As a live-in caregiver the care that I provide to my family member is an ongoing process - not something that fits neatly into clock-based shifts. I respond to all of my son’s needs as they arise including seizure support, toileting assistance, elopement management, and supporting him through behavioral meltdowns. Due to the nature of his condition I also care for him during the night, on demand, depending on his needs. This time can vary from day to day. Asking live-in caregivers to clock in and out with each task we perform puts additional stress on an already stressful situation. Using the EVV system requires the caregiver to constantly interact with the app to document each task. This takes time away from the person they are caring for and diverts their attention which can have devastating consequences in some cases. In our case, we live in a rural area. Getting a mobile app to work reliably can be difficult, at best. We have days where our internet crashes. When we lose power we also our WiFi connection. My son will elope from care in mere moments or engage in other dangerous behaviors. If I am trying to navigate the EVV app, I am not focused on caring for him. CMS allows for exemptions to EVV usage by live-in caregivers. Allowing families to continue to use this exemption will allow them to focus on supporting their loved ones. EVV usage is best designed for short term shifts, not continuous care situations. Please allow families to continue to utilize the EVV exemption for live-in caregivers.

DD waiver reimbursement rates for DSPs and other staff were supposed to be reviewed and increased during the 2026 Virginia assembly. However, it looks like more than 12 of these service categories may be excluded from the Governor’s proposed rate increase including those listed below: - consumer-directed services - day support - group supported employment - personal assistance - most residential services - nursing - respite - crisis supports Low pay rates for these services already make it hard to retain DSP staff. If the Virginia Assembly raises rates for other service categories ,but not these services, then hiring and retaining staff for day programs, consumer directed services, personal assistance, etc. will be even harder. I am an employer of differently abled adults. We lost our group supported employment provider because they could not get a single back up job coach over the course of an entire year due to lousy pay rates and the hiree's inability to pass a manager level ServSafe certification. We had no back up when our group supported employment person was out sick or on vacation. That meant that either I, as the owner of the business, had to step up and be the group coach (at no pay for my services while the providing company was still being paid for providing services that were non-existent) or tell the staff who needed the group supported services not to report to work. This is an untenable situation. Group supported services are already inadequate in that they only provide support for 4 FTE at a time and only between the hours of 10 and 4 - never evenings and weekends. When the staff person requires group support, they often have limited hours that they can work due to SSI, SSDI or Medicaid constraints on income. In order to get 4 FTE, I had to hire 9 different people. This whole system of supported employment needs a major overhaul since it benefits the provider and not the staff or the business. Regardless, they have trouble keeping staff to work these positions due to lousy pay rates. I recognize that there are budget shortfalls and this limits what you can do. Minimum wage is now $12.77. Most of these group support staff people are making $15-17 per hour and expected to handle way too many people with inadequate training and back up support. This whole system is a house of cards and failing to pay people adequately to provide the services needed will hasten the crash of the system. Those people who cannot be employed or who are limited in their employment options use the day support programs or personal assistants when they can find them. There are too few of these programs and trained individuals. Expecting this whole system to work on a "volunteer" basis is ludicrous. Go spend some time in these venues where people are working with group supports, are using day support programs, are in need of personal assistance or respite care. You'll see the demands on the staff providers for grossly inadequate pay.

I have worked in the field of developmental disabilities for nearly 50 years including as a manager at the Fairfax-Falls Church Community Service Board and as an independent consultant, working with providers here in Virginia. I am a member of both vaACCSES and VNPP. I strongly ask for support for appropriate rate adjustments for all services offered in the DD Medicaid Waiver. As a professional I have seen the benefits of these services to individuals and families. Providers are financially limited in their service provision by reimbursement rates set by the General Assembly. I ask for you to support an overall increase of 3% in the rates paid from July 1, 2026 through December 31, 2026 for ALL critical DD Waiver Services which were not included in the DOJ mandate for review. Additionally, since I support the planned Virginia minimum wage increases, I also ask for an ADDITIONAL 4.6% increase in the rates paid from January 1, 2027 for ALL of the services offered through the DD Waiver. This percentage amount is directly linked to the proposed minimum wage increase proposed to be implemented in 2027. Minimum wage increases are critical to enable providers to recruit and retain qualified staff BUT since the Medicaid rates are set, there must be a commensurate increase in Medicaid rates each time there is a minimum wage increase. This rate increase is especially critical to enable providers to partner with DBHDS as they collaborate to reduce the lengthy wait list and to provide critical support to individuals and families. Without proper compensation, providers are limited in their ability to recruit, hire, train, and deploy staff in order to offer personalized supports to individuals. I thank you for your support for this critical need to support vulnerable Virginians.