I am Angela Wirt, Executive Director of Child Care Aware of Virginia – a statewide nonprofit serving all localities across the Commonwealth. CHILD CARE has been hit hard by the pandemic – families and child care programs continue to struggle. Many programs remain at risk of closing permanently due to lost revenue. We need to enable PORTABILITY of BACKGROUND CHECKS for substitute staff to assist with critical staffing shortages so that child care can continue to operate and families can get the care they need to continue working. We must pass legislation to allow portability of background checks and enlist the Rap Back program to maintain safe care settings for children. Public schools have substitute pools of screened staff who can step into classrooms when teachers are absent; child care does not. It’s time to change that. We need to ensure SAFE SLEEP PRACTICES for all infants in child care and ask for ALL registered providers to be required to comply with safe sleep recommendations of the American Academy of Pediatrics. Voluntarily registered providers are currently not required to follow these practices. We urge the GA to close this loophole and adopt safe sleep legislation for registered providers to prevent the unnecessary deaths of babies in regulated child care. Child Care Resource and Referral offers critical BUSINESS SUPPORT technical assistance and training to the child care workforce statewide. Supplemental funding to support the development and sustainability of child care businesses is needed to strengthen and rebuild the child care community and Virginia’s economy. Families cannot work without child care – businesses cannot operate without a workforce. There is no economic recovery without child care!

Virginia's brain injury services were awarded $1,000,000 in new funding only to have it cancelled due to the pandemic. New funding is desperately needed. Virginia's brain injury services providers serve some of Virginia's most vulnerable citizens, people with unique cognitive and physical challenges, and we have continued to provide these vital services throughout the pandemic. On the Eastern Shore we have worked hard to pivot to virtual services where possible, to reach survivors confined in institutional care, and to keep the survivors we serve healthy and anchored during these dark days. It breaks my heart that for survivors of brain injury in the remaining unserved areas of the Commonwealth no help is coming. Please. We need to strengthen existing services and ensure that the services of case management and day support are available to all Virginians with brain injury. Thank you.

On behalf of the Healthy Rivers Initiative, a coalition of nonprofit organizations working to protect and restore water quality within Virginia’s Chesapeake Bay watershed, we offer the following comments on the Governor’s proposed amendments to the 2021-22 Biennial State Budget. We appreciate that of the $25 million permanently unallotted during the Special Session for the Water Quality Improvement Fund, the Governor has restored $13,550,000 in supplemental general funding for FY22. We also support the Governor’s proposal to set aside $4.55 million of this supplemental funding for technical assistance. These funds will help close the gap in unmet need for installing water quality best management practices on farmland, consistent with our commitment to the Chesapeake Bay cleanup effort and to Virginia farmers. In order to fulfill our Chesapeake Bay goals by 2025, Virginia must also continue to invest in stormwater improvements and wastewater treatment plant upgrades. Notably, the Governor’s budget does not include additional funding for the Stormwater Local Assistance Fund or for Nutrient Removal Grants in FY22. We encourage the General Assembly to include an additional $50 million for each of these programs in the final budget. Finally, we appreciate that the Governor proposes to restore almost $12 million to DEQ to help reverse years of budget cuts that have limited the agency’s ability to monitor and enforce our environmental protections. Access to clean air and clean water are critical to public health, and each day, more Virginians are relying on accessible green spaces for peace of mind and refuge during this pandemic. We urge the General Assembly to retain this funding.

Andrew K. Stith Traumatic Brain Injury Speech My name is Andrew K. Stith from Hampton, Virginia. I have served my country with Honor and Dignity. I served in the military from January 24, 1987-December 31, 2015; 28 years, 11 months 7 days. The way that I received my Traumatic Brain Injury was by colliding into another person, while playing soccer twice. The third time when I served in Iraq in 2011, I Had a cast on my left foot for a premature rupture of my Achillies Tendentious. Suddenly, I accidently stepped on an unequal surface down couple of flights of stairs in the building that I worked for the time being. I was an out cold for 5 minutes. I went to the Field Hospital and stayed over night for test observation. When coming back from Iraq, dealing with a TBI, death of my daughter, having ADHD and Dyexlsia, my unit back to Fort Hood, TX, the doctor could not find nothing serious, but still did treatment when stationed in Germany until I finally transition and retired out of the military. Finally, being a civilian, coming back to Hampton, Virginia. When doing my VA claim from the VA Hospital, one of my diagnoses was from the Poly-Trauma Brain Injury with no service for me to go. Instead, I had to go to the State of Virginia, with Department of Aging and Rehabilitation Services and help with the VA Wound Warrior Project. This when I was introduced and Approved for the Denbigh House in Newport News, Virginia. Throughout all of the struggles that me, and other veterans have to deal with PSTD, Suicide, Drugs, Homeless, and always looking, not staying and finding decent employment that we can keep long term. Especially, having bad experiences at the VA, State bad Labor Law, “Right to Work Law” for Veterans, disabled, Handicap and my last job was November 2019. I am asking for $1.4 million to retain qualified and committed staff at community-based brain injury programs. All of these programs have difficulty offering competitive salaries and retaining staff because of a lack of flexibility in how our state funding is structured. This request was funded in last year's regular session, and our need is even greater now. Thank you Andrew K. Stith

