against Medicaid and Medicare that the agencies have identified and prosecuted. NO enrollees are in the listing. For more information, please see "The Trust About Fraud Against Medicaid" and "The Truth about Waste and Abuse in Medicaid." There is simply no way to cut this community living program from Medicaid without cutting critical care services for millions. EVV for live ins will erode this valuable community living program. Almost all of the fraud, waste and abuse we see in the system, comes from the billing and payment processes and sky rocketing health care prices - not from the recipients of Medicaid. Rushing EVV for live ins won't address these problems and it won't bring down costs for families. It's just taking quality live in care away from people who can least afford it - like cancer patients, seniors, children, and people with disabilities to name a few.

Would like for you to speak on home care workers 16 hours trying to be able to take care of their family vote on $20 for home care workers and collect the bargaining for home care workers so they can have a voice on the job

Just like it is currently in Virginia, the majority states have the exception for live in caregivers from EVV electronic visit verification in place. It makes sense to have the exception in place because live in caregivers "Do. Not. Visit". Mine lives in my home with me. They do more hours than is paid for, they drive me everywhere and often get home late because of an evening dentist visit, groceries, evening community activities, etc.... The portal works fine for posting allotted times. How is my caregiver supposed to clock in and out at times forced on them by an arbitrary budget model when they are busy doing way more than they are asked to do? STOP EVV for live ins! Thank you!

Thank you for listening today! Families and consumers don't feel they have a voice. Why would DMAS, Dept. of Medicaid Services, be using emergency regulations to push EVV Electronic Visit Verification for live in caregivers? This isn't an emergent change. It is currently exempted for live ins. The federal government allows for the exemption. It's does not compute. How exactly is there any positive financial benefit coming from this when there is already a system in place with proven accessibility and ease of use for live in caregivers? Why is it in the budget? It has no financial impact to the state.

The cost of living continues to increase contributing to nurses working multiple jobs to live. Clients continue to endure the negative impact of rates being denied an increase making it hard clients to find help that’s willing to work without breaks for long periods. The waiver systems and the agencies that service the clients have a massive responsibility finding staff and providing standard care for clients with such financial restrictions to offer PTO, Health, insurance, socks time, and bereavement . These are important benefits needed for emotional integrity and health Maintenance for nurses to not get burned out and have self care. Clients deserve to have quality care and agencies and nurses deserve to be reimbursed.

Hello, I am writing as a private duty care nurse. I provide care under waiver services for 24 hour nursing. Agencies take a substantial portion of our rates, with no benefits, PTO, or back-up coverage options. For this reason, myself and many other nurses in this field work multiple jobs. I am currently in search for my third concurrent job to stay afloat. I started in my current private position as a single mom of four. In prior years, I have been able to support my family fairly comfortably, but more recent years have had me on the verge of homelessness. Nurse wages are not keeping up with the cost of living, especially for such an essential career that requires so much skill, critical thinking, mental and emotional investment, and education.

To the Honorable Members of the Virginia General Assembly, I am writing to you out of deep urgency and sincere hope. I rely on 24/7 private duty nursing through Virginia’s Medicaid waiver system to survive, and I am truly begging you to address the crisis that people like me face every single day. Without meaningful increases to reimbursement rates for private duty nursing, the system that keeps us alive is slowly collapsing beneath us. The reality on the ground is stark. Nursing agencies take a substantial portion of the hourly reimbursement rate, leaving nurses with wages far below what their skill, responsibility and workload demand. As a result, nurses understandably seek employment elsewhere—hospitals, travel nursing, or even other states—where they can earn significantly more for the same or less demanding work. This leaves medically fragile individuals like me scrambling to find dependable, qualified nurses willing to accept the pay that remains after agency cuts. The consequences are not theoretical. They are lived, daily experiences. Patients with private duty nursing endured countless schedule gaps, last minute cancellations, and stretches of time without adequate coverage. I have watched dedicated nurses leave—not because they don’t care, but because they simply cannot afford to stay. I have seen agencies struggle to recruit new staff because the reimbursement rate is too low to offer competitive wages. And I have felt the fear that comes from knowing that my safety, health, and basic survival depend on a system that is stretched far past its breaking point. Private duty nursing is not optional for people like me. It is not a luxury. It is the only thing that allows me to remain safely in my home, avoid institutionalization, and live with dignity. When there are no nurses, there is no backup plan. There is no alternative setting that can provide the same level of individualized, continuous care. Without stable staffing, my health is at constant risk. Raising reimbursement rates is not simply an investment in healthcare—it is an investment in human lives, in community inclusion, and in the values of compassion and responsibility that Virginia has long upheld. Higher rates would allow agencies to offer competitive wages, attract and retain skilled nurses, and ensure that medically fragile individuals receive the care they are authorized for and desperately need. I am asking you to see the human beings behind the numbers. To understand that every hour of nursing coverage lost is an hour of vulnerability, fear and risk. To recognize that without legislative action, more people will be forced into hospitals or long term care facilities at far greater cost to the Commonwealth. And to acknowledge that the current rates simply do not reflect the realities of today’s healthcare workforce. I urge you to increase the reimbursement rates for private duty nursing under Virginia’s Medicaid waivers. Give nurses a reason to stay. Give agencies the ability to recruit. Give people like me the chance to live safely in our homes. Thank you for your time, your service, and your willingness to hear the voices of those who depend on you the most.

