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HB 470

Medicaid waivers; consumer-directed services, employer of record.

2026 Regular Session Introduced by Laura Jane Cohen

Virginia bill authorizes Medicaid waivers enabling beneficiaries to directly employ home care workers, shifting from traditional agency model to consumer-directed employment structure.

Assigned HAPP sub: Health & Human Resources
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Bill Summary · HB 470

Legislative bill overview

HB 470 authorizes Virginia to seek federal Medicaid waivers that would expand consumer-directed services, allowing Medicaid beneficiaries greater control over selecting and managing their own care workers. The bill specifically enables an "employer of record" model where participants can directly employ personal care assistants rather than relying solely on traditional agency-based services.

Why is this important

Consumer-directed Medicaid services can improve care quality and flexibility for participants with chronic conditions or disabilities while potentially reducing costs through reduced administrative overhead. This model also addresses workforce shortages in home care by making positions more attractive to workers who prefer direct employment. However, expanding these services requires careful federal coordination and adequate funding to ensure beneficiary protections and worker standards are maintained.

Potential points of contention

  • Worker protections and wages: Direct employer models may result in lower worker pay, benefits, or labor protections compared to agency-employed staff, potentially worsening home care workforce conditions
  • Beneficiary vulnerability: Participants managing their own employers may face challenges with payroll, tax compliance, and worker screening, creating potential exploitation or safety risks
  • Fiscal sustainability: The bill's fiscal impact statement (requested from state planning/budget office) will determine whether savings materialize or if expansion strains Medicaid funding during implementation

Compiled from official sources — confirm details with the bill’s official record.

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