Members of the House and Senate, Your reckless and unwarranted austerity has created a crisis for our public schools. Between your unwise fiscal behavior and your anti-union bullying, you have pushed our Commonwealth's most important institution to a breaking point. Education workers, parents, and students were promised a new era of school funding and advocacy when the Democrats took control of the General Assembly and the Governor's office. Yet, you have betrayed those promises, and along with your Republican counterparts, you have been a great source of disappointment. Last year, and the year before, no amount of back-slapping and platitudes could hide your decisions to watch Virginia's schools remain some of the most pathetically underfunded in the nation. No amount of Dick Saslaw petulantly chastising union members during a public hearing can veil your failures. Education workers and their unions see completely through your very thin smoke screens. We see the brunt of Democrats more concerned with holding their majority than taking bold progressive action. We seen the majority of Republicans cartoonishly reconstitute McCarthyism while they don't even bother to pretend to care about funding schools, at least not the public ones. Further, both parties are culpable of exasperating economic inequality and preventing revenue growth by perpetuating Virginia's regressive tax code. The proposal to place another $650 million into the rainy day fund, is one of the most absurd fiscal decisions the Governor can make. During a time of global pandemic, it is unconscionable to not tap into those emergency funds. It's even more absurd to dump additional money into "reserves" when those funds are desperately needed by schools and other public institutions. Yet, most members of the General Assembly are more concerned with serving the will of the Chamber of Commerce than working Virginians. The reality is that before the pandemic, you, the General Assembly, had the opportunity to make real investments in our public schools as a result of record setting revenue. Instead, you chose to serve the corporate class by dumping unnecessary amounts of cash into our rainy day fund and giving millions to Amazon. Virginia is one of the wealthiest states in the nation, yet teachers rank far below the national average in salary and are ranked dead last in the nation in the teacher pay gap- a metric that compares teacher pay to occupations with equal amounts of education. This remains true even after the General Assembly passed a bipartisan resolution to raise teacher pay to the nation average. Years later, nothing has changed. Virginia's per-pupil spending is also below average and our students in rural and urban settings, students who historically have faced poverty and racial inequality, are even worse off. School infrastructures are literally falling apart or filled with mold and vermin, and yet the General Assembly has done little to change this. As I said, education workers are watching. Education workers have been resigning this year more than any other year in recent history, and who can blame them? Many more educators are organizing like never before and have made bold resolutions to draw lines in the sand. They have resolved to submit to the abuse and neglect no longer. If the General Assembly doesn't reverse its course, there may not be enough educators in the classrooms to staff our schools.

I live in my own apartment with caretakers that take care of me and support me. They work very hard and should get paid as much as group home staff do. Because my staff help me be more independent like helping me find a job and go to college and getting me everything I need. You don't get that kind of care in a group home so the pay should be the same across the board.

Thank you for your attention and consideration. I look forward to speaking with you all.

Homecare workers are essential workers. We continue to work without benefits and pay. We contine to fight for $15/hr which we work for and deserve. Eventually we will all need homecare and I hope we will have benefits to help not only homecare workers but those who need our assistance.

