As a person of Faith it is my calling to support these areas of concern and I ask you to consider how important these issues are and to vote to approve them!

Chairman & Committee Members: On behalf of SALT's 1300 members I urge you to vote for HB 1820 to increase Access to SNAP: Implement Broad-Based Categorical Eligibility by (Delegate Helmer). The Supplemental Nutrition Assistance program (SNAP) is a federal food assistance program that helps low-income families put food on the table. Broad-Based Categorical Eligibility (BBCE) streamlines SNAP enrollment for all individuals receiving a TANF funded service. 43 states have implemented BBCE. Virginia is one of the seven who have not. As a result, Virginia is missing out on: • Helping over 25,000 families put food on the table and • Millions of federal dollars entering our economy. Federal regulations allow for states to set SNAP eligibility levels between 130% and 200% of the Federal Poverty Line (FPL). Virginia is at the bare minimum of 130%. Currently, to qualify for SNAP in Virginia, an applicant must: • Have a gross income that must fall within 130% of the FPL, • Have net income fall within 100% of FPL, and • Pass an asset test. The Solution: Increase the gross income eligibility level to 200% of the FPL and remove the asset test. The Wins: This will increase access to SNAP for more children. • Children who are eligible for SNAP are then also eligible for free school meals. • This will help reduce school meal debt, which is a growing issue in VA schools. Increasing the number of SNAP recipients in Virginia will pump more money into local economies, helping smaller grocery stores. • Every SNAP dollar will generate ~$1.50 in economic activity. The state’s investment in BBCE will result in an e $10.5 million of economic activity. Budget Request • General Fund: $281,292 / Non-General Fund: $342,558 If funded, this budget amendment will help over 25,000 more families . SALT urges you to Vote for HB 1820.

Voices for Virginia's children is supportive of HB1820. Families are witnessing the closing of nearby community centers they may have relied on, unemployment, choosing between going to work, staying home sick, or putting food on the table. Economic Trauma occurs when financial stress and/or economic shocks impact a person’s feelings of safety, their ability to remain calm, manage healthy relationships with others, and maintain the belief that their situation can improve, which can lead to an impaired ability to function in daily life. Currently, families are facing financial stress, economic shock, and financial health. The temporary assistance for needly families would further put families in a position where they can experience the supports to achieve financial independence, which means children are able to be resilient and live, long, health, and successful lives without trauma.

Hunger for the very poor is an ongoing problem. It has been exacerbated by the pandemic. Many Virginia families are suffering. I, along with many others, have been contributing to charitable food sources. It is not enough. Virginia can help alleviate this problem by, among other things, expanding SNAP benefits. This is not only a good thing to do, it is the right thing to do. I respectfully urge you to act favorably on HB1820.

Our families drive our economy. We are leaving them behind. It is long past time for us to join the other 43 states making it easier for families to get enough to eat. We have to give the families of Virginia every opportunity to succeed. As long as food is a luxury we can't do that. Please ensure we can feed Virginia's most vulnerable families.

The Virginia Community College System supports HB 1820 provided that the language changes that VDSS requested are made so that the bill aligns to Federal regulations.

I am writing today in support of HB1820- which has the potential to help more than 25,000 more families feed their families. I was born in Virginia, while my father was stationed in Norfolk as a submariner. In adulthood, I found my way back to the state and now live in NOVA and work for the National Governors Association Center for Best Practices. I am submitting these comments as a private citizen and not on behalf of my employer, but the work that I have been able to do with state leaders has certainly informed my perspective on supporting students and families. 43 states have already implemented Broad-Based Categorical Eligibility (BBCE) which streamlines SNAP enrollment for all individuals receiving a TANF funded service. I hope that, through this bill, Virginia will join that large group of states to streamline access to these programs to support their families. This type of effort is a perfect example of the ways that state can leverage federal programs to maximize the impact of every dollar to support Virginia families. I approach this issue from a postsecondary education perspective, which is my policy area. I am so proud that Virginia is so proactive and strategic in it's efforts to build a future workforce and provide economic opportunity to it's residents. HB1820 is yet another opportunity to move towards these goals. Providing accessible basic supports for Virginia families while they work to obtain quality education and employment opportunities can break cycles of poverty. Postsecondary attainment and workforce participation are not just numbers, they represent people. People who have pathways to support their families and children who have their needs taken care of and can focus on their future opportunities. My policy work has taught me that when federal and state support programs can be better connected and made more accessible for families- positive impacts can be maximized. HB1820 is a relatively small step that will make huge impacts in the lives of families in need in Virginia. I hope that delegates will vote to pass this bill and continue to double down on state efforts to provide support for Virginia residents as they work towards a brighter economic future.

Delegate Helmer, I am writing in support of HB1820. I was made aware of this by a friend and must say it is embarrassing to see that Virginia is one of a handful of states that has such restrictive requirements to qualify for the most basic of human needs - food. The dollar amount to support increasing the gross income eligibility to 200% of the FPL and remove the asset test is minimal, and should absolutely be passed to ensure that Virginians so desperately in need of support receive it. There are so many positive things that would result in the passing of HB 1820, and it is critical to increase the eligibility so that children and families can benefit and ensure they are not presented with yet another obstacle to being food insecure. Thank you.

On behalf of Virginia's seven regional food banks, I am requesting your support for HB1820. The bill will significantly improve food security in our Commonwealth at a time when we are seeing unprecedented levels of demand for emergency food service. First, it is long past time for Virginia to implement Broad Based Categorical Eligibility - a policy option which 43 other states have already adopted. Increasing the gross income limit to 200% of the federal poverty level and removing the asset test will help 25,000 families put food on the table and generate much-needed economic activity in local communities. Second, HB1820 will expand SNAP access for college students, who often fall through the gaps of the nutrition safety net. Two surveys conducted at James Madison University in 2019 found that 30% of JMU students suffered from food insecurity, which is comparable to national estimates. Despite high levels of need, college students face restrictive eligibility criteria in order to qualify for SNAP. With the passage of this bill, we can take important steps to increase SNAP participation among college students, which will allow them to focus on their studies instead of worrying where their next meal will come from. The Federation of Virginia Food Banks strongly urges the passage of HB1820.

As the Legislative Affairs Chair for the Student Government Association of James Madison University, I support this legislation’s recognition of the laborious demands of postsecondary education. This bill needs your support in order to help students receive the VIEW assistance and SNAP benefits that will support them as they earn their degree. Food insecurity on college campuses has only increased during the COVID-19 pandemic and this legislation would help alleviate a lot of the burden on students who are balancing a full course load and also trying to find income to cover food costs.

