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For Penny Black, the director of home and community services with the Washington Department of Social and Health Services, the GAO report, which is raising questions about quality assurance for Medicaid beneficiaries services by home and community service waivers, is worrisome for its potential impact on the programs, especially when political leaders say future waivers should not be approved until the quality issues are addressed.

GAO report is ‘worrisome,’ according to state official