Thank you for taking the time to read my comments. I am the mother of Haley Smith, a 20 year old young lady that has had uncontrolled seizures since she was 5 months old. Her first neurologist is now our Governor and he knows our situation well. Haley was not diagnosed with her rare, catastrophic form of epilepsy until she was 7 YEARS old. We went over 7 years of numerous hospitalizations, therapies, and pharmaceuticals before we received any assistance from a ED/CD (Elderly and Disabled Waiver), now CCC+. In those early years our family struggled tremendously financially. I had my own business which I had to shut down and I have not been able to be an income earner until the last year when I became Haley's full time caregiver. Haley has been Priority One status for about 5 years. We are patiently waiting for a full waiver slot. Having a child with special needs is a 24/7 stressor and everyone in the family feels it. In addition to Haley, I have twin boys. Having a full waiver would reduce our stress and allow Haley access to a better quality of life. We could afford to bring in a person to help assist with her care and give the family a break. Everyone knows that if you don't care for the caregiver you are in trouble. Haley has been to the General Assemble for the last six years. She was integral in passing the first cannabidiol legislation. She had several seizures in the GAB, most notably in the Senate hearing room. Many of you know her or have met her. She is a delightful young lady and because of your actions in 2015, you have given her a better quality of life. It is our request that you continue to assist those who cannot help themselves. I can not imagine putting her into an institution, but lack of assistance may determine that is her future. I hope that you will strongly consider funding the Priority One Waiver slots. “The best index to a person's character is how he treats people who can't do him any good, and how he treats people who can't fight back.”― Abigail Van Buren

More money allocated to the state of Virginia for people with disabilities in rural areas. More money to non profit organizations like Hope house Foundation. These are supported living organizations that allow people the freedom to live life in the way they choose....a life like yours!

The Healthcare for All Virginians (HAV) Coalition consists of over 100 organizations dedicated to making Virginia a leader in offering affordable, accessible, and quality health coverage options to everyone who lives in the Commonwealth. The COVID-19 pandemic has put into sharp focus long-standing inequities in health care coverage and access in Virginia and across the country, which has contributed to the higher incidence of the virus in Black and Latinx individuals, as well as in immigrant communities. As we navigate the public health crisis, every policy and funding decision made should move Virginia closer to becoming a place where everyone has the opportunity to survive and thrive. Please Increase Access To Health Coverage For Immigrants Extend Medicaid/FAMIS MOMS pre-natal coverage to undocumented women who meet all other non-immigration eligibility criteria -This federal option is already in use in 17 other states and would require a CHIP state plan amendment. -Extending pre-natal coverage would result in net savings for the state ($2.3m in FY22) due to drawing down a higher federal match rate compared to emergency only services that might otherwise be utilized. -This policy was a DMAS budget request for 2021. Clarify that Medicaid “Emergency Services” specifically cover COVID-19 screening, testing, and all related treatment -12 states have elected to cover COVID-19 screening, testing, and all related treatment for any immigrant who meets financial requirements for Medicaid. -This would ensure more people can seek testing and treatment for COVID-19 without concerns of costs. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community. Increase the age that “legally residing” immigrant children can qualify for Medicaid and FAMIS -Currently, “legally residing” immigrant children in Virginia qualify for coverage up to 19. Federal law allows optional coverage to continue up to age 21 allowing for continuity of care and reducing gaps in health coverage.

It is necessary to increase the Private Duty Nursing service rates on the DD Waivers, CCC Plus Waiver and EPSDT to “at least” that of the DD Waiver Skilled Nursing service rates. When Private Duty Nursing services was added to the DD Waivers, all individuals receiving Skilled Nursing services in their homes or inclusive communities were switched to Private Duty Nursing and only individuals living in Group Homes maintained the higher reimbursed Skilled Nursing services. Do you see a reason why an agency should be able to bill a greater rate for a nurse administering medication to another individual living in a group home or training others to give the medication than the agency providing a nurse to take care of a very medically complex individual in their own home? As a parent of a young adult who has a tracheostomy, gastrostomy, is on a ventilator 24 hrs/day and dependent one someone else for all of her activities of daily living, this rate inequity is atrocious. Virginia should be ashamed and embarrassed of themselves! Parents like me are trying to maintain our loved ones with very significant medical needs in their homes or inclusive environments instead of placing them in institutions, maintain jobs so that we can maintain a place to live and contribute to Virginia’s economy instead of just taking from it, deal with and obtain all of the medical equipment and medication our loved ones need, try to maintain relationships with our spouses and other children to prevent divorces or Child Protective Services involvement and deal with all of the scheduling changes and shortage of nursing staff due to the inefficient rates reimbursed to the agency and then to the Private Duty Nurse! If you look back at studies that have already been done in Virginia based on the US Department of Justice settlement agreement (i.e. Burns and Associates, etc.), you will see that in order for individuals to move into the community in inclusive environments, Nursing and Behavioral services are needed and significant rate increases MUST occur. Just to give you an idea of the needs, our commercial insurance pays almost double the rate per hour than is reimbursed by Medicaid. The families currently caring for their loved ones with significant medical needs in their homes are the most vulnerable population of individuals in the Commonwealth. They are trying to keep the individuals in their homes as long as possible instead of placing them in institutions. They are not in huge numbers like the individuals residing in Group Homes, they are unable to yell the loudest for rate increases, don’t have their own lobbyist, etc. They are just trying to keep their head above water, deal with the many nursing agencies unwilling to accept the Medicaid rates due to them being too low and the ongoing nursing shortage. All you need to do is talk with some of these families caring for their loved ones, myself included, with significant nursing needs in their home, talk with some of the nursing agencies, look at the Private Duty Nursing rates provided in other states, assess the need for a Private Duty Nursing rate increase to the Virginia Department of Medical Assistance Services, talk with Governor Northam who use to be the Medical Director of Edmarc Hospice for Children and a pediatric Neurologist about these medically involved children and adults, etc. and you will see that the Private Duty Nursing rate in Virginia must increase.