Communication is greatly needed in the distribution of information: Medical Appointments Medical Needs Travel Daily Living Assistance Urgent Matters

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

I have gotten to know Mister David recently and learn of the DisAbility Resource Center. Having a location close by as opposed to an hour away would help me and my neighbors tremendously. 9th District is in need of the DisAbility Resource Center and funding for this would be greatly appreciated. My hip injuries and leg injury has made both travel and mobility tricky. Not impossible. DisAbility is a call to adapt, innovate and create a world where everyone and thrive. Not just the bare minimum of survive. Let's build a bridge for our community, not walls.

EVV (electronic visit verification has so many flaws. It is always glitching and not working. When these various problems happen, you will get nasty letters saying your services are going to be discontinued, because you couldn't clock in and out. EVV for live ins is like a dog constantly chasing their tail and getting nowhere. It just does not work.

None

When one does round the clock care giving or live-in care giving, it occupies the full mind and body. The mind occupation is a main reason clocking in and out is next to impossible. One is so occupied mentally and physically that asking them to do one more task is too overwhelming. When you understand that EVV for live-ins is unnecessary because live ins do not visit, EVV is not required by CMS, and EVV puts an impossible burden on the live in caregiver, you tend to ***question the motives of DMAS especially when they declare an emergency without giving the families a chance for input.

EVV FOR LIVE INS PUTS ALL THE BURDEN ON THE CAREGIVER FAMILY AND NONE ON DMAS OR ANY OTHER AGENCY INVOLVED. Most caregivers are not tech savvy. Lots live rural and don't have cells. DMAS should be required to provide ALL EQUIPMENT that is fully reliable ALL THE TIME, easily accessible, readily available AT ANY TIME, NOT AT SPECIFIC TIMES to make this happen. ****What they already have does this WITH THE PORTAL. THE BURDEN SHOULD NOT BE ON THE CAREGIVER FAMILY TO PROVIDE ANYTHING FURTHER THAN PROOF OF RESIDENCE BECAUSE IT IS EXPENSIVE AND VERY CUMBERSOME TO PROVIDE. EVV FOR LIVE IN FAMILIES MAKES THE PROGRAM INACCESSIBLE AT WORST AND VERY DIFFICULT AT BEST.

My son is one of 50,000 Virginians with disabilities who rely on the Commonwealth to fund the residential, community, and employment supports that he needs across his lifespan to be a contributing member of society. After 13 years of DOJ oversight for failure to ensure adequate capacity in home- and community-based services, Virginia still has not defined what “adequate” is, how far below it we are, or a multi-year plan to reach it. Fear of the true cost is not a reason to avoid a valid, transparent rate-study methodology—just as fear of utilization spikes is not a reason to exclude services from a DOJ-mandated rate increase that also covers people with disabilities who are eligible for services under the CCC+ waiver. CMS guidance identifies three essential rate-design elements that Virginia still lacks: First: a target DSP hourly wage. Using federally validated data, I found that 100% of Virginia DSPs are eligible for SNAP, compared to about 50% in other states. Until rates stabilize providers—the employers of DSPs—another 50,000 Virginians will remain reliant on public assistance, in a system already facing federal noncompliance and potential $270 million in penalties. Second: a provider rate build-up factor. CMS recommends roughly 1.8 times the DSP wage to cover non-wage costs of being a Virginia employer and maintaining Medicaid and waiver licensure. Without it, providers cut services and turn people away—reducing access and pushing Virginia further out of compliance. Third: staffing ratios by service that support both needs and choice. DOJ findings and DBHDS quality review data already show what adequate staffing requires to meet physical needs and ensure community inclusion. Yet despite years of studies, adjustments, and administrative changes, Virginia has not identified, validated, or routinely updated any of these three elements. Other states do this with transparent methods—and they are not under DOJ scrutiny for violating the civil rights of 50,000 people with disabilities. This system is in critical distress, and the current approach is unsustainable and inconsistent with the Commonwealth’s obligations. I ask for a two-part remedy: (1) include all waiver services in this budget’s rate increases, and (2) require DMAS to immediately begin a rate initiative that sets target DSP wages by locale, applies a justifiable build-up factor, and establishes staffing ratios by service to ensure adequate support for both needs and choice. Families like mine cannot wait another year for the Commonwealth to start measuring what it is already obligated to fix.