<p class=ldtitle>A BILL to direct the Department of Medical Assistance Services to submit state plan amendments to the Centers for Medicare and Medicaid Services to seek to modify the program rules for consumer-directed services available through certain Medicaid waivers.</p>
Summary
HB470 directs the Virginia Department of Medical Assistance Services (DMAS) to seek federal approval to change how consumer-directed services work under certain Medicaid Home and Community-Based Services waivers. The core change would let the person receiving services serve as the employer of record for their own care, while also allowing that person to designate another individual to carry out some or all employer-of-record duties when the recipient cannot do so or cannot direct their own care.
The bill also requires that the employer identification number (EIN) be assigned to the service recipient rather than transferred to another person, subject to limited exceptions. Those exceptions include minors, individuals who cannot use an existing EIN for tax purposes, or others DMAS determines are ineligible by rule. DMAS may also limit how often a recipient can change the designated person, capping such designations at no more than twice per calendar year if it chooses to do so through the waiver or state plan amendment.
Impact
If enacted and approved by the federal Centers for Medicare and Medicaid Services, the bill would alter the administration of consumer-directed Medicaid waiver services in Virginia by expanding who may act as employer of record and by tying the EIN to the individual receiving services. It would affect DMAS, Medicaid waiver participants, family members or other designees who help manage care, and providers operating under 1915(c) waivers. The bill does not itself change federal law, but it directs Virginia to seek the necessary state plan or waiver amendments to implement the policy.
Sentiment
The bill appears to have generally favorable support in the House and early committee stages, with multiple subcommittee and committee votes reporting it forward and the House passing it by a wide margin. However, it ultimately stalled in the Senate Finance and Appropriations Committee, where it was continued to the next session on a 12-3 vote. That pattern suggests broad interest in the policy but not enough agreement or time to advance it through the full legislative process in this session.
Contention
The main policy issue is how much control a Medicaid consumer should have over their own consumer-directed services and whether the employer-of-record role should be formally assigned to the recipient. Supporters likely view the bill as increasing autonomy and flexibility for people with disabilities or other waiver participants, while concerns may center on administrative complexity, tax and payroll compliance, and the limits on transferring the EIN. The ability of DMAS to restrict designation changes and to determine additional ineligibility by rule may also be a point of concern for those seeking broader participant control.