Dear Senator Howell and Delegate Torian: Doran died. Virginia’s taxpayers paid more for worse care and outcomes than if Doran had been able to stay home with me where he belonged with the Waiver support he was authorized, but was never able to get consistently. It did not have to be this way. At the Fairfax Regional Budget Hearing two years ago, I told the legislators present I would be forced to admit Doran to an institution if he did not successfully receive the Private Duty Nursing he was authorized. To avoid the institutionalization, I requested the Department of Behavioral Health and Developmental Services be required to implement the customized rate for Private Duty Nursing to support people with complex needs. Waiver reimbursement rates for Private Duty Nursing were too low for companies to provide Private Duty Nursing services adequate enough to meet his complex needs. The Independent Reviewer for the U.S. Department of Justice (DoJ) settlement reported this same problem. A customized rate for Private Duty Nursing was not made available, and Private Duty Nursing did not improve, so I admitted Doran to an institution on 11 September 2018. His medical condition began to deteriorate immediately. Within a month, a chronic wound was substantially worse than I had ever let it get when he was home with me. I had to intervene directly to reverse the situation. It took a year and a half to heal the wound and required invasive surgery, which had never been needed when he was home with me. Someone broke three of Doran’s ribs. That had never happened when he was home with me. It was not discovered until three months after it had happened. I cannot imagine how painful it must have been left untreated. Doran lost twenty-five percent of his body weight and was hospitalized as a result. That had never happened before when he was home with me. On 11 August 2020, Doran died in an institution after being administered a combination of medications with a known risk of stopping breathing because he had been agitated through the night. When he was found unresponsive, he could not be revived. I managed hundreds of Doran’s agitated nights without him dying. A Private Duty Nurse should have been managing that night with me at home, too. It probably would not have been his last night, if that had been the case. Doran’s death was avoidable, and his final care was expensive. The claim from the institution to insurance for Doran’s final thirty-five days of life is $44,850.92. That comes to $53.93 per hour for each hour of a twenty-four day. It is $16.51 more per hour than Private Duty Nursing companies were reimbursed for a Registered Nurse under Medicaid Waivers in Northern Virginia on 31 May 2019. Based on Doran’s complex needs, if those companies could have recruited and hired Registered Nurses with a customized rate closer to $53.93 per hour than $36.88 per hour, he could have received the care he required at home, and he would probably still be alive. Doran did not need to be in an institution, but Virginia’s Waiver system failed him, and the taxpayers paid more for that failure. If you want to reduce the chance Doran’s peers suffer the same fate, in addition to increasing Waiver reimbursement rates in general, I still request the Department of Behavioral Health and Developmental Services be required to implement the customized rate for Private Duty Nursing. Sincerely, Erin Coady