I urge passage of HB1820, which would relax the eligibility for the Supplemental Nutrition Assistance Program (SNAP). By increasing the gross income eligibility level to 200% of the Federal Poverty Line, many more families would receive federal assistance for food. Additionally, this law would also pump more money into local economies. I also urge others to support this legislation. Andrew Rhodes

To whom it may concern, I am writing to voice my support for HB1820 and to encourage Delegates to support this important legislation that will extend SNAP benefits to more Virginians and address food insecurity. In doing so, Virginia will join 43 states that have already implemented Broad-Based Categorical Eligibility (BBCE) to streamline the enrollment of individuals receiving a TANF funded service for SNAP benefits. By funding HB1820, Virginia would extend benefits to an estimated 25,000 residents. Children of these families would also receive access to free school meals. And, Virginia’s estimated investment in BBCE would generate an estimated $10.5 million in economic activity. This is a win-win for the Commonwealth. Thank you in advance for your support of HB1820. Best, Harmony Knutson Alexandria

I respectfully submit the following comments on behalf of the Hope Center for College, Community, and Justice in support of HB1820. HB 1820 accomplishes two goals; it will expand access to food assistance through the Supplemental Nutrition Assistance Programs (SNAP) to an estimated 25,000 Virginia families. The children in these families will then be newly eligible for free school meals. It will also improve access to SNAP and the VIEW program for college students, many of whom are struggling to complete college credentials during COVID-19. SNAP, the nation’s largest and most effective food assistance program, provides a monthly supplement for purchasing nutritious food. HB 1820 improves access to SNAP by allowing Virginians living at up to 200% of the federal poverty level to access nutrition assistance. This policy change is critical because it allows a household’s SNAP benefit to decrease slowly as their income rises, providing a smoothing effect as people transition off assistance programs. Virginia’s current policy of cutting families off at 130% of the federal poverty level means that a very small raise could leave someone worse off than they were before the raise due to the total loss of SNAP benefit, essentially penalizing a household for getting a raise. Evidence from our latest #RealCollege During the Pandemic survey, completed in the spring by more than 38,000 students, revealed that 44% of students at two-year institutions and 38% at four-year institutions experienced food insecurity due to the pandemic. Students were also impacted by record unemployment. The survey showed that two-thirds of students were experiencing job insecurity, with one-third having recently lost a job. As this crisis rages on, these challenges will likely grow. HB1820 recognizes the reality of the job market during the COVID-19 emergency -- and the importance of an educated workforce to Virginia’s future – by improving access to critical basic needs supports for college students. This bill maximizes federal rules in student eligibility and eases the restrictions that force students to choose between continuing their education or subsisting in a low-wage, limited-growth job. College completion is critical for individuals, their families, and for the national economic recovery. People without college degrees were harmed most by the Great Recession. They did not experience the same recovery that college degree holders did and in many cases, they are now worse off. In an economy in which the vast majority of new jobs require some form of postsecondary credential, improving college student success will improve the likelihood that our nation can recover economically and do so faster. Given the extensive research that shows college improves a vast array of social and economic outcomes, improving student access to support programs that bolster their educational success should be a priority for all policymakers. Thank you, Carrie R. Welton Director of Policy & Advocacy The Hope Center for College, Community, and Justice

I am for nurse practitioner to be able to practice without a doctor being there

Addressing topics for perspective is a form of growth.

The professional organizations preparing Advanced Practice Registered Nurses and Certified Midwives unwaveringly teach consultation and collaboration with MD's and other professionals as a standard of client care. NP, CNM, and CM's are all certified professionals who take an oath to do no harm. Malpractice insurance for a physician is steep and coverage of an additional provider (said professional currently required to have a written agreement with) is care-prohibitive.

I am in favor of licensed certified nurse midwives to have full scope of practice. I am a Professor Emerita from Shenandoah University in Winchester. I was a graduate faculty member who taught foundation courses to the student nurse midwives and found each of them to be exceptionally smart and genuinely caring nurses seeking to aid women and their families through this course of study and calling. The breadth and depth of their education and certification and licensure process is among the highest for the professionals - they are capable and competent to practice without supervision and collaboration. Please support this bill. We need every licensed health professional practicing at the top of their education to meet the needs of Virginians during this healthcare crisis.

In favor of programs to better facilitate the development and progress of my community.

I write in full support of HB 1953. I was born and raised in Manassas, Virginia, and many of my family members continue to live in the Northern Virginia area. I currently live in New York, where I am employed as a Certified Midwife by a large federally qualified health center. I am not able to work in Virginia. I submit this letter in support of HB 1953 to license Certified Midwives in Virginia. As a Certified Midwife, I provide the full scope midwifery care that was my education and training, including routine gynecological care, primary care, and care during pregnancy through the postpartum period. I perform diagnostic biopsy procedures and refer patients for imaging and specialist care. I have full prescriptive authority, in keeping with my scope of practice, which allows me to provide timely, appropriate care for my patients. I have had privileges at 4 hospitals in the Hudson Valley region. My hospital privileges allow me to independently manage the care of low-risk women during labor, birth, and postpartum; I collaborate with a physician to co-manage high-risk patients, and I am a surgical first assist for cesarean deliveries. The high quality of my care has been recognized and awarded in the past by my employer. There is growing awareness and alarm over the poor maternal health outcomes and pronounced racial health disparities in the United States. Virginia’s maternal health record reflects these same outcomes and disparities. Virginia’s women need solutions. Increasing access to midwifery care, as noted by the March of Dimes, is an essential aspect of eliminating maternal health care deserts while providing high-quality care that is shown to reduce costly interventions and improve outcomes for mothers and babies (https://www.marchofdimes.org/materials/2020-Maternity-Care-Report.pdf). Thank you for your attention to the needs of women and their families in Virginia. Respectfully, Marian Seliquini, CM, MS President, NY Midwives, ACNM Affiliate

I write in full support of HB1953/SB1320 to authorize licensure of Certified Midwives (CM). At the Midwifery Institute at Thomas Jefferson University, we have been educating midwives since 1996. Beginning in 2010, we expanded our admission process to include all qualified applicants rather than limiting application to Registered Nurses. I am an author on a retrospective study demonstrating that prior work and educational experience are not associated with successful completion of a master's-level, distance education midwifery program. All graduate students completing education leading to board eligibility for the Certified Nurse-Midwife (CNM) or Certified Midwife (CM) credential demonstrate health, social, and basic science pre-requisites prior to beginning graduate studies in midwifery. Students are educated side-by-side using the same curriculum, standards, and outcome measures. Our program provides didactic courses using robust online teaching methods, on-campus simulation for skill acquisition and clinical reasoning, and clinical education under the supervision of qualified and licensed preceptors. Prior to graduation and board-eligibility, all students demonstrate the Core Competencies for Basic Midwifery Practice published by the American College of Nurse-Midwives and pass a comprehensive exam for the degree. In 2020, our program had a 100% board pass rate. Our graduates are successful and work in all settings where midwives practice. CM graduates go on to work in community hospitals, academic medical centers, internationally, in birth centers, and in communities, including Federally Qualified Community Health Centers. Our graduates have successfully worked with insurance companies to ensure equitable reimbursement with their CNM colleagues. One of my graduates lives in Lorton, Virginia. She is unable to be licensed despite having accredited graduate education in midwifery and national certification because she is not a Registered Nurse. I hope that the legislature will grant licensure to Certified Midwives consistent with the Core Competencies, Standards of Practice, Code of Ethics, and joint statement of practice relations between Certified Nurse-Midwives and Certified Midwives and Obstetrician-Gynecologists. By ensuring multiple pathways to accredited, graduate education in the full-scope of midwifery, more aspiring midwives can afford to attend school, take out fewer loans, and enter the workforce. Decades of research support midwifery as a key component of quality maternal-child and preventative healthcare. However, midwives are underutilized in the United States. I urge you to license Certified Midwives to help alleviate the provider shortage in over 50% of Virginia counties with no maternity care. Dana B. Perlman, DNP, CNM, FACNM Director, Midwifery Institute Associate Professor

