Concerned Citizens of Self Direction Maryland

Mission and 2026 Priorities

Concerned Citizens of Self-Direction Maryland supports legislation and policy that ensure access, choice, and accountability in Maryland’s Medicaid waiver system.

Our priorities focus on preserving community-based services, protecting participant choice, and ensuring that administrative actions do not undermine access to medically necessary supports.

1. Preserve Self-Direction and Individual Choice

• Waiver participants must retain meaningful access to self-direction, including:
  • employer authority (who provides services and where), and
  • budget authority (how services are used).
• Self-direction should not be eliminated or materially restricted through agency policy or guidance without legislative oversight.

1. Protect Paid Family As Staff

• Policies must not impose blanket restrictions on paid family as staff when family members are an available and appropriate workforce
• Any limits on paid family as staff should be:
  • individually determined,
  • based on documented health or safety concerns,
  • clearly reflected in the service plan, and
  • subject to notice and appeal.
• Restrictions that reduce access or increase the risk of institutionalization should be avoided.

1. Require Transparency and Due Process for Waiver Changes

• Material changes to waiver services or service delivery should not occur without:
  • public disclosure,
  • data on expected impacts,
  • meaningful opportunity for public input, and
  • written responses to stakeholder concerns.
• Service changes must not create gaps in care or rely on unpaid or unavailable support
• Individuals affected by service reductions must receive timely notice and access to appeal rights consistent with Medicaid law

1. Ensure Functional Access to Waiver Services

• Waiver services must remain usable in practice, not just in name
• Services should not be narrowed or redefined through internal guidance in ways that undermine their ability to meet documented health, safety, or daily living needs
• Policies that materially limit access to services should be transparent and subject to appropriate oversight

In addition to our priorities, legislators should understand that there are alternative, sensible approaches available that preserve the integrity of self-direction and achieve cost savings.

For more information about our priorities or approaches, please contact at Concerned Citizens of Self-Direction Maryland, [email protected].