Important Procedure Changes

Dear Moms In Motion Families,

We hope this message finds you well. We are writing to inform you of an important change in the LRI approval process for minors and spouses receiving Medicaid Waiver services through Moms In Motion. We also would like to update all EOR's and current clients to the process we will be utilizing going forward in regards to fiscal agent issues that have increased drastically, both of these changes will be effective immediately.


Consumer-Directed Medicaid Waiver Services have existed since 2005. Since that time, CD services providers have received just 1 rate increase of 12.5% two years ago, which equates to roughly 0.62% year over year. 

  • If a Service Facilitator was paid $31,000/year in 2005, the 12.5% increase in 2020 brought them up to $35,000/year. That's only a $4,000 raise over 15 years of work (That's $250 each year. Or $00.12/hour each year). And since Service Facilitation has not been increased since 2020, it's actually a $4,000 raise over 19 years. The three percent proposed in 2024 would bring that salary up to $36,000/year. That's another $1,000 in total over 4 years!
  • Minimum wage has increased 94% during those years, and is set to increase another 13% in 2025. That means from $5.15/hour to $13.50/hour. Minimum wage annual income would have gone from $11,000/year in 2005 to $28,000/year in 2024
  • Attendants have seen a 50% increase in wages since 2005. Average attendant wages have increased from $9.50/hour to $15.50/hour. That's an annual income of $20,000 in 2005 to $32,000 in 2024.

In that time, DMAS/legislators have added the requirement that our Service Facilitators hold degrees and have several years of direct care experience. They have added 5 MCO's, 2 fiscal agents (bringing the count to 3 currently), and authorizations have gone from once every 4 years to twice per year per person. With the LRI guardrails coming up on March 1, 2024 and the MCO's capping the number of visits we can do (our only source of revenue), we just cannot support all of this going forward.

We know that you are fed up with us constantly changing your Service Facilitators. We're just as frustrated that we cannot get meaningful rates that would allow us to pay a competitive salary. Because of all of the administrative burden, stress of this role, and because we cannot pay them a competitive salary, it is hard to keep people.  

Moms In Motion and the families we serve have been advocating for 3 years now to Virginia's legislators to give Consumer Directed services providers a meaningful increase that would allow providers like Moms In Motion to pay our team members livable wages. But the House and Senate cannot seem to agree on what that looks like and, as a result, it is highly likely that we will see just a 3% increase this year, which is not the meaningful lifeline we needed

What this means to you:

The following changes will take place effective immediately.

Fiscal Agent Issues:

Moms In Motion can no longer be the middleman for Fiscal Agent issues. So if you are having a payroll problem, or you need assistance adding an attendant, or getting your LRI enrolled, please go directly to the fiscal agent (PPL, CDCN, or Aces$) vs. calling Moms In Motion or your Moms Service Facilitator. We will do our part in making sure the Fiscal Agents know who the EOR is and we will submit requests for authorizations as required for attendants to get paid, but beyond that, we ask that you contact the Fiscal Agents directly with any payroll issues

LRI Issues:

We want you to know that we have heard from numerous Fiscal Agents that there may be a delay in the deadline, also we received notification from DMAS on Friday that they were "monitoring the outstanding General Assembly bills, and will be communicating next week to all affected FFS providers and the plans". However, March 1st is days away, and we must continue to help guide our clients as they prepare for the changes until clear instruction is relayed directly from DMAS. At this point if you have questions about the deadline or possible extension please contact DMAS directly as we have no further information. Going forward, there will be a revised procedure for Moms In Motion parents/spouses (LRI's) seeking approval to serve as the paid attendant for their minor or spouse receiving Medicaid Waiver services. We can no longer serve as the middleman for issues between the EOR and the MCO/DMAS/or CSB outside of the scope outlined below. If you have questions please go directly to your Care Coordinator, Support Coordinator, or DMAS vs calling Moms In Motion or your Service Facilitator. We understand the significance of this change and aim to streamline the process while ensuring the best possible support for your loved ones.

The new LRI process, effective immediately will entail the following steps:

1) Make attempts to hire outside of the home: Post job ads for a week to attempt to hire someone outside of the home to be the paid attendant. Job ads must not include words like "babysitter", "nanny", "childcare", etc. Please be detailed in the job duties and the pay rate, which is $13.34/hr Rest of State and $17.27/hr Northern Virginia. Take screenshots/pictures of your ads showing the date posted and the responses (or lack thereof) to the ads.

2) Fill out the forms:  Visit our website by clicking here.

A. Fill out the DMAS-95B.

B. Fill out the Extraordinary Care (EC) Form (you can fill out the form and upload any ads, interviews, etc - proof of attempts to hire outside the home). Moms In Motion will review the form and determine eligibility.

3) Wait for contact from us:  Once we have received your forms and reviewed everything, we will contact you within 1-2 business days and provide you with the following documents via secure email:

A. An LRI plan of care - make sure the Employer of Record (EOR) signs this document

B. Extraordinary Care Form - signed by Moms In Motion


4) Submit your request for approval:  

A. If you are being served through an MCO, contact your Care Coordinator and they can instruct you on how to get your documents to them.

B. If you are being served through a DD Waiver, contact your Support Coordinator at the CSB and they can give you those instructions.  

C. If you are Fee For Service (CCC+ Waiver, but not under an MCO), please reach out to [email protected] and request a secure email or fax number to which you can fax your documents.  

5) Follow up on approval/denial:  Follow up with your Care Coordinator, Support Coordinator, or [email protected] about 1-2 weeks later to find out if you've been approved to be the paid attendant for your minor child. This approval is provided by the MCO, CSB, or DMAS, not Moms In Motion.  

If you have any questions about the Legally Responsible Individual (LRI) process that starts officially March 1, 2024, please contact [email protected]. For questions about what attendant packet to submit to the fiscal agent, please contact the fiscal agent directly.  

Contact DMAS

Thank you for your patience as we try to help families navigate through these new LRI guardrails. We encourage you to contact your legislators and encourage them to support HB909, which would remove some of these guardrails.




Fiscal Agents


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