Dear Chairman and Members of the Committee: The requirement of a nursing degree prior to formal midwifery education is not only unnecessary in terms of wasteful student expense and time; overall, it weakens the nursing workforce. Students who pursue nursing education as a stepping-stone to midwifery (when there is no other choice in the state) take up a seat in the classroom and clinical placement for another student that truly wants to be a bedside nurse. I am Certified Midwife (CM) that lives in New York State and works in Washington, DC at Georgetown University. I am the former Program Director of the Georgetown Nurse Midwifery/WHNP and the WHNP programs as well the former director for the NYU Midwifery Program. Currently, we have 239 midwifery students in the program. They are all nurses. I could double that number if I could accept applicants that were not nurses. We could educate the midwives that we need to provide midwifery and primary care in many of the places that need health providers. Nationally, at the American College of Nurse-Midwives, I have served in numerous leadership positions and my background is in birth, both out of the hospital and in the hospital setting which prepared me to understand the needs of the women I have served. I was the first CM in two hospital settings and worked alongside my CNM colleagues like every other midwife. In the hospital setting at both Bon Secours Hospital (Port Jervis, NY) and Nyack Hospital, I attended hundreds of births in a full scope capacity and I served as First Assist for any of my patients that needed a cesarean section in Nyack. Additionally, in Nyack, I was on call for and managed complicated gynecological cases in the Emergency Room. CMs have the same midwifery education and the same scope of practice as their CNM colleagues. CMs not only practice midwifery, but they can also excel in health leadership and systems management. I also practiced for many years without a written practice agreement (WPA). The studies show that midwifery care is just as safe with or without a WPA which often has to signed by someone who is in direct competition with you. The WPA actually discourages midwifery practice!!! As a private practice owner for five years, my flourishing practice had to close when my MD colleague who did sign my WPA moved out of state! The same happened in NYC when almost 20 midwifery practices had to close when St. Vincent’s Hospital went under, prior to the passage of full practice authority for CNMs and CMs. This left hundreds of pregnant patients without a provider! I whole-heartedly and without reservation support HB 1953 and trust that you will consider your constituents who deserve have a midwife, if they so desire. Thank you for your consideration. Feel free to contact me should you have any questions. Julia Lange Kessler  CM, DNP, FACNM Program Faculty: Nurse Midwifery/WHNP Program Course Coordinator: Primary Care Assistant Professor Georgetown University School of Nursing & Health Studies

I am the current president of the Virginia Association of Clinical Nurse Specialists. I am writing in support of HB1953 to license certified midwives in Virginia. The addition of certified midwives will improve access to primary and maternal health care for Virginia residents.

On behalf of the American College of Nurse-Midwives (ACNM), I appreciate the opportunity to provide comments in strong support of H.B. 1953, legislation to license and regulate the practice of certified midwives (CM) in VA. If enacted, H.B. 1953 would increase access to evidence-based, high-value maternal health care and improve maternal and newborn health outcomes during a time in which the Commonwealth faces a shortage of high-quality maternal health providers and significant race-based disparities in maternal and infant outcomes. While there are many different types of midwives, each holding different certifications based on their education and/or experience, a majority of midwives in the US have a master’s degree and many are doctorally-prepared. Certified Nurse-Midwives (CNMs) & CMs attend approximately 93% of all midwife-attended births in the US and are required to have a master’s degree to practice. CMs and CNMs differ in how they entered their master’s level midwifery educational program, but they do not differ in how they leave their programs, and how they leave is what is important for their practice. Like CNMs, a CM is an individual educated in the discipline of midwifery. CMs earn graduate degrees, meet health and science education requirements, and complete a midwifery education program accredited by Accreditation Commission for Midwifery Education. CMs pass the same national certification examination given by the American Midwifery Certification Board (AMCB) as CNMs, who are already licensed to practice in Virginia and receive the professional designation of CNM. Both CNMs and CMs demonstrate the Knowledge, Skills and Behaviors Prerequisite to Midwifery Clinical Education prior to commencing midwifery clinical training. Both CNMs and CMs demonstrate the identical Core Competencies for Basic Midwifery Practice of the ACNM upon completion of their midwifery education programs. Both CNMs and CMs must practice in accordance with ACNM Standards for the Practice of Midwifery. ACNM competencies and standards are consistent with, or exceed, the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every 5 years through AMCB and must meet specific continuing education requirements. Licensed to practice in DE, HI, ME, NY, NJ, OK & RI, individuals choosing this career path are pioneers in the profession, much like the early CNMs who practiced in the U.S. 50 – 70 years ago. CNMs and CMs have the identical ACNM defined scope of practice and follow ACNMs standards and code of ethics for midwifery. Like CNMs, CMs provide a full range of primary health care services in all stages of life, from the teenage years through menopause, including general health check-ups, screenings and vaccinations; pregnancy, birth, and postpartum care; gynecologic care; treatment of sexually transmitted infections; and prescribing medications, including all forms of pain control medications and contraception. While a majority of CNM/CM attended births occur in the hospital setting, CMs work in a variety of settings, including hospitals, health clinics, OB/GYN practices. Recognition of the CM credential in VA will cultivate increased access to a wide range of primary and maternal health care services and will help combat the ever-growing maternity care provider shortage plaguing many regions throughout the Commonwealth.

I am for nurse practitioner to be able to practice without a doctor being there

I support the bill to license Certified Midwives (CMs) in Virginia, HB1953. Born and raised in Virginia, I am a certified nurse-midwife (CNM) in a home birth and birth center practice based in Alexandria. CNMs have been licensed in VA since the 1970s. Though the CM credential, an equally academically rigorous pathway to becoming an advanced practice midwife, emerged in the 1990s, VA has yet to update our legislative language to welcome these qualified practitioners into our workforce. To become a CM, one must complete the same graduate level midwifery coursework as a CNM and take the same national certification exam from the American Midwifery Certification Board. The difference between the two credentials is simply that CNMs are also registered nurses, usually with a bachelor’s in nursing, whereas CMs can have any undergraduate major. Just like CNMs, CMs graduate from midwifery programs equipped with the core competencies that make them ready to practice safely and autonomously from day one. Our Commonwealth faces a shortage of women’s health and primary care providers, and CMs could be part of the solution. According to March of Dimes, 47% of counties in Virginia are either maternity care deserts or have low access to maternity care (https://www.marchofdimes.org/materials/2020-Maternity-Care-Report.pdf). Recognizing the CM credential will help us respond to our maternal health provider shortage in three key ways i) the talented CMs already living in VA will be able to provide care to our citizens; ii) CMs for whom our restrictive practice laws were once a deterrent will now be able to live and work here; and iii) VA universities will be able to attract midwifery students with diverse non-nursing backgrounds. Shenandoah University, for example, is poised to start a CM program as soon as this legislation is adopted. In addition to increasing our workforce, this could also generate revenue in VA. This bill has personal significance to me, as I heard my calling to become a midwife after having already earned an undergraduate degree in a field other than nursing. I am eager to remove unnecessary barriers and pave the way for others like me to answer the call to take care of women and families in our community. For this and the many reasons above, I support this bill without reservation. Thank you for your time and consideration. Sincerely, Tana K. McCoull, MSN, CNM, FNP-C

