Medicaid waivers; consumer-directed services, employer of record.
Summary
SB 1328 directs the Department of Medical Assistance Services (DMAS) to seek federal approval to change Virginia’s Medicaid consumer-directed services rules under certain 1915(c) Home and Community-Based Services waivers. The goal is to allow a person receiving services to serve as the employer of record for his or her own care, rather than requiring another individual to hold that role, and to permit the recipient to designate someone else to perform some or all employer-of-record duties when the recipient cannot do so or cannot direct his or her own care.
The bill also requires DMAS to structure the requested federal authority so that the employer identification number remains assigned to the service recipient and is not transferred to another person except in limited circumstances, such as when the recipient is a minor, cannot use the existing EIN for tax purposes, or is otherwise found ineligible by DMAS rule. DMAS may also limit how often a recipient can change the designated person performing employer-of-record duties, with the bill allowing no more than two such designations per calendar year if the agency chooses to impose that restriction.
Impact
If enacted and approved by the federal Centers for Medicare and Medicaid Services, the bill would alter how consumer-directed Medicaid waiver services are administered in Virginia by expanding the ability of waiver participants to act as their own employer of record. It would affect DMAS program rules, state plan or waiver amendments, and the administration of 1915(c) waiver services, especially for individuals who rely on consumer-directed personal assistance and related home- and community-based supports. The bill also has tax and administrative implications because it ties the employer identification number to the person receiving services and addresses when that identifier may be used or reassigned.
Sentiment
The available voting history suggests broad support for the measure: the Senate Education and Health Committee reported the bill with a substitute on a 15-0 vote and rereferred it to Finance and Appropriations. No committee transcript was provided, so there is no recorded debate to indicate opposition or concern in the materials supplied. Overall, the bill appears to have been received favorably at the committee stage.
Contention
The main policy issue is who should legally serve as employer of record in consumer-directed Medicaid services: the person receiving care or another individual acting on that person’s behalf. Support for the bill likely centers on autonomy and flexibility for Medicaid participants, while potential concerns involve administrative complexity, oversight, tax handling, and the risk of confusion if employer-of-record duties are delegated or changed too often. The bill addresses some of those concerns by allowing DMAS to limit the number of times a designation can change and by setting exceptions for minors and other ineligible recipients.