On January 12, 2025, Virginia's Senate introduced Bill No. 1328, aimed at reforming consumer-directed services within the state's Medicaid program. This legislation, sponsored by Senator Durant, seeks to empower individuals receiving home and community-based services by allowing them to serve as their own employer of record (EOR) for service delivery. This change is particularly significant for those who may require assistance in managing their care but wish to maintain control over their services.

The bill mandates that the Department of Medical Assistance Services (DMAS) submit amendments to the Centers for Medicare and Medicaid Services (CMS) to modify existing program rules. Specifically, it allows individuals to designate another person to perform EOR duties on their behalf if they are unable to do so. This flexibility is crucial for individuals with disabilities or health conditions that may hinder their ability to manage their care independently.

Key provisions of the bill include the stipulation that the employer identification number (EIN) will be assigned to the individual receiving services, ensuring that it remains under their control. The bill also limits the designation of an EOR to twice per calendar year, which aims to prevent potential misuse while still providing necessary support.

The introduction of VA SB1328 has sparked discussions among stakeholders, particularly regarding its potential impact on the autonomy of individuals with disabilities. Proponents argue that the bill enhances personal agency and aligns with broader trends toward consumer-directed care models. However, some critics express concerns about the administrative burden this may place on DMAS and the potential for confusion among service providers.

The implications of this bill extend beyond individual care; it reflects a growing recognition of the need for more personalized and flexible healthcare solutions. As Virginia navigates the complexities of Medicaid reform, the outcomes of this legislation could set a precedent for similar initiatives in other states, influencing how consumer-directed services are structured nationwide.

As the bill progresses through the legislative process, it will be essential to monitor debates and amendments that may arise, as these could shape the final form of the legislation and its implementation. The anticipated changes could significantly enhance the quality of life for many Virginians, making it a critical issue for both lawmakers and the communities they serve.