My name is Elle Schnetzler, I am a Certified Midwife (CM), a Fellow of the American College of Nurse-Midwives, a Board member of the American Midwifery Certification Board, and a Lieutenant Colonel in the US Army living in Virginia. I hold a Master of Science in Midwifery, from Philadelphia University, which I attended alongside student nurse-midwives and a doctorate in Midwifery from Thomas Jefferson University. I completed my clinical training at Womack Army Medical Center at Ft Bragg, North Carolina while living in Virginia. I would drive to Womack monthly to complete my clinical requirements. After graduation and becoming an AMCB board-certified midwife, I would fly to NY, where I am licensed, monthly to practice as a midwife. I chose the CM pathway because I needed to take the most direct path to accomplishing my goal of becoming a midwife due to military and family constraints. Though the travel was taxing it was important to stay the course because I believe in the vital impact of the profession and I wanted to maintain my valuable skills. More American women are dying of pregnancy-related complications than any other developed country and the rate continues to increase. This increase is greatest among African American women, who are 2 to 3 times more likely to die from pregnancy-related complications than Caucasian women. A recent study mapping integration of midwifery in the US demonstrated a correlation between high density in midwives/higher proportion of midwife-attended births and significantly higher rates of spontaneous vaginal delivery, VBAC, and breastfeeding at birth to six months. As important as full integration of midwives in the health care system is developing a means to produce more midwives overall and more specifically midwives of color. Licensing CMs provide this means. Many nursing schools have a waitlist for those who want to become a nurse. Requiring those who want to become midwives to become nurses first further compounds the waitlist when they have no intentions to practice as a nurse. Further, the nursing and midwifery professions have failed to keep pace with changing demographics in the US. Research has shown that quality of, and access to, health care for people of color has been improved by increasing racial diversity in the healthcare workforce. Licensing CMs provides a pathway to directly increase midwives without burdening the pathway to nursing, where a shortage already exists. Further, increasing pathways to midwifery can increase diversity thereby increasing access and decreasing disparities. Race-concordant care produces longer visits, increased provider participation, and communication, and produced higher ratings of client satisfaction and trust compared with race-discordant visits. Provider-client communication has been associated with commitment to care plans/medical instructions, client satisfaction, and health outcomes resulting in greater quality of care. As a multi-ethnic midwife of color, I understand the importance of race concordant care first-hand. I strongly urge you to support HB 1953 Licensure of CMs in Virginia not only because CMs are equivalent to CNMs in their midwifery preparation and national board certification but because women in Virginia deserve the benefits that expanding the midwifery workforce can offer.

Nurse practitioners are more qualified and more caring than most of the medical practitioners you deal with. They have the skills, the education and take time to hear their patients .

I appreciate the opportunity to submit testimony on this bill. My name is Maryann Long, and I am a midwife, now retired, with over 30 years of experience as a midwifery clinician and educator. I completed my midwifery education at Downstate Medical Center in Brooklyn, NY in 1981, I hold a master's degree in public health and a PhD in midwifery. I am a Fellow of the American College of Nurse-Midwives. Maternity care in this country is in a sorry state. Maternal mortality is higher here than in any other high-income country and higher than in quite a few middle-income countries, especially among mothers of color. Some mothers are over-treated, subjected to unnecessary and non-evidence based birth interventions, while others, many in rural areas, cannot even access basic prenatal care for lack of nearby providers, and have to travel for miles to a hospital that offers maternity care. Costs associated with US maternity care continue to increase. Increased utilization of midwives has been recommended as part of the solution to these problems. Virginia has licensed Certified Nurse-Midwives (CNMs) for practice since 1975. Virginia's CNMs have a record of excellent outcomes using fewer interventions, which lowers the cost of care. Ideally, there would be a midwife for every childbearing person. Virginia is failing so far to take advantage of another source of midwives to bring needed care to our population. I refer to Certified Midwives (CMs), who are equivalent in all ways to CNMs, but currently able to practice in only 6 states: Delaware, Hawaii, Maine, New Jersey, New York, and Rhode Island. I would like to see Virginia added to this list. Two university midwifery programs in the US educate midwives from both nursing and non-nursing backgrounds. Their students all take the same courses and are held to the same standards for success. Coming from a background other than nursing is not a disadvantage. Indeed, those students perform as well or better in their course and clinical work than their peers who are nurses. They all must demonstrate the same competencies, and upon graduation, they all must pass the same certification examination to be entitled to call themselves either CNMs or CMs. The only difference is whether or not they were nurses before their midwifery education. The bill before you would extend the same licensure that CNMs now enjoy to CMs. Given that their education, competencies, and professional standards are identical, and given the need to expand our maternity care workforce to improve our outcomes, I strongly urge you to support this bill. Thank you.

In favor of programs to better facilitate the development and progress of my community.

I am for nurse practitioner to be able to practice without a doctor being there

HB1915- Children are the future. Teachers care for our future and should be paid in a way that reflects the sentiment that we care for the future of our country. HB1987- This should be allowed for mental health especially. Many mental health in-person appointments are missed because someone’s mental illness keeps them from leaving the house or the person doesn’t have childcare at the time where they need to make the appointment. Telehealth will help with accessibility.

The Virginia Poverty Law Center strongly supports HB 1987 which extends and clarifies Medicaid telehealth services and remote monitoring of many health conditions. During this horrible COVID-19 pandemic, Virginia (and the U.S.) has gained new appreciation for the value of tele-medicine. Both providers and patients have benefited from easier access to medical care and improved monitoring of chronic conditions. The Medicaid program has fully participated in authorizing more telehealth during the pandemic. HB 1987 builds upon this experience and maintains valuable telehealth services to Medicaid enrollees. I have two concerns about the FIS for HB 1987. The estimated costs to DMAS appear inflated because (1) the FIS seems to count all telehealth services as ADDITIONAL services, rather than replacements for appointments and services that would normally occur; and (2) the FIS doesn't consider any cost benefits or reduced hospital/ED services which are very likely to result from better access and monitoring through telehealth. Thank you for supporting HB 1987. Jill Hanken, VPLC Health Attorney

We support this bill. Extending the use of telhealth in Virginia will benefit those with chronic conditions that live in our underserved communities. It can also reduce hospitalizations and other health care costs by helping to control conditions such as diabetes, high blood pressure, etc.

Chairman Sickles, members of the Subcommittee, good morning. I am Dr Karen Rheuban, Director of the UVA Center for Telehealth and board chair of the Virginia Telehealth Network. Thank for the opportunity to speak to HB1987, which directs the Department of Medical Assistance Services to cover remote patient monitoring services for priority, high risk, high cost patients and conditions. Remote patient monitoring programs improve patient outcomes, and lower the cost of care. I would respectfully like to address the fiscal impact statement prepared by the Department of Planning and Budget. UVA began our remote monitoring program in 2014. Based on our prior data, and the first 6 months of FY 21, we anticipate monitoring approximately 6200 high risk patients this year. For those monitored patients with the conditions identified in this bill, we project a reduction of 25,034 hospital bed days. These reductions result from hospital admissions and readmissions avoided and shortened length of stay. With an average total cost per bed day of $2015 for low case mix index patients, we conservatively project cost savings across all payers of $50,443,510 in FY21. In addition, our data demonstrated a reduction in emergency department visits for our monitored patients by 14%. One additional note for consideration as it relates to the costs of remote patient monitoring: many patients only require 30 days of monitoring, others only 3 months, rather than as projected, all patients for a full year. Medicare has covered remote patient monitoring for a broad range of conditions since 2018. We urge the committee to consider this additional information, particularly regarding cost savings to the Medicaid program, when considering the true fiscal impact of HB1987. Thank you.