Hi, my name is Sheri and I acquired a traumatic brain injury from an auto accident. Like many people, I ended my various therapies with still many deficits in ability. I really didn't know what to do beyond the traditional therapies. I was fortunate when someone suggested The Denbigh House ( A Clubhouse for Brain Injury Survivors) It was a game changer. I came back to The Denbigh House in Jan 2020, as I had to leave previously to return to work. Part of life I was missing was independence so my case manager and I were to work on this area. Then in March the unthinkable happened. The pandemic herded us back home. Any chance of independence faded! The thought of being socially isolated and losing any prospect of gaining any independence was defeating. Fortunately, the staff stepped up and offered virtual services. For me, it was a lifeline. The virtual services have offered me the opportunity to socialize and be productive within our community. I 'm able to attend the clubhouse and do work unit tasks virtually, play virtual games and activities with Members and staff. I'm able to work 1:1 with my Case Manager on personal goals, I attend mindfulness activities and Chair One Fitness to work out my body. These are some examples of the virtual services to help me remain involved in the clubhouse. The unlimited nature of virtual services, even after the pandemic, will bring many more into our community for the much needed socialization and feelings of self worth and productivity. We are fortunate here at The Denbigh House. I'm advocating for Community Supports being patroned by Delegate Emily Brewer and Senator Monty Mason We are asking for $1 million to address waitlists, continue and expand virtual programming, and build a better community based system of care for brain injury. Virtual programming has met the needs of many people and will have to continue after we can safely gather again and see each other in person. Our staff is amazing. They go beyond their normal hours to provide opportunities for social and productive activities. Each of them has these great gifts which they share with us daily. We are asking for $1.4 million to retain qualified and committed staff at community based brain injury programs. All of these programs have difficulty offering competitive salaries and retaining staff because of a lack of flexibility in how our state funding is structured. This request was funded in last year's regular session, and our need is even greater now. What this will mean for me: I will continue to have a case manager to assist me and help me to work on independence, apply for benefits and provide resources and referrals in the community. Thank you for your time today. It is such a privilege to speak with you and relate to you my experience with The Denbigh House.

Year-Round School in Virginia until COVID Learning Losses are Made Up I recommend that each school board implement what the title suggests. COVID-related learning losses are extreme, and they are most extreme among poor children. I suspect that any standardized measurement such as SOLs will yield dreadful results. Social promotion will ruin these children’s lives. The concept is far from fanciful. Year-round schools are acknowledged to improve student learning, and Virginia permits and funds the transition to year-round schedules. More than 3 million children nationwide go to year-round schools. Code of Virginia § 22.1-79.1. Opening of the school year; approvals for certain alternative schedules authorizes school boards to switch to year round schedules. That law and appropriations act funding for planning and start-up of year-round schools to improve student achievement have been in place since 2014. The law and appropriations have been supported by both parties. See the VDOE webpage Year-Round and Extended Schools for program details. The funding policy detailed in the Superintendent’s Memo Fiscal Year 2021 Planning and Start-up Grants for Extended School Year or Year-Round School Programs is linked from that web page. While I recommend year-round school, it is up to each school board to decide how it will act. There is no slack in the schedule to make that decision. Guaranteed state funding support is required for the school boards to plan their approaches to mitigation. Federal COVID funding for schools has been appropriated for use by the states. There is no better use for that money than for learning loss mitigation. See https://www.baconsrebellion.com/wp/year-round-school-in-virginia-until-covid-learning-losses-are-made-up/ for more information

I am requesting support of the budget amendments for Brain Injury services. There are 37000 individuals living with a disability as a result of a brain injury in Hampton Roads yet we have only been able to provide services last fiscal year 100 individuals due to limited funding in our area.

Hello. My name is Esther S. Merves, and I live in eastern Virginia, in Middlesex County. I am a member of the Virginia Coalition for Human Rights, which is a coalition of 18 organizations with a combined membership of over 10,000 Virginians. The reason I am here today is to ask you to give serious consideration to defunding and decommissioning of the Virginia-Israel Advisory Board. My concern is the fiscal impact to Virginia’s budget. Having one country represented means other countries will request the same (and have already done so). The government of the Commonwealth is not the place for an in-house lobbying organization to represent the business interests of a foreign country. Israeli businesses are free to establish a Virginia-Israel Chamber of Commerce to lobby on their behalf. But as a state agency, the Israel Advisory Board has set unsustainable precedent. For example, when a bill was introduced last year in the 2020 regular session of the General Assembly, to create the Virginia-Korea Advisory Board, the problem was noted by the Fiscal Impact Statement issued from the Department of Planning and Budget which said, “The bill establishes a new fund in the state treasury to be used solely for carrying out the purposes of the Board.” This observation highlights the inherent problem in having created the Virginia Israel Advisory Board. How can the General Assembly be expected to fund advisory boards for the businesses of other countries? No one country should have its own office space in the Pocahontas Building, full-time director, administrative staff, and travel expenses all paid for by the citizens of the commonwealth for the purposes of lobbying within state government. In light of what I have presented, I request an amendment to defund and decommission the Virginia-Israel Advisory Board. Thank you for your time and consideration.

Thank you for your time.