My name is Stephen Grammer, from Roanoke. I encourage you to pass HB1987 and HB2124. HB1987 would allow people who without transportation easier access to being able to communicate with their primary doctors. This also would be cost-effective, due to the fact that people will not have to get ambulances going to hospitals over non-emergency situations. HB2124 would allow people with disabilities to get treatment for COVID. We are on a very low-budget, and can not afford to pay out of pocket for treatment. Again, I encourage you to support HB2124 and HB1987. Thank you for your time and consideration.

January 20, 2021 Chair Mark Sickles Health Welfare and Institutions Committee Virginia General Assembly 1000 Bank St Richmond, VA 23219 RE: HB 1987--Physical Office Location Amendment to Conduct Telehealth Chair Sickles and Member of the Committee, On behalf of Hims & Hers, a direct-to-consumer digital health company, we urge you to preserve access to healthcare treatment for thousands of Virginians by removing language recently added to HB 1987 that would require a physical office or relationship with a practice” in order to conduct telehealth in the Commonwealth. This onerous and unnecessary language will have a chilling effect on direct-to-consumer health platforms like Hims that are providing care to thousands of Virginia residents during a global pandemic but do not have a physical location. Especially during the COVID-19 pandemic, it is critical that we encourage, not curtail telehealth usage, and reduce nonessential, face-to-face encounters between patients and healthcare workers while maintaining the highest quality of care. At Hims & Hers, we connect patients to licensed healthcare providers for medical consultations and treatment across all 50 states. Our platform is powered by virtual care, without an in-person visit, which is a care delivery model that has been embraced by state legislatures, hospitals, healthcare providers and patients across the country. Since our launch in 2017, we’ve powered more than two million digital healthcare visits across a variety of conditions, ranging from sexual health to psychiatric health. In response to the pandemic, Hims & Hers has incorporated access to additional telemedicine offerings, including primary care services, mental health support groups, and access to at-home COVID-19 testing kits. We believe providers should always be held to the highest standard of care regardless of the mode of delivery, and that is why providers on our platform are licensed, highly-credentialed, and held to evidence-based clinical standards. Our executive team and board of directors are composed of some of the most experienced minds in healthcare, like Dr. Toby Cosgrove, former CEO and current Executive Advisor of the renowned Cleveland Clinic, and Dr. Patrick Carroll, our Chief Medical Officer (CMO), the former CMO of Walgreens. We recognize that telehealth is not an appropriate mode of care delivery for all conditions, and that is why we rely on licensed providers to make those determinations and refer patients to the appropriate healthcare systems and platforms. However, the current proposed physical location requirement in HB 1987 would effectively ban Hims and other direct-to-consumer digital health platforms from providing care in the Commonwealth. This is especially troubling for those in underserved areas, where telehealth is a lifeline for receiving quality care. We hope that you will remove this language from the bill, and ensure that quality care is preserved for thousands of Virginia residents. Sincerely, April Mims VP of Public Policy Hims & Hers, Inc cc: Vice Chair Rasoul, Committee Members, and Clerk Rushawna Senior

To the Members of the Committee: On behalf of the Virginia Community Healthcare Association and the 155 community health center sites across the Commonwealth that serve over 355,000 Virginians in medically underserved communities, we ask for support for House Bill 1987. Remote Monitoring Services would be invaluable in monitoring the health conditions of some patients, particularly those recently released from a hospital setting. In North Carolina, a pilot program conduced several years ago in a community health center led to significantly reduced A1C numbers in diabetic patients. For cardiac patients, one can cerrtainly see the benefit of having remote monitoring at home after having stents, or having a heart attack. On the last paragraph on audio only services – this has been an important part of delivery of services in medically underserved areas that have limited access to internet broadband services. In some parts of the Commonwealth, video is not available due to limited bandwidth. Although not mentioned in the bill, I would ask the committee to remember that when a health provider does provide services by audio only, they bring to bear their full knowledge. Reimbursement for audio only services should be at a full and regular rate, not a discounted rate, as the services of the provider requires their full abilities. Thank you, Rick Shinn - Director of Government Affairs Virginia Community Healthcare Association

VACo supports this legislation in keeping with our long-standing position in favor of the use of telemedicine to provide long-distance clinical care, patient and professional education, and public health, as well as support for flexibility in the delivery of these services.

On behalf of the Virginia Association of Community-Based Providers (VACBP), the largest association of private-sector providers of community-based behavioral health services to Virginia's Medicaid population, I want to express our support for HB1987. The ability to provide and be reimbursed for behavioral health services delivered via telehealth and telephone has been absolutely critical to our members as they have worked to meet the needs of Virginia's most vulnerable residents. We applaud DMAS, DBHDS and DMAS for their quick action to develop the regulatory framework within which services could be provided early in the pandemic and in close coordination with providers. We support efforts to continue to allow use and reimbursement for telehealth and telephonic delivery of services where appropriate throughout the duration of the current public health crisis and beyond it. Thanks to Del. Adams for introducing this bill and for her commitment to identifying how telehealth can continue to be leveraged to increase access to quality healthcare services for all Virginia residents. The VACBP also supports HB2197, which would create a workgroup to evaluate and provide recommendations for the permanent use of virtual supports and assistive technology for the ID/DD population in Virginia. We believe that such an effort that is collaborative and inclusive will yield valuable insight that can guide future policy in this space. Thanks to Del. Runion for introducing this bill.

Teladoc Health would like to register our concerns with amendments to House Bill 1987. Recognized as the world leader in virtual care, Teladoc Health directly delivers millions of medical visits across 175 countries each year through the Teladoc Health Medical Group and enables millions of patient and provider touchpoints for thousands of hospitals, health systems and physician practices globally. Specifically, we strongly oppose the amendment to Section 54.1-3303 B. As written, the bill would require that a Virginia-licensed health care provider practicing using telemedicine and prescribing Schedule II–V controlled substances also have a physical office practice in the Commonwealth or an immediately contiguous jurisdiction. This provision has no clinical basis and is an arbitrary restriction to Virginia-licensed practitioners who treat patients using remote technology. The clinical guidelines for telehealth and telemedicine are anchored in standard of care, and the Commonwealth should maintain such standards and continue to tie state policy to federal restrictions on prescribing controlled substances. A requirement for a physical practice in Virginia or an immediately contiguous jurisdiction is an artifact of “old thinking” and would gut the ability of telehealth to deliver access to affordable quality health care. This bill fails to acknowledge the capacities of technological innovations in medicine. Today there is no other state with such an antiquated requirement in statute or regulation. Federal law (Ryan Haight Online Consumer Protection Act of 2008) already imposes rules around the prescription of controlled substances (Schedules II–V). This is simply bad public policy and ill-advised. Simply stated, the standard of care should dictate whether or not a prior physical examination of the patient is required prior to diagnosis and treatment of the patient, including prescribing Schedule II–V controlled substances. After the establishment of the valid professional relationship and treatment in accordance with the standard of care, geographic restrictions on follow-on care are arbitrary. We are very appreciative of the hard work that has gone into this legislation and respectfully request the sub-committee reject the proposed amendment. Thank you for your consideration. We are happy to answer any questions.

On behalf of the ATA and the 400 organizations we represent, I am writing to express concerns about an amendment made to HB 1987 in §54.1-3303 (B). In its revised form, HB 1987 would create unnecessary and impractical barriers to the establishment of telehealth services across Virginia, limiting practitioners’ ability to prescribe vital medications to their patients throughout the state based on arbitrary geographic restrictions. Currently, the bill would place geographic restrictions that determine the practitioners who can provide prescriptions to their patients, the language reading: “To prescribe a Schedule II through V controlled substance utilizing telemedicine, prescribers must maintain and practice or maintain a relationship with a practitioner at a physical office practice in the Commonwealth or in an immediately contiguous jurisdiction in order to unsure availability for an in-person examination when required by the standard of care.” In mandating the existence of a physical presence for practitioners to prescribe Schedule II through V controlled substances, the language establishes an arbitrary geographical barrier that would limit Virginians’ access to the prescriptions they need to lead healthy lives. When applied to real-world scenarios, the requirement proposed in this amendment is not practical in protecting Virginians’ safety or ensuring their access to accessible and high-quality care. If this bill were passed with the amended language, a Virginia citizen located in Alexandria could legally receive a prescription from a provider in Memphis, Tennessee (as Tennessee shares a border with Virginia), 881 miles away. However, a practitioner in Philadelphia, Pennsylvania, just 146 miles away from that same citizen, could not prescribe this patient’s medication simply because Pennsylvania does not border Virginia. Moreover, this language is not needed because if an in-person examination is needed to meet the standard of care for prescribing, then the practitioner would already be violating the standard by using telehealth technology to do so - regardless of whether they have a physical office or a relationship with a practitioner in Virginia or a “contiguous jurisdiction.” Simply put, there is no overlap between when a practitioner can use telehealth to prescribe medication and when an in-person exam is needed to prescribe, making this proposed amendment unneeded. Finally, the language also is likely in violation of the 10th Amendment. While the 10th Amendment gives broad discretion to states to regulate the health, welfare, and safety of its citizens, it still cannot “arbitrarily” or “capriciously” violate the Commerce Clause when doing so. The requirements imposed by this bill certainly would legally violate the Commerce Clause by limiting an out-of-state practitioners’ ability to practice medicine in Virginia despite the fact that they are licensed to practice there. The ATA applauds other aspects of HB 1987 which guarantee that nothing shall preclude coverage of telehealth services by insurers, including those services which involve remote patient monitoring. However, the ATA strongly objects to the amended language, and we believe that passing House Bill 1987 in its current form would be a step backward for patients and practitioners in the Commonwealth. We urge you and all of your colleagues to strike the amended language in §54.1-3303 (B) before considering the approval of this bill.

It is essential to address the demand for healthcare in a practical way - and these proposals are safe, evidence based, and needed. HB1987: Reimbursement for remote patient monitoring is proven to improve quality of care, lower readmissions, and lower travel and treatment costs. Remote patient monitoring is an essential benefit that allows patients to leave the hospital and get the same quality of care at home. For high risk pregnancies, it can cost as little as $26 a day to provide this service with higher convenience, better care, and keeps a hospital bed open for someone else who might need it more. Compare that to a $5,000 a day stay in the hospital with lower convenience, higher costs, and lower satisfaction. The Governor wisely removed reimbursement barriers to providers to offer this service to those suffering COVID-19 with great results. Virginians deserve access to this benefit and remote patient monitoring needs to be reimbursed immediately. HB1737: Nurse practitioners have safely served their communities with 2 years experience during the pandemic, and states across the country already allow for them to practice with the scope of practice with less restrictions that we have in Virginia. We need frontline healthcare workers practicing to their full capability and this reform achieves that safely. HB1747 / hb1817 : Enabling providers s to practice to their full capability is essential. Nurse practitioners deserve the opportunity be certified and practice according to their skills and education. This common-sense reform helps front line care providers to be more efficient and useful in serving in care deserts. In the same way, we should better leverage physician assistants in the field who could do more but are restricted by regulatory barriers. HB1769: Virginia law, unfortunately, puts walls between patients who are seeking care from licensed providers beyond our state lines. The commonwealth of Virginia does not care if a patient gets in the car and travels to another state to get treatment from an outstanding provider, but if a Virginia gets on the information highway, it can lead to criminal charges who is merely offering care to a Virginian in need of it. When the law was written, a phone was tethered to the kitchen wall. Today, our phones are supercomputers that can provide detailed healthcare information to a doctor in real-time. Our laws are still looking backwards in healthcare - not forward. Patient behavior is seeking better care with more convenience. This bill removes barriers between patients and providers across the country.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

Representing many groups of the EMS community I have heard horror stories from providers who have responded to calls for patients whom the providers have no idea what the problem is. There is a need to know what the problem or illness is prior to arriving or even leaving their headquarters in order to get the PPE on and be ready. We appreciate Del. Aird for submitting this bill in order to assist the EMS providers across the state.

Thank you to the committee, my name is Shaddai R. from Richmond, Virginia. I am here to encourage you to.. 1. Increase the allocation of tax revenue towards the reinvestment fund from 30% to 70% because anything less than a majority of the revenues is disingenuous to the priorities of the bill. 2. Allocate 50% of all licenses towards Virginia social equity license holders as no other licenses are required to be owned by Virginia residents. 3. Add another tier of license, micro-business licenses, so that smaller applicants can enter with unique integration privileges. 4. Do not add any new crimes nor criminalize another generation of youth because of a fake war on drugs

I am a constituent of the 7th district but I feel it is necessary to work together to protect the younger members of our society and stop the criminalization of the Hispanic and African American communities. Rules must be stated clearly now so we are better prepared to face a future when marijuana is officially legalized in the Commonwealth of Virginia. Please increase the reinvestment from 30% to 70% for new companies and entrepreneurs. Make sure the new market is equitable and accessible to all not just large corporations.

The Virginia Academy of Nutrition and Dietetics and the Virginia Nurses Association strongly supports Delegate McQuinn's efforts around food access and security to improve the health of all Virginians. We hope the General Assembly will support this legislation. COVID-19 has increased Virginia's food insecurity rate from 9.9% to 13.1%. Numerous studies have demonstrated correlation between food insecurity and poor health outcomes, particularly higher levels of chronic disease such as diabetes, hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, arthritis, COPN and CKD. Similar programs in other states have demonstrated efficacy for increasing participants' consumption of fruits and vegetables.

Virginia First Cities' 16 older, core city members are supportive of HB2065 and all investments to ensure our cities and citizens have access to thriving, sustainable food options. Delegate McQuinn's bill will help remove barriers and costs of access to healthy foods so that no one has to experience food insecurity.

On behalf of our 57 free clinic members located throughout the Commonwealth, including 11 clinics are also Medicaid, providers, the Virginia Association of Free and Charitable Clinics supports HB2065. Our clinic members serve over 60,000 vulnerable Virginians each year, many of whom suffer from chronic conditions such as diabetes and heart disease and would benefit from improved access to healthier foods. Our clinics that currently offer food pharmacy programs similar to the Produce Rx Program pilot proposed in HB2065 have experienced positive outcomes from these programs with their patients, including lower blood sugar levels, weight loss, and lower blood pressure readings, and in some cases a decreased level of need for prescription medications to address certain conditions. Based on this positive experience our clinics are having with their food pharmacy efforts, we strongly believe the proposed Produce Rx Program pilot will yield improved health outcomes for the Medicaid patients who participate in it, help to decrease the need for prescription medicines among these same patients, and ultimately reduce the overall cost of their care.

Virginia First Cities' 16 older, core city members are supportive of HB2065 and all investments to ensure our cities and citizen have access to thriving, sustainable food options. Delegate McQuinn's bill will help remove barriers and costs of access to healthy foods so that no one has to experience food insecurity.

In favor of programs to better facilitate the development and progress of my community.

Why are we paying for illegal people here when we need to take care of African American, Hispanic and Asian Americans concerns FIRST? Some of our own need food.

As a lead Community organizer for the latinx population in Richmond Va I have seen that many people did not go to the hospital with COVID-19 or with symptoms of the pandemic because just thinking about the bills that these people could face, they put their lives in danger and that of others, it is not fair that because they do not have legal status they cannot access to a health care. I ask please consider this bill, there are thousands of people who would benefit

As a family physician in Richmond, VA, I am acutely aware of devastating and disruptive consequences of COVID-19 on our communities. Access to testing, treatment, and vaccination, is essential to get us functional as soon as possible. With an illness that has disproportionately affected our Black and Brown community members, we must level the access to care and provide free testing, treament, and vaccination, regardless of insurance or immigration status. This is the only way that we, together, can move forward. Thank you.

The Jewish Community Relations Council of Greater Washington (JCRC) submits this testimony in support of HB 2124, because the public health crisis we are facing is a clear emergency, and ensuring widespread testing for, treatment of, and vaccination against COVID-19 is a necessity for individuals and the community at large. Access to COVID-19 related treatment and services will improve individual health outcomes, as well as curb the spread of this virus throughout the Commonwealth and beyond. Enabling all individuals to get treatment – both preventative and therapeutic – ultimately will reduce the burdens on our medical facilities and on society. JCRC is honored to present this testimony on behalf of over 100 local synagogues, schools and institutions, including a network of agencies that provide excellent cost-effective social services to the community at-large on a non-sectarian basis. We are guided by Jewish law, history and tradition, which insists that we assist in the caretaking of all immigrants.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

My name is Stephen Grammer, from Roanoke. I encourage you to pass HB1987 and HB2124. HB1987 would allow people who without transportation easier access to being able to communicate with their primary doctors. This also would be cost-effective, due to the fact that people will not have to get ambulances going to hospitals over non-emergency situations. HB2124 would allow people with disabilities to get treatment for COVID. We are on a very low-budget, and can not afford to pay out of pocket for treatment. Again, I encourage you to support HB2124 and HB1987. Thank you for your time and consideration.

Hello Mr. Chair and members of the committee. I am Zowee Aquino, Community Health Manager at NAKASEC VA. During the special session, the General Assembly made a monumental fix that gave legal permanent residents greater access to Medicaid in Virginia. I worked with Asian American youth and impacted families to support this effort, and was so glad to be part of this legislative victory. In this session, as COVID-19 continues to decimate working class communities, we have another opportunity to support access to health care for immigrants in HB 2124. I speak with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion. They think COVID-19 vaccination is only for citizens, and won’t sign up for the vaccine. In some cases, they don’t even get tested - they instead stay at home, isolate, and deal with it themselves - because they think it is their only option. This is one of their stories: My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now. People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread. Thank you Mr. Chairman and members of the committee.

I am Zowee Aquino, Community Health Manager at NAKASEC VA. I work with undocumented, uninsured Asian American residents of Virginia about accessing healthcare and there is considerable confusion around COVID-19 treatment and services: They think COVID-19 vaccination is only for citizens, and won't sign up for the vaccine. Sometimes, they don’t get tested - they instead stay at home, isolate, and deal with it themselves. This is one of their stories: "My name is Mi-Kyung, I live in Burke, and I am an undocumented person. I have rheumatoid arthritis and my husband has been laid off due to COVID-19. We’ve been surviving off of our two college aged children’s part-time jobs. Because we cannot afford to go to the hospital if I get COVID-19, I fear even going to the grocery store. I have heard of many people like me, who immigrated to the U.S. only to go bankrupt due to hospital bills through no fault of their own. These stories feel even closer to me now with the COVID-19 pandemic and make me fear for my safety. I hope this bill, HB 2124, passes for low income, undocumented people so that I can feel some security for doing necessary things, like going grocery shopping or picking up my medication, right now." People like Mi-Kyung are why we need HB 2124. Passage of HB 2124 could make it very clear that anyone in Virginia can receive COVID-19 testing, treatment, and vaccination without concern over affordability or fear for everyday tasks - so that everyone can help protect their communities and themselves. Without access to treatment for all Virginians, we cannot effectively stop or slow the spread.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

Thank you for the opportunity to provide comments on HB 2124 by Delegate Lopez. The American Lung Association in Virginia strongly supports this proposed legislation and asks members of the committee to vote yes. The American Lung Association is the oldest voluntary public health association in the United States, representing the millions of Americans living with lung diseases, including chronic obstructive pulmonary disease (COPD), lung cancer, asthma, cystic fibrosis and pulmonary fibrosis. The Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through research, education and advocacy. We are especially concerned with COVID-19 as it is a respiratory disease. The COVID-19 pandemic has continued to highlight 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, Latinx, and immigrant communities. Unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. As more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages access to these treatments and care is even more critical. Virginia can support wider access to COVID-19 testing, treatment and vaccination by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy. The Lung Association believes all individuals should receive vaccination at the appropriate phase of the framework regardless of immigration status. Undocumented workers are disproportionally employed in many essential industries where they have a higher risk of exposure to COVID-19, such as agriculture and home health.1 Migrant workers also have high rates of lung diseases, such as asthma, and other health conditions that may put them at greater risk for severe illness from COVID-19. If large proportions of certain communities do not receive vaccinations, the risk of COVID-19 outbreaks increases for everyone. 2 Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Providing COVID-19 care to individuals with low-incomes will help reduce the spread of the virus. The Lung Association urges the Committee to support HB 2124 and include COVID-19 testing, treatment and vaccination for all Virginians regardless of immigration status. 1Tracy Jan, “Undocumented workers among those hit first – and worst – by the coronavirus shutdown. The Washington Post. April 4, 2020. Available at: https://www.washingtonpost.com/business/2020/04/05/undocumented-immigrants-coronavirus/ 2 Holguin, Fernando et al. “Respiratory Health in Migrant Populations: A Crisis Overlooked.” Annals of the American Thoracic Society vol. 14,2 (2017): 153-159. doi:10.1513/AnnalsATS.201608-592PS

My name is Austin Chavez. I am with NAKASEC Virginia. I live in Springfield, Virginia. I support HB 2124 because I think it will help uplift all different types of families during this unprecedented pandemic. Many families are already burdened with rising unemployment and decreased wages. To offset COVID testing and treatment costs from families will be a huge benefit for the community at large. It will empower folks to get tested and seek treatment, and create a unified culture in stopping the pandemic.

Voices for Virginia’s Children is a member of the Healthcare for All Virginians coalition and supportive of this bill. As of January 17th, VDH reported 19,982 Hospitalizations. While the Black community accounts for about 27 percent of that group, they represent just 20 percent of the commonwealth’s population. Likewise, the Latinx population makes up roughly 20 percent of Virginia’s COVID-19 hospitalizations, but only 10 percent of the population. Meanwhile, the white community accounts for 42 percent of the commonwealth’s coronavirus hospitalizations, but nearly 61 percent of the population. Communities of color are experiencing much higher hospitalization rates. Black communities have almost a 7% hospitalization rate compared to the 4% average. In order to increase equitable access to healthcare, especially during this time, Virginia should follow the patterns of 12 other states that have elected to cover COVID-19 screening, testing, and all related treatment for any immigrant who meets the financial requirements for Medicaid. This clarification would allow a singular statewide message to be shared widely. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community. Thank you, Delegate Lopez, for championing this bill.

VIRGINIA POVERTY LAW CENTER SUPPORT HB 2124 & BUDGET AMENDMENT 313 #4H Cover COVID-19 Services as “Emergency Only” Medicaid Services Medicaid is required by federal law to provide “Emergency Only” services to any immigrant who (1) resides in the state and (2) is financially eligible for Medicaid, but does not meet the specific requirements for non-citizens. [For example most LPRs with a Green Card must be in the U.S. for 5 years before qualifying for full Medicaid.] Medicaid’s Emergency-Only services are now available for urgent health needs generally provided by hospital emergency departments (e.g. accidents, heart attacks, labor/delivery). As allowed by federal law, HB 2124 appropriately broadens such services to COVID-19 testing, treatment and vaccines. • The disparate impact of the COVID-19 pandemic on black, brown and immigrant communities is well established. If low-income individuals in those communities are not encouraged to get tested, treated and vaccinated (through free, and broadly available services), ALL OF US suffer because of community spread. The Medicaid Emergency Only mechanism is in place to ensure access to this essential care for needy Virginians. • At least 12 states have administratively declared this policy for their Medicaid programs. Those states are able to ensure and market free services and timely treatment to all low-income individuals, regardless of immigration status. • This bill is desperately needed NOW! Virginia must reach out to encourage all low income immigrants to come forward to get COVID-19 testing, treatment and vaccines. This helps all Virginians by reducing the spread of the virus, long-term health issues and death. This is truly a matter of life or death – not just for immigrants, but for all of us. For More Information Contact: Jill Hanken, Health Attorney, jill@vplc.org. (804) 351-5258

I am writing in support of HB2124 on behalf of The Commonwealth Institute and the Healthcare for All Virginians Coalition. The COVID-19 pandemic has put into sharp focus long-standing inequities in health care coverage and access and working conditions in Virginia and across the country, which has contributed to the higher incidence of the virus in Black, Latinx, and immigrant communities. And, unfortunately, some low-income Virginians who are excluded from most Medicaid coverage due to their immigration status fear that seeking treatment for COVID could result in unaffordable medical bills. This is particularly tragic as more therapies are approved that can reduce the likelihood that COVID will progress to more serious stages. Virginia can support wider access to COVID-19 testing and treatment by clarifying that emergency Medicaid specifically covers COVID-19 testing, treatment, and vaccination. The emergency Medicaid program is offered to people that would qualify for regular Medicaid but are ineligible due to immigration status. Services are traditionally limited to medical treatment required after the sudden onset of a medical emergency that places the individual’s health and bodily function in severe jeopardy, such as a heart attack or a broken bone. Twelve states are already offering COVID-19 services through this program and doing so may encourage all individuals regardless of status to seek the services they need without fear of how they will pay for it. Legislation (HB2124, Del. Lopez) to make this change has been introduced during Virginia’s 2021 legislative session. This clarification would allow a singular statewide message to be shared widely and leave no doubt as to health care costs related to COVID-19 for all families with low incomes. Providing COVID-19 care to our neighbors with low-incomes will help reduce the spread of the virus throughout the community.

VPLC supports implementing these minimum standards for nursing home staffing. This bill would set in place these standards and allow adequate staffing to be defined. Virginia ranks 38th in states overall in care hours. Due to Covid-19, the issues in nursing homes have been highlighted and the needs for change is great. Sufficient staff needs to be defined and be enforced to protect vulnerable adults. Although there is a cost, the impact on people's lives has shown to be great and we urge Virginia to move forward with protections for vulnerable individuals.

Mr. Chairman and Members of the Committee, I strongly believe nursing home and long term care facilities should provide excellent care for the elderly and disabled and should have few complaints in regard to lack of care and abuse. They should be vetted, trained in regard to infection control and dosing of medications to these patients, and provided sufficient ppe. It concerns me, however, that “Medical facilities inspectors of the Department of Health are exempt from reporting suspected abuse immediately while conducting federal inspection surveys in accordance with § 1864 of Title XVIII and Title XIX of the Social Security Act, as amended, of certified nursing facilities as defined in § 32.1-123.” Suspected abuse should be reported by them.

Please consider putting these bills into effect.

In favor of programs to better facilitate the development and progress of my community.

SUPPORT FOR HB 2156 Every day Virginia nursing home residents experience needless injury, decline and poor care because there are simply not enough nursing staff to provide for basic needs. COVID-19 has exposed the devastating effects of longstanding and persistent understaffing. We need a clear,enforceable standard to ensure sufficient staff to meet resident basic daily needs. HB 2156 takes a realistic, practicable approach toward achieving the 4.1 staffing standard that extensive research has shown to be effective. The Northern Virginia Aging Network (NVAN) urges your support for HB 2156.

AARP Virginia supports HB2156.

AARP Virginia supports HB2156.

In concert with the federal and state mandates of the Long-Term Care Ombudsman Program to bring the concerns of our nursing home residents to our leaders, we urge our legislators to enact urgently needed, enforceable standards for the minimum levels of staff nursing homes must ensure in order to meet the basic care needs of residents. Delegate Watts’s House Bill 2156 proposes a clear and practicable plan to move Virginia gradually toward an evidence-based standard that would ensure nursing homes provide enough staff to meet residents’ basic care needs. We have attached to this email a brief summary of why this legislation is critically needed. On a daily basis, ombudsmen around the state hear of tragic outcomes, unnecessary suffering, avoidable injuries, and serious and life-threatening health complications resulting from inadequate staff in many of our nursing homes. The pandemic has exposed in new and alarming ways the tragic effects of longstanding, persistent patterns of low staffing in our nursing homes. While we can never undo the devastating impacts of COVID-19 on our most vulnerable citizens – those in our nursing homes – we must take steps now to ensure a tragedy of this magnitude does not happen again. We urge that you enact legislation to create a standard that is critically needed to protect our parents, grandparents, teachers, retired military heroes, public servants, and neighbors from the undue suffering and decline and the loss of human dignity that result from the lack of adequate staff in nursing homes to meet their most basic needs. Thank you for your consideration of these urgently needed protections for those who so often cannot speak for themselves. Sincerely, Joani Latimer State Long-Term Care Ombudsman

This is Scott Reiner, Executive Director of the Office of Children's Services. The administration has no position on this bill. I can be available to respond to questions at the request of the Chair r members of the committee.

Voices for Virginia's Children and the Foster Care Policy Network comprised of 25 organizations is in support of this bill.